Urethra, fistula of (DC 7519)

Body system: Genitourinary SystemRegulation: 38 CFR § 4.115b

A urethral fistula is an abnormal channel connecting the urethra to another structure — most commonly to the perineum (urethroperineal fistula), scrotum, or skin. Causes include prior urologic surgery, radiation, infection, malignancy, prolonged catheterization, and trauma. Symptoms include continuous urine leakage through abnormal openings, recurrent infection, and obstructive voiding. The VA assigns a 100% rating when there are MULTIPLE urethroperineal fistulae (two or more). Otherwise, 38 CFR § 4.115a directs raters to evaluate the residual symptoms under the voiding dysfunction umbrella, which contains three parallel sub-formulas: urine leakage (20/40/60%), urinary frequency (10/20/40%), and obstructed voiding (0/10/30%). The rater applies the sub-formula matching the predominant symptom.

Rating levels

100% — You qualify for 100% if you have multiple (two or more) urethroperineal fistulae — abnormal channels connecting the urethra to the perineum (the area between the scrotum or vagina and the anus). Multiple fistulae produce continuous urinary leakage through abnormal openings, recurrent infection, and significant functional impairment. A single fistula does not meet this criterion; the rating is based on multiple fistulae.
60% — You qualify for 60% under the urine leakage sub-formula if your urethral fistula causes leakage requiring a urinary collection appliance OR absorbent materials changed more than 4 times per day.
40% — You qualify for 40% under the urine leakage sub-formula if you wear absorbent materials and change them 2 to 4 times per day.
40% — You qualify for 40% under the frequency sub-formula if your fistula causes you to urinate more than once per hour during the day, OR wake 5+ times per night.
30% — You qualify for 30% under the obstructed voiding sub-formula if the fistula causes urinary retention severe enough to require intermittent self-catheterization OR continuous indwelling catheter.
20% — You qualify for 20% under the urine leakage sub-formula if absorbent material changes are fewer than 2 per day.
20% — You qualify for 20% under the frequency sub-formula with daytime intervals of 1-2 hours OR 3-4 nocturnal voids.
10% — You qualify for 10% under the frequency sub-formula with daytime intervals of 2-3 hours OR exactly 2 nocturnal voids.
10% — You qualify for 10% under the obstructed voiding sub-formula if you have marked obstructive symptoms PLUS at least one objective finding (PVR > 150 cc, peak flow < 10 cc/sec, recurrent UTIs from obstruction, or strictures requiring dilation every 2-3 months).
0% — You qualify for 0% under the obstructed voiding sub-formula if obstructive symptoms only require dilation 1-2 times per year or no dilation. Recognized as service-connected but not currently producing compensable disability.

Disclaimer: This tool is for informational purposes only and is not legal or medical advice. Always consult with your VSO representative or a qualified veterans benefits attorney for guidance on your specific claim.