Papillary necrosis (DC 7538)

Body system: Genitourinary SystemRegulation: 38 CFR § 4.115b

DC 7538 covers renal papillary necrosis — ischemic death of the papillary tip of the renal medulla. Causes include analgesic nephropathy (chronic NSAID or phenacetin use), diabetes mellitus, sickle cell trait or disease, severe obstruction with infection, and pyelonephritis. Clinical presentation includes flank pain, hematuria (sometimes with passage of necrotic papillary tissue), and progressive renal dysfunction. The VA rates this condition under the renal dysfunction ladder (38 CFR § 4.115a) from 0% to 100% based on GFR sustained over 3 consecutive months in the past 12 months.

Rating levels

  • 100% — You qualify for 100% if your condition has progressed to end-stage renal disease — GFR under 15 mL/min/1.73 m² sustained for 3+ consecutive months, OR routine dialysis dependence, OR transplant eligibility.
  • 80% — You qualify for 80% if your condition has progressed to Stage 4 CKD — GFR 15-29 mL/min/1.73 m² sustained for 3+ consecutive months.
  • 60% — You qualify for 60% if your condition is at Stage 3b CKD — GFR 30-44 mL/min/1.73 m² sustained for 3+ consecutive months.
  • 30% — You qualify for 30% if your condition is at Stage 3a CKD — GFR 45-59 mL/min/1.73 m² sustained for 3+ consecutive months.
  • 0% — You qualify for 0% if your GFR is 60-89 mL/min/1.73 m² (Stage 2 CKD) AND you have one of three additional markers sustained for 3+ consecutive months: recurrent urinary casts, structural kidney abnormalities, or proteinuria with ACR ≥ 30 mg/g.

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.