Body system: Genitourinary SystemRegulation: 38 CFR § 4.115b
A bladder diverticulum is an outpouching of the bladder wall, either congenital or acquired (most often secondary to chronic obstruction such as bladder outlet obstruction from prostatic enlargement). Diverticula trap residual urine, leading to stasis, recurrent infection (urinary tract infection), stone formation, and sometimes malignancy. Symptoms include obstructive and irritative voiding symptoms, recurrent UTIs, and hematuria. The VA does not maintain a separate ladder for bladder diverticulum. Instead, 38 CFR § 4.115a directs raters to evaluate this condition under whichever ladder yields the higher result: voiding dysfunction (0-60%, three sub-formulas) or urinary tract infection (0/10/30%). Apply the ladder matching the predominant symptom.
Rating levels
- 60% — You qualify for 60% under the urine leakage sub-formula if your bladder diverticulum 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 you 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 diverticulum causes urinary retention requiring intermittent self-catheterization OR continuous indwelling catheter. Bladder diverticula commonly produce stasis, retention, and recurrent infection.
- 30% — You qualify for 30% under the UTI sub-formula if recurrent infection within the diverticulum requires a urinary drainage device, more than 2 hospitalizations per year, or continuous intensive management.
- 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 marked obstructive symptoms are accompanied by any objective finding (PVR > 150 cc, peak flow < 10 cc/sec, recurrent UTIs, or strictures requiring dilation every 2-3 months).
- 10% — You qualify for 10% under the UTI sub-formula with 1-2 hospitalizations per year, OR continuous suppressive antibiotic therapy for 6+ 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.
- 0% — You qualify for 0% under the UTI sub-formula if recurrent infections do not require hospitalization but require suppressive antibiotic therapy for less than 6 months.