SgtDBrownRet
11-21-08, 10:15 PM
Below is the rating criteria and residual ratings for prostate cancer. There is also a form to take to your doctor to complete. If the format is not right, PM me and I can send it in word format for you to printout and take to your doctor.
Rating Criteria for Prostate Cancer and Residuals
7528
Malignant neoplasms of the genitourinary system – Prostate Cancer
100
Note: Following the cessation of surgical, X-ray, antineoplastic chemotherapy or other therapeutic procedure, the rating of 100 percent shall continue with a mandatory VA examination at the expiration of six months. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of §3.105(e) (http://vbaw.vba.va.gov/bl/21/publicat/Regs/Part3/3_105.htm) of this chapter. If there has been no local recurrence or metastasis, rate on residuals as voiding dysfunction (http://vbaw.vba.va.gov/bl/21/publicat/Regs/Part4/4_115a.htm#bm03) or renal dysfunction (http://vbaw.vba.va.gov/bl/21/publicat/Regs/Part4/4_115a.htm#bm02), whichever is predominant.
Once the cancer has gone into remission, or you have had surgery to remove the prostate, the VA then rates on the residuals. It is advised that your and your doctor discuss the following conditions, and determine which criteria most describe your symptoms. Once you acquire the medical evidence to support your claim, please forward it our office for review and submission to the VA.
Voiding dysfunction:
Rating
Rate particular condition as urine leakage, frequency, or obstructed voiding (http://vbaw.vba.va.gov/bl/21/publicat/Regs/Part4/#bm05).
Continual Urine Leakage, Post Surgical Urinary Diversion, Urinary Incontinence, or Stress Incontinence:
Requiring the use of an appliance or the wearing of absorbent materials which must be changed more than 4 times per day
60
Requiring the wearing of absorbent materials which must be changed 2 to 4 times per day
40
Requiring the wearing of absorbent materials which must be changed less than 2 times per day
20
Renal dysfunction:
Rating
Requiring regular dialysis, or precluding more than sedentary activity from one of the following: persistent edema and albuminuria; or, BUN more than 80mg%; or, creatinine more than 8mg%; or, markedly decreased function of kidney or other organ systems, especially cardiovascular
100
Persistent edema and albuminuria with BUN 40 to 80mg%; or, creatinine 4 to 8mg%; or, generalized poor health characterized by lethargy, weakness, anorexia, weight loss, or limitation of exertion
80
Constant albuminuria with some edema; or, definite decrease in kidney function; or, hypertension at least 40 percent disabling under diagnostic code 7101
60
Albumin constant or recurring with hyaline and granular casts or red blood cells; or, transient or slight edema or hypertension at least 10 percent disabling under diagnostic code 7101
30
Albumin and casts with history of acute nephritis; or, hypertension non-compensable under diagnostic code 7101
0
Urinary frequency:
Rating
Daytime voiding interval less than one hour, or; awakening to void five or more times per night
40
Daytime voiding interval between one and two hours, or; awakening to void three to four times per night
20
Daytime voiding interval between two and three hours, or; awakening to void two times per night
10
7101
Hypertensive vascular disease (hypertension and isolated systolic hypertension):
Rating
Diastolic pressure predominantly 130 or more
60
Diastolic pressure predominantly 120 or more
40
Diastolic pressure predominantly 110 or more, or; systolic pressure predominantly 200 or more
20
Diastolic pressure predominantly 100 or more, or; systolic pressure predominantly 160 or more, or; minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control
10
Physician’s Statement for Prostate Cancer
(To be completed by Doctor)
Veteran’s Name: __________________________________________________ __
Claim Number: ________________________________ SS Number: _________________________
Diagnosis:
o The veteran has been diagnosed and has active prostate cancer
Evaluation: (Check all that apply)
Voiding Dysfunction: Rate particular condition as urine leakage, frequency or obstructed voiding. Continual Urine Leakage, Post Surgical Urinary Diversion, Urinary Incontinence, or Stress Incontinence:
o Requiring the use of appliance or the wearing of absorbent materials, which must be change more than 4 times a day.
o Requiring the wearing of absorbent material which must be changed 2 to 4 times a day
o Requiring the wearing of absorbent materials which must be changed less than 2 times a day
Renal Dysfunction:
o Requiring regular dialysis, or precluding more than sedentary activity from one of the following: Requiring regular dialysis, or precluding more than sedentary activity from one of the following: persistent edema and albuminuria; or, BUN more than 80mg%; or, creatinine more than 8mg%; or, markedly decreased function of kidney or other organ systems, especially cardiovascular
o Persistent edema and albuminuria with BUN 40 to 80mg%; or, creatinine 4 to 8mg%; or, generalized poor health characterized by lethargy, weakness, anorexia, weight loss, or limitation of exertion
o Constant albuminuria with some edema; or, definite decrease in kidney function; or, hypertension at least 40 percent disabling under diagnostic code 7101
o Albumin constant or recurring with hyaline and granular casts or red blood cells; or, transient or slight edema or hypertension at least 10 percent disabling under diagnostic code 7101
o Albumin and casts with history of acute nephritis; or, hypertension non-compensable under diagnostic code 7101
Urinary Frequency:
o Daytime voiding interval less than one hour, or; awakening to void five or more times per night
o Daytime voiding interval between one and two hours, or; awakening to void three to four times per night
o Daytime voiding interval between two and three hours, or; awakening to void two times per night
Complications/Residuals: (Check all that apply)
Hypertensive vascular disease (hypertension and isolated systolic hypertension):
o Diastolic pressure predominantly 130 or more
o Diastolic pressure predominantly 120 or more
o Diastolic pressure predominantly 110 or more, or; systolic pressure predominantly 200 or more
o Diastolic pressure predominantly 100 or more, or; systolic pressure predominantly 160 or more, or; minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control
o Depression secondary to prostate cancer and its residuals
o Other; please add remarks: __________________________________________________ ______________________
__________________________________________________ ________________________________________________
_______________________________ __________________ ____________________________
Physician’s Signature Date ____________________________
____________________________
_______________________________ ____________________________
Physician’s Printed Name Physician’s address & phone #
Rating Criteria for Prostate Cancer and Residuals
7528
Malignant neoplasms of the genitourinary system – Prostate Cancer
100
Note: Following the cessation of surgical, X-ray, antineoplastic chemotherapy or other therapeutic procedure, the rating of 100 percent shall continue with a mandatory VA examination at the expiration of six months. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of §3.105(e) (http://vbaw.vba.va.gov/bl/21/publicat/Regs/Part3/3_105.htm) of this chapter. If there has been no local recurrence or metastasis, rate on residuals as voiding dysfunction (http://vbaw.vba.va.gov/bl/21/publicat/Regs/Part4/4_115a.htm#bm03) or renal dysfunction (http://vbaw.vba.va.gov/bl/21/publicat/Regs/Part4/4_115a.htm#bm02), whichever is predominant.
Once the cancer has gone into remission, or you have had surgery to remove the prostate, the VA then rates on the residuals. It is advised that your and your doctor discuss the following conditions, and determine which criteria most describe your symptoms. Once you acquire the medical evidence to support your claim, please forward it our office for review and submission to the VA.
Voiding dysfunction:
Rating
Rate particular condition as urine leakage, frequency, or obstructed voiding (http://vbaw.vba.va.gov/bl/21/publicat/Regs/Part4/#bm05).
Continual Urine Leakage, Post Surgical Urinary Diversion, Urinary Incontinence, or Stress Incontinence:
Requiring the use of an appliance or the wearing of absorbent materials which must be changed more than 4 times per day
60
Requiring the wearing of absorbent materials which must be changed 2 to 4 times per day
40
Requiring the wearing of absorbent materials which must be changed less than 2 times per day
20
Renal dysfunction:
Rating
Requiring regular dialysis, or precluding more than sedentary activity from one of the following: persistent edema and albuminuria; or, BUN more than 80mg%; or, creatinine more than 8mg%; or, markedly decreased function of kidney or other organ systems, especially cardiovascular
100
Persistent edema and albuminuria with BUN 40 to 80mg%; or, creatinine 4 to 8mg%; or, generalized poor health characterized by lethargy, weakness, anorexia, weight loss, or limitation of exertion
80
Constant albuminuria with some edema; or, definite decrease in kidney function; or, hypertension at least 40 percent disabling under diagnostic code 7101
60
Albumin constant or recurring with hyaline and granular casts or red blood cells; or, transient or slight edema or hypertension at least 10 percent disabling under diagnostic code 7101
30
Albumin and casts with history of acute nephritis; or, hypertension non-compensable under diagnostic code 7101
0
Urinary frequency:
Rating
Daytime voiding interval less than one hour, or; awakening to void five or more times per night
40
Daytime voiding interval between one and two hours, or; awakening to void three to four times per night
20
Daytime voiding interval between two and three hours, or; awakening to void two times per night
10
7101
Hypertensive vascular disease (hypertension and isolated systolic hypertension):
Rating
Diastolic pressure predominantly 130 or more
60
Diastolic pressure predominantly 120 or more
40
Diastolic pressure predominantly 110 or more, or; systolic pressure predominantly 200 or more
20
Diastolic pressure predominantly 100 or more, or; systolic pressure predominantly 160 or more, or; minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control
10
Physician’s Statement for Prostate Cancer
(To be completed by Doctor)
Veteran’s Name: __________________________________________________ __
Claim Number: ________________________________ SS Number: _________________________
Diagnosis:
o The veteran has been diagnosed and has active prostate cancer
Evaluation: (Check all that apply)
Voiding Dysfunction: Rate particular condition as urine leakage, frequency or obstructed voiding. Continual Urine Leakage, Post Surgical Urinary Diversion, Urinary Incontinence, or Stress Incontinence:
o Requiring the use of appliance or the wearing of absorbent materials, which must be change more than 4 times a day.
o Requiring the wearing of absorbent material which must be changed 2 to 4 times a day
o Requiring the wearing of absorbent materials which must be changed less than 2 times a day
Renal Dysfunction:
o Requiring regular dialysis, or precluding more than sedentary activity from one of the following: Requiring regular dialysis, or precluding more than sedentary activity from one of the following: persistent edema and albuminuria; or, BUN more than 80mg%; or, creatinine more than 8mg%; or, markedly decreased function of kidney or other organ systems, especially cardiovascular
o Persistent edema and albuminuria with BUN 40 to 80mg%; or, creatinine 4 to 8mg%; or, generalized poor health characterized by lethargy, weakness, anorexia, weight loss, or limitation of exertion
o Constant albuminuria with some edema; or, definite decrease in kidney function; or, hypertension at least 40 percent disabling under diagnostic code 7101
o Albumin constant or recurring with hyaline and granular casts or red blood cells; or, transient or slight edema or hypertension at least 10 percent disabling under diagnostic code 7101
o Albumin and casts with history of acute nephritis; or, hypertension non-compensable under diagnostic code 7101
Urinary Frequency:
o Daytime voiding interval less than one hour, or; awakening to void five or more times per night
o Daytime voiding interval between one and two hours, or; awakening to void three to four times per night
o Daytime voiding interval between two and three hours, or; awakening to void two times per night
Complications/Residuals: (Check all that apply)
Hypertensive vascular disease (hypertension and isolated systolic hypertension):
o Diastolic pressure predominantly 130 or more
o Diastolic pressure predominantly 120 or more
o Diastolic pressure predominantly 110 or more, or; systolic pressure predominantly 200 or more
o Diastolic pressure predominantly 100 or more, or; systolic pressure predominantly 160 or more, or; minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control
o Depression secondary to prostate cancer and its residuals
o Other; please add remarks: __________________________________________________ ______________________
__________________________________________________ ________________________________________________
_______________________________ __________________ ____________________________
Physician’s Signature Date ____________________________
____________________________
_______________________________ ____________________________
Physician’s Printed Name Physician’s address & phone #