Kidney Stones VA Rating: DC 7508, DC 7509, and 38 CFR 4.115b Criteria

The November 2021 revision: DC 7510 removal and diet/drug therapy changes

Older decisions and guides often state that DC 7508 (nephrolithiasis) and DC 7510 (ureterolithiasis) award 30% whenever recurrent stones require diet therapy or drug therapy. Effective November 14, 2021 (86 FR 54081, RIN 2900-AQ71), the VA made three key changes to 38 CFR 4.115b:

1. Removal of Diagnostic Code 7510 (Ureterolithiasis): Because kidney and ureteral stones cause the same symptoms and impairment, the VA deleted DC 7510 and consolidated ureterolithiasis into DC 7508.
2. Addition of nephrocalcinosis to Diagnostic Code 7508: DC 7508 was retitled “Nephrolithiasis / Ureterolithiasis / Nephrocalcinosis” so renal calcium accumulation is evaluated under the same code.
3. Elimination of diet and drug therapy under Diagnostic Code 7508: Prior to November 14, 2021, DC 7508 and DC 7510 awarded 30% for recurrent stone formation requiring (1) diet therapy, (2) drug therapy, or (3) invasive or non-invasive procedures more than two times/year. The 2021 rule removed diet and drug therapy from DC 7508 because hydration, diet changes, and preventive medications (potassium citrate, thiazides, or allopurinol) are broadly recommended and do not measure average earning impairment. Under current DC 7508, the automatic 30% stone-formation rating requires invasive or non-invasive procedures more than two times per year.

Two exceptions where diet and drug therapy still apply

• Protected pre-November 14, 2021 ratings (38 CFR 3.951(a)): Veterans granted 30% under DC 7508 or former DC 7510 before November 14, 2021 based on diet or drug therapy remain protected by 38 U.S.C. 1155 and 38 CFR 3.951(a) unless medical evidence shows sustained material improvement under ordinary conditions of life.
• Ureteral stricture with recurrent stones (Diagnostic Code 7511): The 2021 rule did not remove diet or drug therapy from DC 7511 (Ureter, stricture of), which still awards 30% for ureteral stricture with recurrent stone formation requiring diet therapy, drug therapy, or invasive or non-invasive procedures more than two times per year.

Understanding the DC 7508 and DC 7509 rating tiers

30% rating under DC 7508 (procedures more than twice a year)

Qualifying for 30% directly under DC 7508 requires recurrent stone formation and invasive or non-invasive procedures more than two times per year (three or more procedures in 12 months):

• Non-invasive procedures: Extracorporeal shock wave lithotripsy (ESWL) using external shock waves to fragment calculi.
• Invasive procedures: Ureteroscopy (URS) with laser lithotripsy or basket extraction, cystoscopic ureteral stent placement or exchange, percutaneous nephrolithotomy (PCNL) or nephrostomy tube drainage, and laparoscopic or open nephrolithotomy.

Diagnostic scans (CT, ultrasound, X-ray) and oral medical expulsive therapy (such as tamsulosin) do not count as procedures under DC 7508.

10%, 20%, and 30% ratings as hydronephrosis (DC 7509)

When procedures are not required more than twice per year, DC 7508 rates stones under Diagnostic Code 7509 (Hydronephrosis) based on renal colic:

• 0% evaluation: Service connection is established (such as in-service calculi or asymptomatic stones on imaging), but symptoms do not reach the 10% colic threshold or a compensable rating under 38 CFR 4.115a.
• 10% evaluation: Only an occasional attack of colic, not infected and not requiring catheter drainage.
• 20% evaluation: Frequent attacks of colic, requiring catheter drainage (ureteral catheterization, stent drainage, or bladder catheterization during obstructive attacks).
• 30% evaluation: Frequent attacks of colic with infection (pyonephrosis), kidney function impaired, or when hydronephrosis is severe and warrants at least 30% under the renal dysfunction formula.

General rating formulas in 38 CFR 4.115a: renal, voiding, and UTI dysfunctions

Under 38 CFR 4.115a, genitourinary conditions are rated under three dysfunction schedules: renal dysfunction, voiding dysfunction, and urinary tract infection (UTI). Where a diagnostic code refers to these areas—such as severe hydronephrosis (DC 7509), chronic pyelonephritis (DC 7504), or bladder calculus (DC 7515)—only the predominant area of dysfunction is assigned for a single condition. Distinct disabilities may be rated separately under 38 CFR 4.14 if their symptoms do not overlap.

Renal dysfunction rating formula (38 CFR 4.115a)

Effective November 14, 2021 (86 FR 54081), renal dysfunction is rated using objective glomerular filtration rate (GFR) and albumin/creatinine ratio (ACR) findings over at least 3 consecutive months during the past 12 months.

• Note to Renal Dysfunction (38 CFR 4.115a): GFR, eGFR, and creatinine-based approximations of GFR are accepted when appropriate and calculated by a medical professional.
• Nephrectomy and transplant codes (38 CFR 4.115b): DC 7500 (Kidney, removal of one) assigns a minimum 30% evaluation, or higher as renal dysfunction if there is nephritis, infection, or pathology of the other kidney. DC 7531 (Kidney transplant) assigns 100% from hospital admission for transplant surgery until one year after discharge (with a mandatory VA exam), and a minimum 30% rating thereafter.

Effective 2025-12-01, a veteran with no dependents receives $1,435.02 per month at 60%, $2,102.15 at 80%, and $3,938.58 at 100%.

Voiding dysfunction and urinary tract infection formulas (38 CFR 4.115a)

When stones form in the bladder (DC 7515), cause a urethral stricture (DC 7518), or cause chronic UTIs rated under 38 CFR 4.115a, the VA applies these schedules:

Establishing direct and secondary service connection

Direct service connection (38 CFR 3.303)

Direct service connection under 38 CFR 3.303 requires: (1) a current diagnosis of nephrolithiasis, ureterolithiasis, nephrocalcinosis, or residual dysfunction; (2) an in-service stone episode, symptom, or diagnosis; and (3) a medical nexus to service. Service records showing acute colic, hematuria, or calculi on active duty—paired with continuity of symptoms under 38 CFR 3.303(b) or a medical nexus—support direct service connection. Nephrolithiasis is not on the 38 CFR 3.309(a) chronic list for one-year post-discharge presumptive connection (which covers “nephritis, chronic” rather than stones).

Secondary service connection (38 CFR 3.310)

Under 38 CFR 3.310(a), a disability proximately due to or chronically aggravated by a service-connected condition may be service connected with a medical nexus:

• Conditions that may cause or aggravate kidney stones: Chronic diarrhea and malabsorption from inflammatory bowel disease, bowel resection, or irritable bowel syndrome (IBS) (causing dehydration, hypocitraturia, and enteric hyperoxaluria); endocrine or metabolic disorders such as primary hyperparathyroidism (DC 7904), gout (DC 5017), or diabetes mellitus; neurogenic bladder (DC 7542) from back pain nerve injuries; and lithogenic medications prescribed for service-connected conditions (such as topiramate for migraines or TBI).
• Conditions that may develop secondary to service-connected kidney stones: Chronic kidney disease rated under 38 CFR 4.115a; secondary renal hypertension (DC 7101) from obstructive scarring (while 38 CFR 4.115 bars separate ratings for heart disease and nephritis, non-nephritis renal disease and hypertension can be rated separately when complications do not overlap); ureteral stricture (DC 7511) or urethral stricture (DC 7518); and secondary depression or anxiety under 38 CFR 4.130.

What to expect at the C&P exam and on the Kidney Conditions DBQ

During a VA C&P exam, the clinician completes the Kidney Conditions (Nephrology) Disability Benefits Questionnaire (DBQ)—and, if bladder calculi or lower urinary tract symptoms are claimed, the Urinary Tract Conditions DBQ—from the VA Public DBQs page. The examiner documents:

1. Confirmed diagnosis and imaging: CT, ultrasound, or X-ray findings confirming nephrolithiasis, ureterolithiasis, nephrocalcinosis, or hydronephrosis.
2. Colic frequency and complications: Occasional vs. frequent colic attacks, pyonephrosis or impaired renal function, and catheter, stent, or nephrostomy drainage (DC 7509).
3. Procedures over the past 12 months: Dates and types of invasive or non-invasive procedures (ESWL, ureteroscopy, laser lithotripsy, stenting, PCNL) to verify whether procedures were required more than two times per year under DC 7508.
4. Serial laboratory testing: Serum creatinine, GFR/eGFR, BUN, urine ACR, and urinalysis (RBC, WBC, or granular casts) over at least 3 consecutive months during the past 12 months for 38 CFR 4.115a ratings.

How a kidney stones rating combines with other VA ratings

Compensable ratings under DC 7508, DC 7509, or 38 CFR 4.115a combine with other disabilities under 38 CFR 4.25. Under 38 CFR 4.26, the 10% bilateral factor applies only to paired extremities, so bilateral stones in both kidneys receive one rating. Model how a rating affects your pay with our VA combined rating calculator, and estimate retroactive pay using our VA back pay calculator.

When to seek accredited help with your claim

If your claim was denied, underrated because private procedure records were overlooked, or reduced despite pre-November 2021 protection under 38 CFR 3.951(a), consider working with a VA-accredited representative:

• Veterans Service Organizations (VSOs): Accredited representatives from the DAV, VFW, and American Legion prepare and file claims and appeals free of charge.
• VA-Accredited Claims Agents and Attorneys: Accredited professionals certified by the VA Office of General Counsel represent claimants in Supplemental Claims, Higher-Level Reviews, and Board appeals.

No representative can promise a specific outcome. Confirm accreditation or find free representation through the VA Office of General Counsel Accreditation Search.