quantitative (number of copies per milliliter (ml)). Note: Liver biopsy, ultrasound, and computed tomography (CT) scan tests can detect damage to the liver but will not identify the type of infection. c. Interpreting Lab Reports for HBV The table below provides an example of a laboratory interpretation of serology test results for HBV. Test Results Interpretation Example 1 HBsAg negative susceptible to infection anti-HBc negative susceptible to infection (no hepatitis B) anti-HBs negative no history of hepatitis B Example 2 HBsAg negative immune anti-HBc negative or positive immune anti-HBs positive Example 3 HBsAg positive acute infection anti-HBc positive Immunoglobulin M (IgM) anti-HBc positive acute infection anti-HBs negative Example 4 HBsAg positive chronic infection anti-HBc positive IgM anti-HBc negative chronic infection anti-HBs negative d. Interpreting Lab Reports for HCV After 1992 The table below provides an example of a laboratory interpretation of serology testing for HCV for testing performed after 1992. Tests Results Interpretation anti-HCV positive (probable chronic hepatitis) need to verify diagnosis EIA positive supplemental test required RIBA positive diagnostic
negative and the Veteran is now asymptomatic with no evidence of liver damage may flare up again later. Reference: For additional information on evaluation of HCV, see . 3. Genitourinary Conditions Introduction This topic contains information about evaluating genitourinary conditions, including deformity of the penis with loss of erectile power entitlement to special monthly compensation (SMC) associated with erectile dysfunction (ED) evaluating ED associated with multiple sclerosis or diabetes mellitus determining SC for residuals of venereal disease or human immunodeficiency virus (HIV)-related illness evaluating benign prostatic hypertrophy (BPH) diagnosis of prostate cancer by biopsy rating considerations for prostate cancer considering SC for ED and entitlement to SMC due to prostate cancer evaluating renal conditions using blood urea nitrogen testing (BUN), and creatinine annual review of evaluations based on hemodialysis use of an appliance and voiding dysfunction, and considering claims for SC of kidney donation. Change Date December 16, 2015 a. Deformity of the Penis With Loss of Erectile Power The following two requirements must be met before a 20-percent evaluation can be assigned for deformity of the penis with loss of erectile power under deformity must be evident, and the deformity must be accompanied by loss of erectile power. Important: The condition is not compensable in the absence of penile deformity. b. Entitlement to SMC Associated With ED Entitlement to special monthly compensation (SMC) at the (k) rate for loss of use (LOU) of a creative organ due to erectile dysfunction (ED) is a factual determination. When the evidence shows LOU of a creative organ due to an SC condition, entitlement to SMC (k) will be awarded even though
especially transurethral resection of the prostate (TURP). SMC (k) may be warranted if there is associated ED or retrograde ejaculation as a result of treatment or if hormone therapy is used. SMC entitlement is determined on a factual basis. f. Diagnosis of Prostate Cancer by Biopsy A diagnosis of prostate cancer is made only on the basis of a prostate biopsy. An elevated prostate-specific antigen (PSA) test is not diagnostic of cancer. g. Rating Considerations for Prostate Cancer The table below describes common treatments for prostate cancer as well as the side effects and rating considerations associated with the treatment. Type of Treatment Potential Side Effects Rating Considerations watchful waiting also called conservative management observation, or surveillance. No immediate specific therapy is being used, but cancer is active. none, except for the continued presence and potential metastasis of cancer often used when life expectancy is short due to age or other illness since prostate cancer is slow- growing. Review to confirm the continuation of active cancer previously confirmed by biopsy. Evaluate at 100 percent, despite the lack of treatment and possible lack of symptoms. radical prostatectomy surgery which is characterized by removal of prostate gland and seminal vesicles most common treatment for localized cancer can be curative, and nerve-sparing procedure can be performed to improve chances that the patient will retain normal erectile function. impotence, and/or incontinence. In all cases of radical prostatectomy, award SMC (k) for loss of use of a creative organ. Consider SC for ED on a facts-found basis. Cryotherapy, also known as cryosurgery or impotence incontinence Consider SMC (k) on a facts-found basis.
cryoablation, is a procedure by which the prostate and nearby tissues are frozen with liquid nitrogen via probes in the perineum. urethral scarring, and rectourethral fistula (rare). Radiation can be curative if cancer is confined to the prostate and surrounding tissues and PSA is 15 nanograms (ng)/ml or less is also used as palliative therapy to relieve symptoms of advanced cancer, such as bone pain due to metastasis can be internal radiation therapy, or brachytherapy, in which radioactive seeds are implanted in the prostate. high dose radiation (HDR) seeds are implanted for less than a day and then removed. Radiation is present only while seeds are in place. low dose radiation (LDR) seeds are permanently implanted and give off radiation for weeks to months, depending on the radioisotope used. external radiation therapy, in which radiation is delivered by high-energy eternal radiation for after external beam radiation impotence, and/or incontinence after brachytherapy impotence incontinence bowel problems, and/or urethral complications. After internal HDR the radiation continues only for hours or days, so a six-month assignment of temporary 100 percent under is appropriate, and consider SMC (k) for impotence on a facts-found basis. After internal LDR the effective radiation should be gone by one year assign a 100 percent evaluation for one year, and schedule a review exam six months following the cessation of the treatment period. Note: If radiation is used only as palliative therapy in advanced cancer, the 100-percent evaluation will continue because the cancer will remain active. Therefore review for metastatic disease, and consider permanency.
six to eight weeks. Hormone therapy is primarily for palliation of prostate cancer which is not confined to the prostate for the purpose of testosterone deprivation. Types of hormone therapy include orchiectomy, the removal of testes to prevent testosterone production luteinizing hormone releasing hormone agonists (LHRH analogs), which can lower the testosterone as effectively as orchiectomy such as Lupron (leuprolide) Zoladex (goserelin), and busrelin estrogens or drugs, which lower the level of testosterone second-line hormonal drugs, which are used when first-line hormone therapy fails anti-androgens, which block the ability of the body to use androgens, such as Eulexin (flutamide) Casodex (bicalutamide), and Nilandron (nilutamide), and combined hormone therapy, which is an anti-androgen combined with after any hormone therapy hot flashes osteoporosis loss of muscle mass after orchiectomy impotence sterility loss of sex drive after anti-androgen therapy gastrointestinal upset breast tenderness gynecomastia decreased libido impotence hot flashes after LHRH analogs impotence hot flashes, and gynecomastia. Orchiectomy results in anatomical loss of a creative organ; therefore evaluate under , and award SMC. Hormone therapy may continue for many years; therefore review treatment records for expected duration of treatment, and consider permanence.
been discontinued. Note: If the Veteran does not return the VA Form 21-4142 and VA Form 21-4142a within 60 days, initiate action to adjust the award under . 9 Following completion of development, the RO evaluates each case on the basis of facts found. The authorization activity dates, initials, and annotates the write-out or Work Item EP 680 promulgates the rating decision, if appropriate notifies the Veteran of the action taken PCLRs the EP 680, and if reduction in evaluation under is necessary, establishes EP 600 for control of the adverse action proposal period. l. Use of an Appliance and Voiding Dysfunction The term appliance, as used in the criteria for voiding dysfunction under , includes all types of catheters, as well as any other assistive device for urination. Important: Appliances, including catheters, may be used to treat urine leakage and/or urine retention. The rating activity should review the evidence carefully to determine whether the appliance is required to treat urine leakage or urine retention and evaluate on the predominant disability. Example 1: A Veteran is SC for a bladder injury. Medical records show a catheter is required for urine leakage due to the bladder injury. Result: A 60-percent evaluation should be assigned for this disability based on voiding dysfunction. Example 2: A Veteran is SC for a bladder injury. Medical records show a catheter is required for urine retention due to the bladder injury. Result: A 30-percent evaluation should be assigned for this disability based on obstructed voiding. Reference: For more information on ratings of the genitourinary system based on voiding dysfunction, see . m. Considering Claims for SC of Kidney Donation Kidney donation and any expected residual effects thereof are not subject to SC. Kidney donation is considered an elective surgery, and therefore, does not meet the provisions of a disease or injury incurred coincident with service. Reference: For more information about the principles relating to SC, see , and M21-1, Part IV, Subpart ii, 2.B.