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C&P Exam Prep: Penis, Removal of Glans
DBQ Overview
Interview + Physical- Form Name
- Male_Reproductive_Organ
- Form Code
- Male_Reproductive_Organ
- Page Count
- 10
- Examiner Type
- Urologist or Physician
- Estimated Duration
- 20-30 minutes
- Exam Format
- Interview + Physical
What to Expect During Your Exam
Exam Overview
To document the anatomical extent of penile tissue loss, confirm the nature and cause of the removal or loss, assess any residual functional impairments including urinary and sexual dysfunction, and establish the appropriate disability rating under 38 CFR 4.115b diagnostic codes 7520 or 7521.
What the examiner evaluates:
- Extent of penile tissue removed or lost (glans only vs. half or more of the entire penis)
- Whether loss was due to trauma, disease (e.g., penile cancer, Fournier's gangrene), or surgical procedure
- Presence and severity of urinary voiding dysfunction, including stream abnormalities, hesitancy, frequency, and retention
- Presence of erectile dysfunction with or without penile deformity (DC 7522)
- Any urethral stricture disease or need for periodic catheterization
- Post-void residual urine volume
- Incontinence severity and use of absorbent materials
- Presence of any neoplasm (benign or malignant) related to the condition
- Current treatment status including surgery dates, radiation, chemotherapy, or hormonal therapy
- Functional impact on work, daily activities, and quality of life
- Eligibility for Special Monthly Compensation (SMC-K) based on anatomical loss of a creative organ
This exam involves an in-person physical examination of the genitourinary system. You have the right to request a same-sex examiner. In most states, you have the right to record the examination. Bring a support person if needed, but note the examiner may ask them to wait outside during the physical examination portion. The exam will include review of service treatment records, VA medical records, and any private medical records submitted.
Typical duration: 20-30 minutes
Physical Measurement of Penile Tissue Loss
The anatomical extent of penile tissue removed or absent, specifically whether loss encompasses the glans only (DC 7521, 20%) or half or more of the entire penile shaft (DC 7520, 30%)
What to expect:
The examiner will visually inspect and potentially measure the remaining penile tissue. They will document whether the glans (head of the penis) is absent and the extent of any additional shaft tissue loss. Photographs may be taken for the record.
Key thresholds:
- Loss or removal of the glans only — 20% rating under DC 7521 - confirm the glans is completely absent, not merely scarred or deformed
- Loss or removal of half or more of the penile shaft (including glans) — 30% rating under DC 7520 - the higher rating requires documented loss of at least half of the total penile length
- Loss of less than half of the penile shaft — Rated under DC 7521 or DC 7522 depending on functional residuals; ensure any deformity with erectile dysfunction is captured under DC 7522 (0% but SMC-K eligible)
Tips:
- Ensure the examiner documents the complete absence of the glans, not merely partial damage
- If penile shaft tissue beyond the glans was removed, explicitly state the approximate length or proportion of the shaft that is absent
- Bring operative reports, pathology reports, or discharge summaries that describe the extent of surgical resection
- If the loss occurred due to trauma rather than surgery, bring any service records, injury reports, or post-injury medical documentation
Pain considerations: Report any phantom sensation, stump pain, scarring pain, or hypersensitivity at the surgical site or remaining tissue, as these may support additional ratings or functional impairment documentation.
Uroflowmetry / Voiding Function Assessment
Urinary stream strength and flow rate, particularly peak flow rate, to detect obstructive voiding dysfunction that may result from urethral changes following penile surgery
What to expect:
You may be asked to urinate into a specialized device that measures urine flow rate. A peak flow rate of less than 10 cc/sec is a specific threshold noted in the DBQ. Post-void residual (PVR) may also be measured via ultrasound to determine how much urine remains in the bladder after voiding.
Key thresholds:
- Peak flow rate less than 10 cc/sec — Supports obstructive voiding dysfunction ratings; may support higher combined ratings when evaluated alongside the penile loss rating
- Post-void residual greater than 150 cc — Indicates significant urinary retention; may support additional rating under voiding dysfunction criteria
- Urinary retention requiring intermittent catheterization — Elevates the severity of voiding dysfunction documentation and may support a higher combined genitourinary rating
Tips:
- Arrive with a comfortably full bladder if uroflowmetry is likely to be performed
- Report your typical voiding interval accurately - how often you urinate during the day and how many times you wake at night
- Note whether you experience hesitancy, slow or weak stream, dribbling, or a sensation of incomplete emptying
- If you use a urinary appliance or catheter, bring it to the exam and describe how frequently you use it
Pain considerations: Report any pain or burning with urination, urethral discomfort, or difficulty directing the urine stream due to absence of the glans, which normally assists with stream direction.
Assessment of Erectile Dysfunction
Presence and severity of erectile dysfunction (ED) with or without penile deformity following penile surgery or trauma, evaluated under DC 7522
What to expect:
The examiner will ask about your ability to achieve and maintain erections, whether ED was present before or developed after the penile loss, and whether you use any assistive devices or medications. This is typically an interview-based assessment rather than a physical measurement.
Key thresholds:
- Complete loss of erectile function (loss of use of a creative organ) — Rated 0% under DC 7522 but qualifies for Special Monthly Compensation (SMC-K) under 38 U.S.C. 1114(k) and 38 CFR 3.350(a) - this is a significant benefit separate from the percentage rating
- Penile deformity interfering with sexual function — Also rated under DC 7522; document any scarring, angulation, or structural changes to remaining tissue
Tips:
- Be explicit that your ED is directly related to the penile tissue loss or surgical procedure
- Mention if ED developed immediately after surgery or trauma versus pre-existing
- Ask your examiner to document SMC-K eligibility if you have complete loss of use of the creative organ
- Describe any psychological impact of the condition on intimacy and relationships to support the functional impact section of the DBQ
Pain considerations: Report any pain associated with attempted sexual activity, residual stump sensitivity, or psychological distress (anxiety, depression) related to the sexual dysfunction, which may support claims for related mental health conditions.
Rating Criteria Breakdown
| Rating % | Criteria | Key Symptoms |
|---|---|---|
| 30% | Removal of half or more of the penis, including the glans and a significant portion of the penile shaft. This is the maximum schedular rating under DC 7520 and reflects the most extensive anatomical loss. |
CFR: 38 CFR 4.115b, DC 7520: 'Penis, removal of half or more' - rated at 30%. Note 1 indicates this condition may entitle the veteran to Special Monthly Compensation under 38 CFR 3.350(a) for anatomical loss of a creative organ. |
| 20% | Removal or loss of the glans penis only, without removal of half or more of the penile shaft. This applies when the glans (head) is absent but a substantial portion of the shaft remains intact. |
CFR: 38 CFR 4.115b, DC 7521: 'Penis, removal of glans' - rated at 20%. Note 1 similarly applies for SMC-K eligibility if there is loss of use of a creative organ. |
| 0% | Erectile dysfunction with or without penile deformity rated separately under DC 7522. While the schedular rating is 0%, this is critically important because it qualifies the veteran for Special Monthly Compensation (SMC-K), which provides additional monthly compensation above the combined rating. |
CFR: 38 CFR 4.115b, DC 7522: 'Erectile dysfunction, with or without penile deformity' - rated at 0%. Note: a disease or traumatic injury of the penis resulting in scarring or deformity shall be rated under DC 7522. SMC-K entitlement under 38 U.S.C. 1114(k) and 38 CFR 3.350(a) applies when there is anatomical loss or loss of use of a creative organ. |
30% Removal of half or more of the penis, including the glans an ...
Removal of half or more of the penis, including the glans and a significant portion of the penile shaft. This is the maximum schedular rating under DC 7520 and reflects the most extensive anatomical loss.
Key Symptoms
- Complete absence of the glans and at least half of the total penile shaft length
- Altered or impaired urinary stream direction and control due to absence of the natural urethral meatus positioning
- Erectile dysfunction secondary to tissue loss (rated separately under DC 7522 with SMC-K potential)
- Scarring, contracture, or deformity of the remaining penile stump
- Psychological and functional impact on sexual and reproductive capability
- Possible need for urinary appliance or assistive device for voiding
CFR: 38 CFR 4.115b, DC 7520: 'Penis, removal of half or more' - rated at 30%. Note 1 indicates this condition may entitle the veteran to Special Monthly Compensation under 38 CFR 3.350(a) for anatomical loss of a creative organ.
20% Removal or loss of the glans penis only, without removal of ...
Removal or loss of the glans penis only, without removal of half or more of the penile shaft. This applies when the glans (head) is absent but a substantial portion of the shaft remains intact.
Key Symptoms
- Complete absence of the glans penis confirmed on physical examination
- Remaining penile shaft is more than half of the original length
- Altered urinary stream due to absent natural meatus structure
- Erectile dysfunction may be present and rated separately under DC 7522
- Scarring or deformity at the site of glans removal
- Possible urethral stricture or meatal stenosis as a residual of surgery
CFR: 38 CFR 4.115b, DC 7521: 'Penis, removal of glans' - rated at 20%. Note 1 similarly applies for SMC-K eligibility if there is loss of use of a creative organ.
0% Erectile dysfunction with or without penile deformity rated ...
Erectile dysfunction with or without penile deformity rated separately under DC 7522. While the schedular rating is 0%, this is critically important because it qualifies the veteran for Special Monthly Compensation (SMC-K), which provides additional monthly compensation above the combined rating.
Key Symptoms
- Inability to achieve or maintain an erection sufficient for sexual intercourse
- Loss of use of a creative organ due to penile tissue loss or surgical/traumatic damage
- Penile deformity (scarring, angulation, contracture) interfering with sexual function
- Psychological sequelae including depression and anxiety secondary to sexual dysfunction
CFR: 38 CFR 4.115b, DC 7522: 'Erectile dysfunction, with or without penile deformity' - rated at 0%. Note: a disease or traumatic injury of the penis resulting in scarring or deformity shall be rated under DC 7522. SMC-K entitlement under 38 U.S.C. 1114(k) and 38 CFR 3.350(a) applies when there is anatomical loss or loss of use of a creative organ.
How to Describe Your Symptoms
Anatomical Extent of Penile Loss
How to describe:
Clearly and factually describe what tissue was removed, when, and why. State whether the glans is completely absent. If more tissue was removed, describe the approximate proportion of the shaft that is gone. Reference your operative reports or medical records to anchor your description in documented facts.
Worst-day example:
“On my worst days, the physical absence of the glans and portion of my penis causes significant difficulty with urinary stream control, requiring me to sit to urinate to prevent splashing. I experience discomfort at the surgical site, and the visible disfigurement causes me significant psychological distress, including avoidance of intimate situations.”
What the examiner listens for:
Clear confirmation that the glans is absent and the extent of any additional shaft tissue loss. The examiner needs precise anatomical information to select between DC 7520 (half or more removed) and DC 7521 (glans only). They also listen for any spontaneous description of functional limitations.
Understatements to avoid:
Do not say 'it was just a partial surgery' or minimize the extent of tissue removed. Do not assume the examiner has reviewed your surgical records. State explicitly: 'The glans was completely removed' or 'approximately [X]% of the penile shaft was removed along with the glans.'
Urinary Voiding Dysfunction
How to describe:
Describe your urinary habits in specific, quantifiable terms. Report daytime voiding frequency (hours between urinations), nighttime awakenings to void, stream strength, hesitancy, dribbling, incomplete emptying, and any episodes of retention. Reference your worst typical day, not your best day.
Worst-day example:
“On my worst days, I urinate every hour during the day and wake up three to four times at night to void. My stream is slow and weak, and I have difficulty directing the stream without the glans. I often experience dribbling after voiding and a persistent feeling that my bladder is not fully empty. I have had episodes where I could not urinate at all and required catheterization.”
What the examiner listens for:
Specific voiding intervals, nighttime awakening frequency, stream characteristics (weak, slow, hesitant), and any history of urinary retention or catheter use. These directly map to checkboxes on the DBQ that correspond to different rating levels.
Understatements to avoid:
Do not say 'I use the bathroom a normal amount' if you are compensating with behavioral adjustments like limiting fluid intake. Report your symptoms as they occur when you have not intentionally restricted fluids or activity. Do not omit nighttime voiding symptoms - nocturia is heavily weighted in genitourinary ratings.
Erectile Dysfunction and Sexual Function
How to describe:
Be direct and clinically factual. State whether you can achieve an erection, whether it is sufficient for sexual intercourse, and whether the dysfunction began after your penile surgery or trauma. Describe any penile deformity of the remaining shaft tissue, including scarring or abnormal angulation.
Worst-day example:
“Since the surgery, I have been completely unable to achieve an erection. This represents a total loss of sexual function that I did not experience before my service-connected condition. The scarring on the remaining penile shaft creates a deformity that would prevent normal sexual function even if partial erectile function were present. This has caused significant depression and has severely impacted my relationship with my spouse.”
What the examiner listens for:
Clear establishment that erectile dysfunction is present and that it is related to the penile tissue loss. The examiner also listens for any penile deformity on the remaining shaft, use of erectile aids (vacuum devices, medications, penile implants), and the psychological impact. This supports both DC 7522 and SMC-K eligibility.
Understatements to avoid:
Do not omit erectile dysfunction because it is rated at 0% - the SMC-K benefit it triggers can be worth hundreds of dollars per month in additional compensation. Do not fail to mention the emotional and relational impact. Do not assume the examiner will independently assess SMC-K eligibility without your prompting the documentation of loss of use of a creative organ.
Pain, Scarring, and Residual Physical Symptoms
How to describe:
Describe any ongoing pain at the surgical site or stump, hypersensitivity, phantom sensations, scar tissue discomfort, or difficulty with clothing contact on the remaining tissue. Use a consistent pain scale (0-10) and describe frequency, duration, and triggers.
Worst-day example:
“On my worst days, the scar tissue at the surgical site is hypersensitive and causes a burning, aching pain rated 7 out of 10 that lasts for hours. Contact with clothing aggravates the pain. I experience phantom sensations in the absent glans several times per week. The scarring has contracted and causes visible deformity of the remaining shaft.”
What the examiner listens for:
Any ongoing pain, sensitivity, or physical discomfort associated with the tissue loss. The examiner documents this in the functional impact and remarks sections of the DBQ, which supports the overall picture of disability severity and may support related claims for penile deformity under DC 7522.
Understatements to avoid:
Do not minimize pain by saying 'it's manageable' without describing its frequency and impact. Do not omit phantom sensations - these are medically recognized sequelae of tissue amputation. Report your actual pain levels, not what you think is acceptable to mention.
Psychological and Functional Impact
How to describe:
Describe how the condition affects your work, relationships, daily activities, and mental health. Be specific about activities you can no longer perform or must modify. Include the impact on employment if relevant (e.g., difficulty with urination in workplace settings, need for frequent bathroom breaks, avoidance of physical activity due to discomfort).
Worst-day example:
“The disfigurement and functional loss from this condition has caused me to withdraw from social situations and intimate relationships. I experience depression and anxiety that I attribute directly to this condition. At work, I must take additional bathroom breaks and use the accessible stall to sit and urinate. I avoid physical activity that causes friction or discomfort at the surgical site. I have been in mental health treatment since the injury.”
What the examiner listens for:
Concrete examples of how the condition limits daily function, employment, and quality of life. The DBQ has a dedicated functional impact field that the examiner must complete, and specific examples you provide will be recorded verbatim or summarized. This information also supports secondary mental health condition claims.
Understatements to avoid:
Do not say 'I get by fine' when describing your daily function if you have substantially altered your lifestyle to accommodate this condition. Adjustments and workarounds are evidence of disability, not evidence of normalcy. Describe what you cannot do naturally, not just what you have adapted to do differently.
Common Mistakes to Avoid
Failing to distinguish between removal of the glans only (DC 7521, 20%) versus removal of half or more of the total penis (DC 7520, 30%)
The distinction between these two diagnostic codes is worth a 10-percentage-point difference in the rating (20% vs. 30%). Veterans sometimes broadly describe their surgery without specifying the anatomical extent, leaving the examiner without sufficient information to apply the higher-rated DC 7520.
Instead: Bring your operative report to the exam and explicitly state: 'The surgery removed [the glans and approximately X cm/proportion of the penile shaft].' Ask the examiner to document whether the loss constitutes removal of half or more of the penis, which should trigger DC 7520 at 30%.
Impact: 30% (DC 7520) vs. 20% (DC 7521)
Not claiming erectile dysfunction separately under DC 7522 and missing SMC-K eligibility
Veterans with penile tissue removal frequently have co-existing erectile dysfunction, which is rated under a separate diagnostic code (DC 7522) at 0%. While the rating appears to add nothing financially, it triggers eligibility for Special Monthly Compensation under SMC-K, which provides significant additional monthly compensation beyond the combined disability rating.
Instead: Explicitly report erectile dysfunction to the examiner and ensure it is documented as a separate diagnosis on the DBQ. Ask the examiner to note loss of use of a creative organ and SMC-K eligibility. File a separate claim for erectile dysfunction if it has not been service-connected.
Impact: SMC-K eligibility (significant additional monthly benefit beyond schedular rating)
Describing symptoms only on average days rather than worst typical days
M21-1 guidance directs that ratings should reflect the predominant symptom picture, including the frequency and severity of the worst manifestations. VA adjudicators are trained to consider 'worst day' reporting, and underreporting leads to ratings that do not reflect the full disability.
Instead: Prepare specific examples of your worst typical days before the exam. Use concrete language: 'On my worst days, which occur [X times per week/month], I experience [specific symptoms].- Frame your condition at its worst without fabricating or exaggerating.
Impact: All rating levels - affects both primary rating and functional impact documentation
Neglecting to document urinary dysfunction symptoms that may exist as a residual of penile surgery
Penile surgery, particularly total or partial penectomy, can result in urethral changes, meatal stenosis, or altered voiding mechanics. These voiding symptoms are separately evaluated on the DBQ and can support additional genitourinary ratings when combined with the penile loss rating.
Instead: Track your voiding patterns for at least one to two weeks before the exam. Note your daytime voiding interval, nighttime awakenings, stream characteristics, and any episodes of urinary retention. Report these accurately to the examiner even if you have not previously discussed them with a provider.
Impact: Voiding dysfunction ratings that combine with penile loss rating in the overall genitourinary evaluation
Failing to bring documentation of the surgical procedure, diagnosis, and treatment history
The DBQ requires specific dates of surgery, diagnosis, and treatment completion. An examiner who cannot access these records may document incomplete information, which can delay processing or result in a lower rating due to insufficient evidence of the extent of the condition.
Instead: Bring copies of all surgical reports, pathology reports, operative notes, treatment records, and follow-up care documentation. Organize these chronologically and flag the key documents (date of surgery, description of tissue removed, treating physician's notes on functional outcomes).
Impact: All rating levels - affects completeness of the DBQ and nexus documentation
Not mentioning psychological sequelae (depression, anxiety, PTSD-like symptoms) related to the penile loss
Mental health conditions secondary to physical disability are ratable and compensable as secondary service-connected conditions. Veterans often omit psychological symptoms during genitourinary exams, missing an opportunity to initiate or support secondary mental health claims.
Instead: Briefly but clearly mention any depression, anxiety, relationship difficulties, or psychological distress related to your penile loss or erectile dysfunction. The examiner can document this in the functional impact section, and you can file a separate secondary claim for a mental health condition if not already service-connected.
Impact: Secondary mental health condition claims - separate from the genitourinary rating
Prep Checklist
Before Your Exam
Day Of
During the Exam
After the Exam
Your Rights During a C&P Exam
- You have the right to request a same-sex examiner for this sensitive examination. Submit the request to the scheduling office before your appointment.
- In most states, you have the right to record your C&P examination. Notify the examiner before the exam begins and place your recording device visibly in the room.
- You have the right to have a support person present during the interview portion of the examination, though the examiner may ask them to step out during the physical examination.
- You have the right to review your complete claims file (C-file) before your examination. Contact your VSO or the VA Regional Office to request access.
- You have the right to submit additional evidence (buddy statements, private medical opinions, treatment records) before the rating decision is finalized.
- You have the right to request an independent medical examination (IME) from a private physician if you believe the VA examination is inadequate or inaccurate.
- You have the right to challenge a rating decision that does not reflect the full extent of your documented disability through the Supplemental Claim, Higher-Level Review, or Board of Veterans' Appeals process.
- You have the right to have a Veterans Service Organization representative, accredited claims agent, or accredited attorney represent you at no charge or for regulated fees throughout the claims process.
- You have the right to be informed of Special Monthly Compensation (SMC-K) eligibility when loss of use of a creative organ is documented. This benefit is separate from and in addition to your schedular combined rating and must be explicitly claimed and awarded.
- You have the right to a fully reasoned rating decision that explains how your evidence was weighed. If the decision does not clearly address the DC 7520 vs. DC 7521 distinction or SMC-K eligibility, you have the right to request a Higher-Level Review.
- Under the Benefit of the Doubt standard (38 CFR 3.102), when there is an approximate balance of positive and negative evidence, VA must resolve the question in your favor. Ensure the examiner documents all your symptoms even if their severity is uncertain.
Related Conditions
- Erectile Dysfunction (with or without Penile Deformity) Frequently co exists with penile tissue removal. Rated separately under DC 7522 at 0%, but triggers eligibility for Special Monthly Compensation (SMC K) under 38 CFR 3.350(a) for loss of use of a creative organ. Must be claimed and documented separately to receive SMC K.
- Urethral Stricture Disease May develop as a complication of penile surgery due to scarring or disruption of urethral tissue. Presents as obstructive voiding symptoms and may require periodic dilation. Ratable separately under genitourinary diagnostic codes when documented.
- Urinary Incontinence / Voiding Dysfunction Penile tissue removal can alter urinary stream direction and control. Voiding dysfunction including obstructive symptoms, weak stream, hesitancy, frequency, and urinary retention is evaluated as part of the genitourinary DBQ and may support additional or combined genitourinary ratings.
- Neoplasm of the Male Reproductive System (Penile Cancer) Penile cancer is a common cause of penile amputation. If the removal was due to a malignant neoplasm, the underlying cancer may be separately ratable, and active malignancy or treatment related disabilities (radiation, chemotherapy effects) should be addressed in the claim.
- Depression / Adjustment Disorder Secondary to Penile Loss Psychological conditions including major depressive disorder and adjustment disorder frequently develop as secondary conditions following penile tissue loss, erectile dysfunction, and sexual function impairment. These may be claimed as secondary service connected conditions and rated under mental health diagnostic codes.
- Testicular Atrophy or Removal In cases where penile loss occurred in the context of trauma or Fournier's gangrene, testicular damage or removal may be co existing. Rated separately under DC 7523 (testis atrophy) or DC 7524 (removal of one or both testes). Each separately supports SMC K eligibility for loss of a creative organ.
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This C&P exam preparation guide is for educational purposes only and does not constitute legal, medical, or claims advice. Always consult with a qualified Veterans Service Organization (VSO) representative or VA-accredited attorney for guidance specific to your claim. Never exaggerate, minimize, or fabricate symptoms during a C&P examination.