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C&P Exam Prep: Penis, Removal of Half or More
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 current anatomical status of the penis following partial or complete penectomy (including glans removal), assess associated urinary and sexual function impairments, identify secondary conditions, and establish or confirm the disability rating under 38 CFR 4.115b DC 7520/7521.
What the examiner evaluates:
- Extent of penile tissue loss (less than half, half or more, or glans only) to assign the correct diagnostic code
- Presence and degree of urinary voiding dysfunction, hesitancy, weak stream, frequency, and retention
- Urinary incontinence severity and absorbent material requirements
- Presence of urethral stricture disease and frequency of dilation required
- Erectile dysfunction and any residual penile deformity
- Any secondary or associated genitourinary conditions (epididymitis, orchitis, prostate conditions)
- Testicular status (atrophy, removal) which may independently qualify for Special Monthly Compensation (SMC-K)
- Overall functional impact of the condition on daily activities and quality of life
- Review of surgical records, operative notes, pathology reports, and prior treatment history
The exam will include a physical examination of the genitalia. Veterans may request a same-sex examiner or a chaperone. In most states, veterans have the right to record the exam with prior notification to VA. The examiner will review service treatment records, private medical records, and any submitted nexus letters before or during the exam.
Typical duration: 20-30 minutes
Penile Anatomical Assessment
Extent of penile tissue loss - whether less than half, half or more of the penile shaft was removed, or whether only the glans was removed - directly determining the applicable diagnostic code and rating
What to expect:
The examiner will visually inspect and document the remaining penile tissue. They will describe the surgical site, residual tissue, and any scarring or deformity. This is the most critical measurement for rating purposes.
Key thresholds:
- Removal of glans only — 20% under DC 7521
- Removal of half or more of the penile shaft (including glans) — 30% under DC 7520
- Complete penectomy (total removal) — Rated under DC 7520 at 30%; may also qualify for SMC-K for loss of use of a creative organ under 38 CFR 3.350(a)
Tips:
- Know your surgical operative report and be prepared to describe the extent of tissue removed if asked
- Bring documentation (operative reports, pathology) clearly stating whether the glans and/or half or more of the shaft was removed
- If you have experienced additional tissue loss from radiation necrosis or secondary surgery, mention this clearly
Pain considerations: Describe any phantom pain, scar sensitivity, or discomfort at the surgical site accurately and specifically
Urinary Voiding Assessment (Symptom-Based)
Daytime voiding frequency intervals, nighttime awakenings to void, stream characteristics (weak, slow, hesitancy, decreased force), and presence of obstructive symptoms - all of which affect the overall genitourinary rating and may support a separate or combined rating
What to expect:
The examiner will ask detailed questions about your urinary habits. They may review recent uroflowmetry results or order urinary studies. Key thresholds: daytime voiding intervals less than 1 hour, 1-2 hours, or 2-3 hours; nighttime awakenings of 2, 3-4, or 5+ times.
Key thresholds:
- Daytime voiding interval less than 1 hour — Supports higher rating for associated voiding dysfunction under relevant DC
- Nighttime awakenings 5 or more times — Supports higher combined genitourinary rating
- Uroflowmetry peak flow rate less than 10 cc/sec — Supports obstructive voiding dysfunction rating
- Post-void residuals greater than 150 cc — Supports rating for urinary retention
- Urinary retention requiring continuous catheterization — Supports maximum rating for voiding dysfunction
Tips:
- Keep a voiding diary for 3-7 days before the exam recording time, volume, urgency, and nocturia episodes
- Report your worst typical day, not your best day
- Mention if you have had any urinary tract infections secondary to obstruction or catheterization
Pain considerations: Report any pain or burning with urination, pelvic discomfort, or perineal pain that accompanies voiding dysfunction
Urinary Incontinence Assessment
Whether urinary leakage requires absorbent material, the frequency of pad changes needed per day, and whether an external collection device or appliance is used - directly affecting the incontinence-related rating
What to expect:
Examiner will ask how many pads or absorbent materials you use per day and whether you use any urinary appliance. They will document whether incontinence does not require absorbent material, requires pads changed less than 2 times/day, 2-4 times/day, or more than 4 times/day.
Key thresholds:
- Does not require absorbent material — Lower rating for incontinence component
- Absorbent material changed 2-4 times daily — Moderate rating for incontinence
- Absorbent material changed more than 4 times daily — Higher rating for incontinence
Tips:
- Count the actual number of pads you use on a bad day, not an average day
- Mention any appliance or external catheter you use
- Note whether incontinence is stress, urge, or mixed in character
Pain considerations: Report any skin breakdown, rash, or wound care issues related to chronic incontinence
Urethral Stricture and Obstruction Evaluation
Presence of urethral stricture disease, frequency of dilation required, and severity of obstructive symptomatology - critical for assigning the urethral stricture diagnostic code if applicable as a secondary or combined condition
What to expect:
Examiner will ask about history of urethral stricture, frequency of urologic dilation procedures, and whether you require periodic or continuous dilation. Uroflowmetry or cystoscopy records may be reviewed.
Key thresholds:
- Stricture requiring dilation 1-2 times per year — Lower stricture rating
- Stricture requiring dilation every 2 to 3 months — Moderate stricture rating
- Recurrent UTIs secondary to obstruction or continuous catheterization required — Higher stricture or combined rating
Tips:
- Bring procedure logs or urology visit records documenting dilation frequency
- Note how long the stricture has been present and its progression over time
- Report how the stricture affects daily activities, work, and sleep
Pain considerations: Describe any pain during or after dilation procedures and any ongoing urethral discomfort
Rating Criteria Breakdown
| Rating % | Criteria | Key Symptoms |
|---|---|---|
| 30% | Removal of half or more of the penile shaft (DC 7520). This includes partial penectomy where at least half of the penile length has been surgically excised. Complete penectomy also falls under this code. The rating is anatomically based on the extent of surgical loss confirmed by operative reports. |
CFR: 38 CFR 4.115b DC 7520: Penis, removal of half or more - 30 percent. Additionally, anatomical loss of the penis (creative organ) may independently qualify the veteran for Special Monthly Compensation under 38 U.S.C. 1114(k) and 38 CFR 3.350(a), regardless of the combined disability percentage. |
| 20% | Removal of the glans penis only (DC 7521). The penile shaft remains intact but the glans (head of the penis) has been surgically removed. This is the anatomical criterion; no functional threshold is required beyond the verified surgical loss. |
CFR: 38 CFR 4.115b DC 7521: Penis, removal of glans - 20 percent. The rating is anatomically based; the confirmed removal of the glans is sufficient to meet criteria. |
30% Removal of half or more of the penile shaft (DC 7520). This ...
Removal of half or more of the penile shaft (DC 7520). This includes partial penectomy where at least half of the penile length has been surgically excised. Complete penectomy also falls under this code. The rating is anatomically based on the extent of surgical loss confirmed by operative reports.
Key Symptoms
- Documented partial or complete penectomy with removal of half or more of the penile shaft
- Significant alteration or inability to direct urinary stream without assistance
- Complete or near-complete erectile dysfunction
- Inability to engage in penetrative sexual intercourse
- Major psychological impact: PTSD, depression, relationship disruption, identity disturbance
- Voiding dysfunction including urinary stricture at the surgical site
- Need for urinary appliance or perineal urethrostomy
CFR: 38 CFR 4.115b DC 7520: Penis, removal of half or more - 30 percent. Additionally, anatomical loss of the penis (creative organ) may independently qualify the veteran for Special Monthly Compensation under 38 U.S.C. 1114(k) and 38 CFR 3.350(a), regardless of the combined disability percentage.
20% Removal of the glans penis only (DC 7521). The penile shaft ...
Removal of the glans penis only (DC 7521). The penile shaft remains intact but the glans (head of the penis) has been surgically removed. This is the anatomical criterion; no functional threshold is required beyond the verified surgical loss.
Key Symptoms
- Documented surgical or traumatic removal of glans penis
- Alteration in urinary stream direction or force due to meatal changes
- Sexual dysfunction secondary to glans removal
- Phantom sensation or scar pain at surgical site
- Psychological impact including depression, anxiety, or relationship difficulties
CFR: 38 CFR 4.115b DC 7521: Penis, removal of glans - 20 percent. The rating is anatomically based; the confirmed removal of the glans is sufficient to meet criteria.
How to Describe Your Symptoms
Anatomical Loss and Physical Findings
How to describe:
State clearly and factually the extent of penile tissue removed, citing your operative report. Example: 'My surgeon removed approximately two-thirds of my penile shaft during a partial penectomy on [date] due to [service-connected cause]. My operative report confirms removal of half or more of the penis.' Bring the actual operative report and any pathology reports to the exam.
Worst-day example:
“On my worst days, the surgical scar is tender to the touch, the altered anatomy makes it difficult to control my urinary stream without sitting down, and I experience significant distress when I attempt to engage in any intimate activity.”
What the examiner listens for:
Confirmation that the surgical removal meets the anatomical threshold (half or more, or glans only) for the applicable diagnostic code; any secondary complications at the surgical site such as stricture, fistula, or wound breakdown.
Understatements to avoid:
Do not say 'the surgery went well and everything is fine now.' Even a technically successful surgery results in a permanent anatomical loss that is ratable regardless of healing outcome. Report all residual symptoms and functional changes honestly.
Urinary Voiding Dysfunction
How to describe:
Describe your urinary symptoms in terms of frequency (how often per hour during the day), nocturia (how many times you wake at night to urinate), stream quality (weak, intermittent, spraying, requiring sitting), and any retention episodes. Use specific numbers: 'I urinate every 45 minutes during the day and wake up 3-4 times per night.'
Worst-day example:
“On my worst days I urinate every 30-45 minutes, wake up 4 to 5 times at night, and have such a weak and misdirected stream that I must sit down to urinate and still experience leakage onto clothing. I use 3-4 absorbent pads per day.”
What the examiner listens for:
Specific voiding intervals to check the appropriate frequency boxes on the DBQ; whether a catheter is required; uroflowmetry data confirming peak flow rates; post-void residual volumes indicating retention.
Understatements to avoid:
Do not say 'I have some trouble urinating' without specifics. Vague answers prevent the examiner from checking the correct rating-relevant boxes. Quantify everything: pads per day, awakenings per night, minutes between voids.
Urinary Incontinence
How to describe:
Describe exactly how many absorbent pads or protective garments you use per day and whether you use any external collection device. Indicate whether incontinence is constant, occurs with activity, or is unpredictable. Example: 'I use 3 to 4 adult incontinence pads daily that are soaked and must be changed. I also use an external condom catheter at night.'
Worst-day example:
“On my worst days, I change soaked pads 5 or more times, experience leakage with any physical activity including walking, and have had to leave work or social situations due to embarrassing leakage episodes.”
What the examiner listens for:
Whether absorbent material is required at all, the frequency of pad changes (less than 2, 2-4, or more than 4 times daily), and use of any appliance - all of which correspond to specific DBQ checkboxes tied to rating levels.
Understatements to avoid:
Do not minimize incontinence by saying 'just occasional leakage.' If you use pads daily, specify the number. If you have stopped certain activities because of incontinence, say so explicitly.
Sexual Dysfunction and Erectile Dysfunction
How to describe:
Describe the complete inability or significant impairment of sexual function resulting from the penile loss. If you have erectile dysfunction, loss of sensation, or inability to engage in intercourse, state this directly. Example: 'Following my partial penectomy, I have complete erectile dysfunction and am unable to engage in sexual intercourse. This has severely impacted my marriage and emotional well-being.'
Worst-day example:
“I have had no sexual function since my surgery. I cannot achieve an erection, and the psychological impact has caused me to withdraw from intimate relationships entirely. I have been treated for depression directly related to this loss.”
What the examiner listens for:
Confirmation of erectile dysfunction for potential rating under DC 7522 (impotency) or DC 7522 as a secondary condition; any penile deformity noted; psychological sequelae that may support a separate mental health claim; whether the veteran is already service-connected for erectile dysfunction.
Understatements to avoid:
Do not omit sexual dysfunction because it feels uncomfortable to discuss. It is directly relevant to rating and to potential SMC-K entitlement. If you have a service-connected mental health condition secondary to penile loss, mention it.
Psychological and Functional Impact
How to describe:
Describe how the condition affects your ability to work, maintain relationships, perform activities of daily living, and participate in social activities. Use specific examples: 'I had to change careers because my voiding dysfunction requires me to be near a restroom at all times. I cannot take long trips or sit in meetings. My marriage has been severely strained.'
Worst-day example:
“On my worst days I am unable to leave the house due to incontinence and shame. I experience significant depression, avoid social situations, and have difficulty maintaining employment due to the need for frequent bathroom breaks and the psychological burden of this condition.”
What the examiner listens for:
Functional limitations that support both the genitourinary rating and potential secondary service-connected mental health conditions (PTSD, depression, adjustment disorder) which may be ratable separately under 38 CFR 4.130.
Understatements to avoid:
Do not say 'I manage okay.' If the condition limits your daily life, be specific about which activities are affected, how often, and to what degree. The DBQ specifically asks about functional impact.
Special Monthly Compensation (SMC-K) Awareness
How to describe:
While you do not need to claim SMC directly, be aware that anatomical loss of the penis (a creative organ) entitles veterans to SMC under 38 U.S.C. 1114(k) and 38 CFR 3.350(a) in addition to the schedular rating. The examiner's documentation of anatomical loss triggers this entitlement automatically in adjudication. Ensure the examiner documents the anatomical loss clearly.
Worst-day example:
“N/A - SMC-K is triggered by the confirmed anatomical loss itself, not by symptom severity. Ensure the examiner explicitly checks the appropriate anatomical loss boxes on the DBQ.”
What the examiner listens for:
Anatomical loss confirmed through physical exam and surgical records, which the rating authority will use to award SMC-K independently of the combined disability percentage.
Understatements to avoid:
Do not assume the VA will automatically connect SMC-K to your claim without clear documentation. Confirm with the examiner that the anatomical loss of the creative organ is explicitly documented in the DBQ narrative.
Common Mistakes to Avoid
Failing to bring operative reports documenting the extent of penile tissue removed
The rating under DC 7520 vs. DC 7521 depends entirely on whether half or more of the penile shaft was removed versus glans only. Without operative documentation, the examiner may default to the less favorable code.
Instead: Obtain your operative report, discharge summary, and pathology report prior to the exam. Highlight the language describing the extent of resection. Submit these to your VA claims file before the exam date.
Impact: 20% vs. 30%
Reporting only average urinary symptoms rather than worst-day symptoms
VA rating criteria under M21-1 guidance recognize that disability should be evaluated based on the full range of symptoms including worst-day presentation, not only on good days. Underreporting leads to underrating.
Instead: Keep a 7-day voiding diary before the exam. Report your worst typical week, not your best day. Explicitly say 'On my worst days...' when describing symptoms to the examiner.
Impact: All rating levels for associated voiding dysfunction
Not mentioning erectile dysfunction or sexual dysfunction
Erectile dysfunction following penile surgery may be separately ratable under DC 7522 (impotency) and independently qualifies for SMC-K for loss of use of a creative organ under 38 CFR 3.350(a). Omitting this leaves a compensable benefit on the table.
Instead: Explicitly report all sexual dysfunction including inability to achieve or maintain erection, loss of sensation, and inability to engage in intercourse. Ensure the examiner documents this on the DBQ.
Impact: SMC-K entitlement; separate DC 7522 rating
Failing to mention psychological sequelae such as depression or PTSD secondary to penile loss
Depression, PTSD, and adjustment disorder secondary to traumatic genitourinary injury or penile amputation may be separately ratable under 38 CFR 4.130 and may increase the combined evaluation significantly.
Instead: Tell the examiner about any mental health treatment you have received since the injury or surgery. If you have not been evaluated for mental health conditions, discuss this with your VSO and consider filing a secondary mental health claim.
Impact: Overall combined evaluation; potential for higher combined rating
Minimizing urinary incontinence by not quantifying pad usage
The DBQ contains specific checkboxes for pad change frequency (less than 2/day, 2-4/day, more than 4/day). Vague answers like 'some leakage' do not allow the examiner to check the appropriate box, resulting in a lower or uncaptured rating.
Instead: Count your actual daily pad usage for one week before the exam. State the number explicitly to the examiner: 'I use X pads per day on average, and on bad days I use Y pads.'
Impact: Incontinence-related rating component
Not requesting exam recording in states where permitted
Exam recordings provide an accurate record if the DBQ contains errors or omits reported symptoms. Without a recording, disputing an inadequate exam is significantly harder.
Instead: Check your state's laws on recording. In most states, you may record a C&P exam with prior notification. Notify the examiner at the start of the exam that you intend to record for your personal records.
Impact: All rating levels - protects accuracy of exam documentation
Assuming the VA will automatically award SMC-K without explicit documentation on the DBQ
SMC-K for loss of use of a creative organ is a separate benefit requiring specific adjudication. If the DBQ does not clearly document anatomical loss of the penis, the rating authority may not trigger SMC-K review.
Instead: Confirm with the examiner that the anatomical loss is explicitly documented. After the exam, request a copy of the completed DBQ and review it for accuracy. If the anatomical loss is not clearly noted, submit a buddy statement or obtain a private medical opinion confirming it.
Impact: SMC-K entitlement (separate from schedular 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 genitourinary examinations. Contact the scheduling facility in advance to make this request.
- In most states, you have the right to record your C&P exam for personal records. Check your state's laws and notify the examiner and facility before recording. Do not record covertly.
- You have the right to review and obtain a copy of the completed DBQ after your examination. Request it from the VA or contracted exam vendor (QTC, LHI, VES).
- You have the right to submit a personal statement (VA Form 21-4138) correcting inaccuracies or omissions in the DBQ after the exam.
- You have the right to submit private medical opinions and independent medical examinations as evidence, including nexus letters from private urologists.
- You have the right to request a new or additional C&P exam if the original exam was inadequate, incomplete, or failed to address all claimed conditions. This may be requested during the appeal process.
- You have the right to a chaperone during any physical examination. You may bring a VSO representative, spouse, or support person to the waiting area, though exam room presence may be limited to medical personnel unless you specifically request a chaperone.
- You are entitled to Special Monthly Compensation (SMC-K) under 38 U.S.C. 1114(k) and 38 CFR 3.350(a) for anatomical loss of a creative organ (penis or testes). This is a separate benefit paid in addition to your combined schedular rating and does not require a separate claim beyond the service connection for the underlying condition.
- You have the right to a thorough, contemporaneous examination. The examiner must review all submitted evidence including private medical records, service treatment records, and any personal statements before or during the exam.
- You have the right to appeal a rating decision you believe is incorrect, including through a Supplemental Claim, Higher-Level Review, or Board of Veterans' Appeals appeal within one year of the rating decision.
Related Conditions
- Erectile Dysfunction (Impotency Without Penile Deformity) Commonly occurs as a direct result of partial or complete penectomy. May be separately ratable under DC 7522 at 0% schedular but independently qualifies for SMC K under 38 CFR 3.350(a) for loss of use of a creative organ.
- Urethral Stricture Frequently develops as a complication of penile surgery, radiation, or trauma. Rated separately under DC 7509 based on frequency of required dilation and severity of obstructive symptoms. May combine with the penile loss rating.
- Urinary Incontinence May develop or worsen following penile surgery, particularly when the urethra is involved. Rated under voiding dysfunction criteria based on pad usage and retention severity. Documents on the same DBQ form.
- Testis, Removal (Bilateral or Unilateral) Removal of one or both testes may accompany penile cancer surgery or trauma. Rated separately under DC 7524 (bilateral: 30%; unilateral: 0% schedular but may qualify for SMC K). Both conditions may independently support SMC K entitlement.
- PTSD Secondary to Genitourinary Trauma Traumatic penile injury, whether from combat, MST, or other service connected causes, frequently causes or exacerbates PTSD. May be claimed as a secondary service connected condition ratable under 38 CFR 4.130 DC 9411.
- Major Depressive Disorder Secondary to Penile Loss Depression is a common and well documented sequela of penile amputation. If not already service connected, may be filed as a secondary condition under 38 CFR 3.310. Rated under 38 CFR 4.130 DC 9434.
- Neoplasms of the Male Reproductive System (Penile Cancer) Penile cancer is a common cause of partial or total penectomy. During active treatment, rated at 100% under DC 7528 for a minimum of six months following cessation of treatment. After treatment completion, rated based on residuals under DC 7520/7521.
- Prostate Gland Conditions (Post-Prostatectomy) Prostate surgery may co occur with or precede penile conditions and shares the same DBQ form. Incontinence and erectile dysfunction from prostatectomy are evaluated on the same form and may create overlapping symptom documentation.
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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.