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C&P Exam Prep: Testis, Removal of
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 surgical removal of one or both testes, confirm whether the loss is service-connected, evaluate any residual symptoms or complications, and assess eligibility for Special Monthly Compensation (SMC) under 38 U.S.C. 1114(k) for anatomical loss of a creative organ.
What the examiner evaluates:
- Confirmation that orchiectomy (testis removal) occurred and which side(s) were affected
- The reason for removal (e.g., trauma, infection, cancer, torsion) and whether it is service-related
- Whether the removed testis was undescended or congenitally undeveloped (which is not ratable)
- Status of the remaining testis if unilateral removal - whether it is functioning or absent/nonfunctioning
- Presence of any neoplasm (benign or malignant) requiring separate rating consideration
- Post-surgical treatment history including radiation therapy, chemotherapy, androgen deprivation therapy, or brachytherapy
- Current voiding symptoms including daytime voiding intervals, nocturia, hesitancy, weak/slow stream, post-void residuals
- Erectile dysfunction or penile deformity as a secondary complication
- Scrotal and epididymis examination findings
- Functional impact on daily activities and occupational performance
Exam will include a physical examination of the scrotal area. You will be asked to disrobe from the waist down. The examiner will palpate the remaining testis (if applicable) and examine the surgical site. You have the right to request a same-sex examiner or a chaperone. In most states you have the right to record the examination - notify the examiner at the start.
Typical duration: 20-30 minutes
Testicular Examination - Side Affected
Confirms which testis or testes have been removed; documents the surgical site and absence of testicular tissue
What to expect:
The examiner will visually inspect and palpate the scrotum to confirm absence of the removed testis and document the status of any remaining testis. They will note presence or absence of an implant (prosthetic testis).
Key thresholds:
- Bilateral removal (both testes) — 30% rating under DC 7524; also triggers SMC (k) for loss of creative organ
- Unilateral removal (one testis) - other testis absent or nonfunctioning and unrelated to service — 30% rating per the Note under DC 7524
- Unilateral removal (one testis) - other testis present and functioning — 0% rating under DC 7524; SMC (k) still applies for anatomical loss of one creative organ
Tips:
- Know and state clearly which side was removed (left, right, or both)
- Know the date of surgery and bring operative reports if available
- If a prosthetic testis was implanted, inform the examiner - it does not restore function
- If the remaining testis is atrophied or nonfunctioning for non-service reasons, this can elevate the rating to 30%; bring supporting medical documentation
Pain considerations: If you experience phantom pain, scrotal discomfort, or referred groin pain at the surgical site, describe the frequency, severity, and how it impacts daily activities and work.
Remaining Testis Assessment (if unilateral removal)
Size, consistency, and functional status of the contralateral testis - determines whether the 30% Note under DC 7524 applies
What to expect:
The examiner will palpate the remaining testis and note its size relative to normal, consistency (normal, softer, harder), and any tenderness or abnormality. Atrophy categories include: size 1/3 or less of normal; size 1/2 or less but more than 1/3; complete atrophy.
Key thresholds:
- Remaining testis absent or nonfunctioning (unrelated to service) — Triggers the Note under DC 7524 - unilateral service-connected removal rated at 30%
- Remaining testis present and functioning normally — Unilateral removal rated at 0% under DC 7524 standard schedule
- Complete atrophy of remaining testis (DC 7523) — May warrant separate or combined rating under DC 7523 if bilateral complete atrophy
Tips:
- If you have known hypogonadism, hormone deficiency, or infertility, mention it as evidence of functional impairment of the remaining testis
- Bring lab results (testosterone levels, FSH, LH, semen analysis) if available to document functional status
- Do not assume the examiner has reviewed all your records - proactively state relevant facts
Pain considerations: Describe any chronic orchalgia, aching, or tenderness in the remaining testis, especially after prolonged standing, physical activity, or at worst-day presentation.
Voiding Dysfunction Assessment
Documents urinary symptoms that may be secondary to surgical procedures, radiation, or hormonal changes; maps to rating criteria for voiding conditions rated under 38 CFR 4.115a
What to expect:
The examiner will ask about daytime voiding frequency, nighttime awakenings, stream quality, hesitancy, incomplete emptying, urinary retention, and incontinence. Uroflowmetry (peak flow rate) or post-void residual measurements may be referenced.
Key thresholds:
- Daytime voiding interval less than 1 hour — Supports higher rating tier for voiding dysfunction if separately claimed
- Nighttime awakenings 3-4 times — Supports moderate voiding dysfunction rating
- Nighttime awakenings 5 or more times — Supports severe voiding dysfunction rating
- Post-void residuals greater than 150 cc — Obstructive uropathy indicator; supports higher rating
- Urinary retention requiring catheterization — Supports highest voiding dysfunction rating tier
Tips:
- Keep a 48-72 hour voiding diary before the exam to accurately report frequency
- Report your worst days - not just typical days - for voiding frequency and nighttime awakenings
- Note any episodes requiring emergency catheterization or hospitalization for retention
- If you experience urinary incontinence, specify how many absorbent pads you use per day
Pain considerations: Describe any pain or burning with urination (dysuria), pelvic pressure, or suprapubic discomfort and how these symptoms interfere with sleep and daily function.
Rating Criteria Breakdown
| Rating % | Criteria | Key Symptoms |
|---|---|---|
| 30% | Removal of both testes (bilateral orchiectomy); OR removal of one service-connected testis where the other testis is absent or nonfunctioning due to a cause unrelated to service (per the Note under DC 7524) |
CFR: 38 CFR 4.115b, DC 7524: 'Both - 30%. Note: In cases of the removal of one testis as the result of a service-incurred injury or disease, other than an undescended or congenitally undeveloped testis, with the absence or nonfunctioning of the other testis unrelated to service, an evaluation of 30 percent will be assigned for the service-connected testicular loss.' |
| 0% | Removal of one testis (unilateral orchiectomy) where the other testis is present and functioning normally. Note: A 0% rating still establishes service connection and entitles the veteran to Special Monthly Compensation (SMC-k) for anatomical loss of a creative organ under 38 U.S.C. 1114(k). |
CFR: 38 CFR 4.115b, DC 7524: 'One - 0%'. SMC (k) under 38 U.S.C. 1114(k) and 38 CFR 3.350(a) applies for anatomical loss of a creative organ regardless of the 0% schedular rating. |
30% Removal of both testes (bilateral orchiectomy); OR removal o ...
Removal of both testes (bilateral orchiectomy); OR removal of one service-connected testis where the other testis is absent or nonfunctioning due to a cause unrelated to service (per the Note under DC 7524)
Key Symptoms
- Bilateral absence of testicular tissue confirmed on physical exam
- Documented surgical removal via operative reports or medical records
- Evidence that remaining testis (if unilateral) is absent or nonfunctioning for non-service reasons
- Hypogonadism, testosterone deficiency, or infertility as evidence of complete functional loss
- Hormonal replacement therapy (TRT) as indicator of bilateral functional loss
CFR: 38 CFR 4.115b, DC 7524: 'Both - 30%. Note: In cases of the removal of one testis as the result of a service-incurred injury or disease, other than an undescended or congenitally undeveloped testis, with the absence or nonfunctioning of the other testis unrelated to service, an evaluation of 30 percent will be assigned for the service-connected testicular loss.'
0% Removal of one testis (unilateral orchiectomy) where the oth ...
Removal of one testis (unilateral orchiectomy) where the other testis is present and functioning normally. Note: A 0% rating still establishes service connection and entitles the veteran to Special Monthly Compensation (SMC-k) for anatomical loss of a creative organ under 38 U.S.C. 1114(k).
Key Symptoms
- Unilateral absence of testicular tissue confirmed on physical exam
- Remaining contralateral testis present, normal size, and functional
- No evidence of hypogonadism or infertility attributable to bilateral loss
- Service-connected orchiectomy documented
CFR: 38 CFR 4.115b, DC 7524: 'One - 0%'. SMC (k) under 38 U.S.C. 1114(k) and 38 CFR 3.350(a) applies for anatomical loss of a creative organ regardless of the 0% schedular rating.
How to Describe Your Symptoms
Surgical History and Reason for Removal
How to describe:
State clearly and factually: which testis was removed, the exact date (or approximate date) of surgery, the diagnosis or reason leading to removal (e.g., testicular torsion, epididymo-orchitis, testicular cancer, trauma), and where the surgery was performed - especially if during active duty service or at a military treatment facility.
Worst-day example:
“On [date], I underwent right orchiectomy at [MTF/hospital] because of [testicular torsion/cancer/injury]. The surgery was performed during my active duty service. I was never counseled about fertility preservation beforehand. Since the surgery I have experienced [hormonal symptoms, fertility issues, phantom pain].”
What the examiner listens for:
Service nexus - did this happen during or because of military service? Was the cause a service-incurred disease or injury? Is the removed testis documented as undescended or congenitally undeveloped (which would disqualify the rating)?
Understatements to avoid:
Do not simply say 'I had surgery.' Specify the type of surgery (orchiectomy), which side, and the service connection. Do not omit the reason for removal - it directly impacts nexus determination.
Status of Remaining Testis
How to describe:
If you had unilateral removal, proactively describe the status of your remaining testis. If it has atrophied, is nonfunctioning, or you have been diagnosed with hypogonadism requiring testosterone replacement therapy, state this clearly. Note whether the condition of the remaining testis is related to or separate from your service.
Worst-day example:
“My remaining left testis has atrophied significantly - my urologist documented it as less than one-third normal size. My testosterone levels have been consistently below normal range, and I have been prescribed testosterone replacement therapy. My endocrinologist confirmed this is due to bilateral functional loss.”
What the examiner listens for:
Whether the remaining testis is clinically absent, atrophied, or nonfunctioning - this triggers the Note under DC 7524 and elevates a unilateral removal rating from 0% to 30%. The examiner will document size and consistency on physical exam.
Understatements to avoid:
Do not say 'my other one is fine' if you have not had it formally evaluated. Atrophy can be subtle. Bring recent testosterone lab values and any endocrinology records to support functional impairment claims.
Hormonal and Systemic Symptoms
How to describe:
Describe the full impact of testosterone deficiency or hormonal changes resulting from testicular loss. Be specific: fatigue, loss of libido, mood changes, depression, cognitive difficulties, osteoporosis risk, muscle wasting, weight gain, hot flashes, and need for ongoing hormone replacement therapy.
Worst-day example:
“On my worst days, I am so fatigued I cannot complete basic tasks. I have significant mood swings and depression that my VA psychiatrist has linked to my testosterone deficiency. I require daily testosterone injections/patches. Without them, I cannot function normally at work or at home.”
What the examiner listens for:
Functional impact of hormonal loss on daily life and occupational capacity. Evidence of hypogonadism. Whether these secondary conditions may warrant separate service-connected ratings (e.g., depression secondary to testicular removal, erectile dysfunction under DC 7522).
Understatements to avoid:
Do not minimize hormonal symptoms as unrelated. Hypogonadism secondary to bilateral orchiectomy is a direct and ratable consequence. Do not fail to mention testosterone replacement therapy - it is critical evidence of functional loss.
Erectile Dysfunction
How to describe:
If you experience erectile dysfunction as a result of testicular removal, hormonal changes, or associated surgical/radiation treatment, describe it accurately. Note whether you have been diagnosed with erectile dysfunction by a provider, what treatments you have tried (PDE5 inhibitors, penile injections, vacuum devices, implants), and the impact on your quality of life and relationships.
Worst-day example:
“Since my orchiectomy, I have been unable to achieve or maintain an erection sufficient for sexual intercourse. My urologist diagnosed me with erectile dysfunction secondary to hypogonadism from my bilateral orchiectomy. I have tried testosterone therapy and sildenafil with limited success. This condition has severely impacted my marriage and mental health.”
What the examiner listens for:
Erectile dysfunction is rated separately under DC 7522 at 0% but also qualifies independently for SMC (k) as loss of use of a creative organ. The examiner needs to document this as a secondary condition to ensure it is rated and flagged for SMC consideration.
Understatements to avoid:
Do not assume erectile dysfunction will be addressed without you raising it. It must be specifically claimed and described. Do not say 'it's not as bad as it used to be' - report your worst-day, baseline impairment.
Voiding Dysfunction and Urinary Symptoms
How to describe:
If you have undergone radiation therapy, chemotherapy, or have developed urinary symptoms related to your condition or treatment, describe voiding patterns accurately. Use specific numbers: how many times per day you urinate, how many times you wake at night, stream strength, any hesitancy or incomplete emptying, and any episodes of retention.
Worst-day example:
“On my worst days, I urinate every 45 minutes during the day and wake up 4-5 times at night. My stream is weak and I often feel like I haven't fully emptied. I have had two episodes where I could not urinate at all and needed catheterization in the emergency room.”
What the examiner listens for:
Frequency, nocturia, stream quality, retention, and incontinence mapped to rating criteria for voiding dysfunction. These may support a separate or higher combined rating if attributable to service-connected treatment (e.g., radiation for testicular cancer).
Understatements to avoid:
Do not round down your voiding frequency. If you wake 3-4 times per night on bad nights, say so. Do not omit incontinence episodes out of embarrassment - these directly affect rating tiers.
Psychological and Quality of Life Impact
How to describe:
Testicular removal can have profound psychological effects including depression, anxiety, body image issues, relationship strain, and loss of masculinity or reproductive capacity. Describe these impacts clearly and connect them to your service-connected condition.
Worst-day example:
“The loss of my testis has caused severe depression and anxiety. I feel less of a man. I have withdrawn from intimate relationships and social activities. My VA mental health provider has documented major depressive disorder that I believe is directly connected to my orchiectomy and hormonal changes.”
What the examiner listens for:
Functional impairment beyond the physical rating. Mental health sequelae may support a separate secondary service-connected claim for depression or anxiety. The DBQ functional impact section requires documentation of how each condition limits daily activities.
Understatements to avoid:
Do not say 'I'm coping okay' if you are struggling psychologically. The examiner is required to document functional impact. Understating psychological effects can prevent secondary ratings for mental health conditions.
Common Mistakes to Avoid
Failing to mention that the remaining testis is atrophied or nonfunctioning
Under the Note to DC 7524, if one testis is removed due to service and the other testis is absent or nonfunctioning (even for unrelated reasons), the rating is 30% instead of 0%. Veterans who do not raise this lose out on the higher rating.
Instead: Proactively tell the examiner: 'My remaining testis is atrophied / I have been diagnosed with hypogonadism / I require testosterone replacement therapy.' Bring lab results and specialist records.
Impact: 0% vs. 30%
Not claiming erectile dysfunction as a separate secondary condition
Erectile dysfunction secondary to testicular removal (due to hormonal loss, surgical effects, or radiation) is separately ratable under DC 7522 and also independently qualifies for SMC (k). Many veterans lose this benefit by not explicitly claiming it.
Instead: File a separate claim for erectile dysfunction secondary to your service-connected testicular removal. Describe symptoms at the exam and ensure the examiner documents it as a separate diagnosis.
Impact: SMC (k) eligibility and secondary rating under DC 7522
Failing to claim or mention Special Monthly Compensation (SMC-k)
Even a 0% rating for unilateral testicular removal triggers eligibility for SMC (k) under 38 U.S.C. 1114(k) for anatomical loss of a creative organ. Many veterans do not know this and never receive the additional monthly payment.
Instead: After the exam, ensure your claim includes a request for SMC (k) consideration. Ask your VSO or accredited claims agent to verify it is coded correctly in your rating decision.
Impact: SMC (k) - applies at all rating levels for DC 7524
Describing only typical/good days rather than worst-day symptoms
VA rating criteria are evaluated based on the full severity of the condition, including worst-day presentations. Reporting only average symptom levels can result in a lower rating than the veteran actually deserves.
Instead: Explicitly state: 'On my worst days, [describe maximum severity].' Then describe average days separately if asked. Per M21-1 guidance, the rating should capture the full extent of disability.
Impact: All rating levels
Not bringing documentation of the reason for testicular removal
The examiner must confirm whether the removed testis was undescended or congenitally undeveloped - if so, it is NOT a ratable disability under 38 CFR 4.115b. Having operative reports and service treatment records that document the reason for removal (e.g., torsion, cancer, trauma, infection) is critical.
Instead: Bring surgical operative reports, pathology reports, and service treatment records documenting the diagnosis that led to orchiectomy.
Impact: Service connection and all rating levels
Failing to report secondary symptoms from cancer treatment (radiation, chemotherapy)
If testicular cancer was the reason for removal and the veteran underwent radiation or chemotherapy, these treatments can cause significant secondary conditions (urinary dysfunction, secondary cancers, neuropathy) that may be separately ratable.
Instead: Disclose all treatment received: radiation therapy, chemotherapy, androgen deprivation therapy, brachytherapy. Describe all side effects and secondary conditions. These should be separately claimed.
Impact: Secondary condition ratings; potential 100% during active malignancy treatment under DC 7528
Minimizing infertility or reproductive impact because 'it doesn't affect daily function'
Infertility and reproductive loss are medically significant consequences of testicular removal and are relevant to the overall disability picture, including potential secondary mental health claims and SMC considerations.
Instead: Document infertility formally with a fertility specialist. Describe the emotional and relationship impact. Ensure your mental health provider links any depression or anxiety to the reproductive loss.
Impact: Secondary mental health ratings; functional impact documentation
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 record your C&P examination in most states - inform the examiner at the start of the appointment.
- You have the right to request an in-person physical examination. A records-review or telehealth exam may be insufficient for a genitourinary condition requiring physical examination of the scrotal area.
- You have the right to request a same-sex examiner for a genitourinary physical examination. Notify VA scheduling in advance.
- You have the right to request a chaperone be present during the physical examination.
- You have the right to receive a copy of the completed DBQ and C&P examination report through your claims file or a FOIA request.
- You have the right to submit a rebuttal to a C&P exam that is inaccurate, inadequate, or fails to address your claimed conditions.
- You have the right to request a second opinion or additional examination if the original exam was inadequate.
- You have the right to have your evidence reviewed before the examiner completes the DBQ - ensure your service treatment records and private medical records are in your claims file.
- A 0% schedular rating for unilateral testicular removal still entitles you to Special Monthly Compensation (SMC-k) under 38 U.S.C. 1114(k) for anatomical loss of a creative organ - this is a separate monetary benefit from the disability rating percentage.
- You have the right to have all secondary conditions (erectile dysfunction, hypogonadism, depression, urinary dysfunction) considered and rated separately if they are caused or aggravated by your service-connected testicular removal.
- Testis that was undescended or congenitally undeveloped is explicitly excluded from rating under DC 7524 - if your removal was for a service-incurred disease or injury of an otherwise normal testis, ensure this is clearly documented.
- You have the right to appeal any rating decision you disagree with through the Supplemental Claim, Higher-Level Review, or Board of Veterans' Appeals lanes.
Related Conditions
- Erectile Dysfunction (with or without penile deformity) Common secondary condition following orchiectomy due to hormonal loss (hypogonadism), surgical effects, or radiation therapy. Rated separately under DC 7522 at 0% but also independently qualifies for SMC (k) as loss of use of a creative organ.
- Testis, Atrophy Complete If the remaining testis (after unilateral removal) undergoes complete atrophy, it may be separately rated under DC 7523. Bilateral complete atrophy is rated at 20%; one testis complete atrophy at 0%. Relevant to the Note under DC 7524 for elevating a unilateral removal to 30%.
- Hypogonadism / Testosterone Deficiency Direct consequence of bilateral or functional testicular loss. Supports the 30% Note under DC 7524 and may warrant separate rating consideration. Requires ongoing hormone replacement therapy.
- Neoplasms of the Male Reproductive System (Testicular Cancer) Testicular cancer is a common reason for orchiectomy. Active malignancy or treatment (chemotherapy, radiation) may be rated at 100% under DC 7528 during treatment. After treatment cessation, residuals are rated under the appropriate diagnostic code.
- Depression / Anxiety Secondary to Testicular Removal Psychological sequelae of testicular loss including depression, anxiety, body image disturbance, and relationship impairment are common and may be separately service connected as secondary to DC 7524. Rated under mental health diagnostic codes.
- Voiding Dysfunction / Bladder Conditions Radiation therapy or surgery for testicular cancer can cause urinary symptoms including voiding dysfunction, urethral stricture, or urinary retention. These may be separately rated under 38 CFR 4.115a if caused by service connected treatment.
- Epididymitis, Chronic Chronic epididymitis may be a pre existing or concurrent condition affecting the remaining testis. Rated separately under DC 7525. Relevant to functional status of the remaining testis for purposes of the DC 7524 Note.
- Orchitis, Unilateral or Bilateral (Chronic) Chronic orchitis can be a cause of testicular atrophy or removal and may affect the remaining testis. Relevant to service connection and functional status of remaining testicular tissue.
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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.