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Federal Register / Vol. 86, No. 187 / Thursday, September 30, 2021 / Rules and Regulations
significant bend to the penis, erection problems, shortening of the penis, pain with or without erection, and mental health disorders due to stress and anxiety. The commenter indicated that the severity of the overall impact of Peyronies disease on male veterans is evidenced by the prevalence of mental health disorders associated with it. The commenter expressed an opinion that the functional impairment due to Peyronies disease affects veterans ability to function under the ordinary conditions of life and work.
Additionally, the commenter stated that, though disabilities relating to creative organs may not affect earning capacity directly, they impact non-economic factors such as personal inconvenience, social inadaptability, or psychological factors. The commenter proposed the addition of a diagnostic code and specific rating criteria for Peyronies disease, including penile deformity and pain.
Moreover, two commenters asked VA
to provide a rationale for its decision to exclude Peyronies disease from ratable conditions. The commenters expressed concern that Peyronies disease may be caused by trauma as a result of an inservice injury and, in some cases, prevent a veteran from having sexual intercourse or make it difficult to get or maintain an erection.
Peyronies disease is typically associated with painful erections or intercourse or a curve in the penis that prevents sexual intercourse. According to the NIH, and based on studies of men who reported having symptoms of Peyronies disease, researchers estimate that Peyronies disease affects more than one in 10 men. Penile Curvature Peyronies Disease, National Institute of Diabetes and Digestive and Kidney Diseases NIDDK, NIH, https
www.niddk.nih.gov/health-information/
urologic-diseases/penile-curvaturepeyronies-disease last viewed May 15, 2020. The etiology of Peyronies disease remains partially understood. More recently, Peyronies disease has been thought to result from vascular trauma or injury to the penis that causes scarring and deformity of the penis.
Lizza et al., Peyronies Disease, Medscape 2018, https emedicine.
medscape.com/article/456574overviewa7 last visited May 15, 2020.
VA agrees with the commenters that penile trauma as a result of an in-service injury should be recognized under DC
7522. Accordingly, VA in this final rule is adding a note under DC 7522 to clarify how rating personnel should evaluate disabling effects of penile trauma or disease, to include Peyronies disease. The note states that, for the
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purpose of VA disability evaluation, a disease or traumatic injury of the penis resulting in scarring or deformity shall be rated under DC 7522. With this clarification, VA ensures that a traumatic injury or disease of the penis will be recognized by the VASRD. VA
would review any mental health disorders associated with erectile dysfunction or Peyronies disease under 38 CFR 4.125, 4.126, and 4.130.
Furthermore, DC 7522s footnote regarding consideration of special monthly compensation for loss of use of a creative organ, where warranted, will apply for both erectile dysfunction or Peyronies disease.
Nevertheless, as noted in the preamble to the proposed rule, VA
provides disability compensation for conditions based on the average impairment of earning capacity pursuant to 38 U.S.C. 1155. Erectile dysfunction, with or without penile deformity, is not associated directly with reductions in earning capacity, which is why VA proposed to provide a noncompensable evaluation for erectile dysfunction under DC 7522.
Similarly, the potentially painful erections and intercourse associated with Peyronies disease do not, on average, impair earning capacity at a compensable level. To the extent these conditions impact social or psychological factors, VA has a variety of mental health and counseling services available for service-connected veterans. But the law specifically links disability compensation to impairment of earning capacity. 38 U.S.C. 1155. VA
thanks the commenters for their input.
IV. Comments Regarding Diagnostic Code 7542
One commenter expressed concern with VAs proposal to rate neurogenic bladder as voiding dysfunction or urinary tract infection, whichever is predominant. The commenter asserted that VA would fail to adequately compensate a veteran who suffers from both effects. Historically, 38 CFR 4.115a has recognized that diseases of the genitourinary system generally result in disabilities related to renal or voiding dysfunctions, infections, or a combination of these. Further, 4.115a directs rating personnel to evaluate such disabilities on the predominant area of dysfunction. VAs proposal for DC
7542 to evaluate neurogenic bladder conditions based on voiding dysfunction or urinary tract infection mirrors the instructions in 4.115a, which instruct that only the predominant area of dysfunction shall be considered when evaluating genitourinary conditions. Moreover,
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4.14 directs that the evaluation of the same disability under various diagnoses is to be avoided. Both urinary tract infections and voiding dysfunctions affect urinary tract functioning, specifically, urination. Consequently, these dysfunctions do not lend themselves to distinct and separate disability evaluations without violating the fundamental principle relating to pyramiding as outlined in 4.14. VA
declines to make any changes based on this comment.
V. Comments Regarding Diagnostic Code 7543
One commenter expressed concern that the noncompensable disability rating for varicocele and hydrocele under proposed DC 7543 does not provide proper compensation for individuals with severe cases of varicocele or hydrocele that result in acute pain during walking or driving.
The commenter suggested a 10 percent disability rating for such severe cases of varicocele or hydrocele. However, the evidence indicates that varicoceles are often asymptomatic and hydroceles are usually painless and disappear without treatment. See Junnile, J. and Lassen, P., Testicular Masses, 574 Am Fam Physician 685692 1998, available at https www.aafp.org/afp/1998/0215/
p685.html last viewed May 15, 2020.
While these conditions may cause a decrease in fertility, or the existence of infertility, neither cause a reduction in earning capacity that would warrant a compensable rating. However, where varicocele or hydrocele causes pain that necessitates surgery, a rating under an appropriate diagnostic code may be available for post-surgery residuals.
Also, in any instance in which a veteran has loss of use of a creative organ due to a service-connected condition, VA
provides special monthly compensation for this functional loss. See 38 CFR
3.350a. VA makes no changes based on these comments.
VI. Comments Beyond the Scope of This Rulemaking One commenter stated that many combat veterans are unknowingly and silently enduring cold injury kidney dysfunction, and VA neglected to notify 1.7 million combat veterans of the longterm sequelae of warm water immersion foot injuries. These aspects of the comment relate to notice and education for veterans, not the rating criteria used in the evaluation of service-connected genitourinary conditions. Therefore, these issues are not within the scope of this rulemaking. VA makes no changes based on these comments.

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