Kidney Cancer

Kidney cancer is rated under 38 CFR § 4.115b, Diagnostic Code 7528, malignant neoplasms of the genitourinary system. Active malignancy is 100 percent. That part is uncontroversial.

The service-connection side is where the published guidance goes wrong. Kidney cancer has three presumptive routes, not one. The PACT Act route is statutory and lives in 38 U.S.C. § 1120, not in the fine-particulate-matter regulation most guides cite. Kidney cancer sits on the radiation-exposed veteran list too, reaching it indirectly in a way that is easy to miss reading the list itself. And kidney cancer is named on the Camp Lejeune contaminated-water list. I have not found a single result covering all three routes correctly.

TL;DR

• DC 7528 assigns 100 percent for a malignant genitourinary neoplasm, including renal cell carcinoma.
• The 100 percent continues past the end of treatment, with a mandatory VA examination at the expiration of six months.
• Any change from that examination is subject to 38 CFR § 3.105(e).
• With no local recurrence or metastasis, VA rates residuals as voiding dysfunction or renal dysfunction, whichever is predominant.
• Renal dysfunction is scored on glomerular filtration rate (GFR) bands, each requiring three consecutive months during the past twelve.
• The PACT Act presumption is 38 U.S.C. § 1120(b)(2)(G), with covered-veteran eligibility from § 1119(c).
• Kidney cancer is not listed in 38 CFR § 3.320, § 3.320a, or § 3.320b. Citing those sections for kidney cancer is an error.
• Kidney cancer also qualifies under 38 CFR § 3.309(d) as cancer of the urinary tract, which the section defines to include the kidneys.
• Kidney cancer is on the Camp Lejeune list at § 3.309(f) for veterans with at least 30 days of service there between August 1, 1953 and December 31, 1987.

The 100 Percent and the Six-Month Conversion

DC 7528 covers malignant neoplasms of the genitourinary system as a group, so prostate, bladder, kidney, and testicular cancer all share the code. Its note controls the timing:

Following the cessation of surgical, X-ray, antineoplastic chemotherapy or other therapeutic procedure, the rating of 100 percent shall continue with a mandatory VA examination at the expiration of six months. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of § 3.105(e) of this chapter. If there has been no local reoccurrence or metastasis, rate on residuals as voiding dysfunction or renal dysfunction, whichever is predominant.

The 100 percent runs through treatment and for six months after treatment stops. The examination that ends it is mandatory. And the reduction that follows is a proposed reduction under § 3.105(e), which means VA must give you notice and an opportunity to respond before it takes effect.

Voiding or Renal, Whichever Is Predominant

The residual choice is the reason two Board decisions on the same diagnosis can produce a 0 percent and a 30 percent. VA picks one framework, the one producing the predominant disability, and rates under it. It does not add them together.

Renal dysfunction is scored on GFR in 38 CFR § 4.115a:

• 100 percent. Chronic kidney disease with GFR less than 15 mL/min/1.73 m2 for at least three consecutive months during the past twelve; or requiring regular routine dialysis; or an eligible kidney transplant recipient.
• 80 percent. GFR from 15 to 29 for at least three consecutive months during the past twelve.
• 60 percent. GFR from 30 to 44 on the same three-month basis.
• 30 percent. GFR from 45 to 59 on the same three-month basis.
• 0 percent. GFR from 60 to 89 combined with recurrent casts, structural kidney abnormalities, or an albumin/creatinine ratio of 30 mg/g or higher, each on the same three-month basis.

Two features of these criteria matter in practice. The bands require persistence, not a single reading, so one bad lab draw does not establish a rating and one good one does not defeat it. And estimated GFR calculated by a medical professional is accepted for evaluation purposes under the note to this section.

Voiding dysfunction is rated as urine leakage, urinary frequency, or obstructed voiding, whichever fits the condition. Continual leakage requiring absorbent materials changed more than four times per day is 60 percent, two to four times per day is 40 percent, and less than twice per day is 20 percent. Urinary frequency runs 40, 20, and 10 percent by daytime voiding interval and nighttime awakenings. Obstructed voiding reaches 30 percent for urinary retention requiring catheterization.

After a nephrectomy, the remaining kidney usually compensates, and GFR often stays in a band that produces a low or noncompensable evaluation. That result surprises veterans, but it is what the criteria measure. If the voiding side of the picture is worse, say so and make sure the examiner evaluates both.

Presumptive Route One: The PACT Act Statute

Kidney cancer is a specified disease under 38 U.S.C. § 1120(b)(2)(G). Under § 1120(a), a specified disease becoming manifest in a covered veteran is considered incurred in or aggravated by service, notwithstanding the absence of any record of it during service, subject to the rebuttal provisions of § 1113.

Section 1120(c) takes the definition of "covered veteran" from 38 U.S.C. § 1119(c), which identifies the qualifying locations, airspace, and service periods.

This is the citation that most published guidance gets wrong. Kidney cancer is not in 38 CFR § 3.320, which lists asthma, rhinitis, sinusitis, and nine rare cancers of the larynx, trachea, and lung. It is not in § 3.320a, which covers urinary bladder and ureter cancer. It is not in § 3.320b, which covers leukemias, multiple myelomas, myelodysplastic syndromes, and myelofibrosis. If a decision or a guide cites one of those sections for kidney cancer, the citation is wrong even when the outcome happens to be right.

The presumption addresses nexus only. It does not set a percentage and it does not remove the need for a pathology-confirmed diagnosis.

Presumptive Route Two: Radiation-Exposed Service

This route is easy to miss because kidney cancer is not named on the list. Section 3.309(d)(2)(xv) lists "Cancer of the urinary tract," and the note to that section resolves it:

For the purposes of this section, the term "urinary tract" means the kidneys, renal pelves, ureters, urinary bladder, and urethra.

So kidney cancer is on the radiation-exposed veteran presumptive list. If you participated in a radiation-risk activity as defined at § 3.309(d)(3), the disease is presumed service connected subject to § 3.307, with no dose reconstruction and no nexus opinion required.

Radiation-risk activity is narrowly defined. It covers onsite participation in a test involving the atmospheric detonation of a nuclear device, the occupation of Hiroshima or Nagasaki by United States forces between August 6, 1945 and July 1, 1946, comparable prisoner-of-war internment in Japan during World War II, certain qualifying service at named gaseous diffusion plants, service on Amchitka Island, Alaska before January 1, 1974 involving exposure from the underground nuclear tests there, certain service that would qualify a Department of Energy employee for the Special Exposure Cohort, the Enewetak Atoll cleanup from 1977 through 1980, and the response efforts after the nuclear weapons accidents near Palomares, Spain (1966 to 1967) and Thule Air Force Base, Greenland (1968).

For ionizing radiation exposure that does not meet that definition, kidney cancer is separately listed as a radiogenic disease at 38 CFR § 3.311(b)(2)(xii). Under that section VA must obtain a dose estimate and refer the claim for a causation opinion. Skipping that development is a procedural error.

Presumptive Route Three: Camp Lejeune

Kidney cancer is listed in 38 CFR § 3.309(f) as a disease associated with contaminants in the Camp Lejeune water supply. Under 38 CFR § 3.307(a)(7), a veteran, former reservist, or former National Guard member with no less than 30 days of service at Camp Lejeune (consecutive or not) between August 1, 1953 and December 31, 1987 is presumed exposed, unless affirmative evidence shows otherwise. As with the other routes, the presumption addresses the connection to service; it does not set the percentage.

Direct Service Connection

Where no presumption applies, 38 CFR § 3.303 governs. That route needs a pathology-confirmed diagnosis, a documented in-service disease, event, or exposure, and competent medical evidence linking them.

Document the exposure history concretely: duty location, dates, the substance involved, and the available service records. Camp Lejeune service is covered by the presumption above; for other installations with documented contaminated water supplies, check the current eligibility rules for the specific installation and period rather than assuming coverage.

Do not let a nexus opinion assert that an industrial chemical caused this veteran's cancer without addressing timing, dose, cell type, and competing risk factors. An opinion that skips those is easy for a reviewer to discount.

Common Failure Modes

• Citing 38 CFR § 3.320 for a cancer that section does not list.
• Missing the § 3.309(d) radiation route because "kidney cancer" does not appear on the list by name.
• Treating the PACT Act presumption as if it sets the percentage.
• Missing the mandatory six-month examination after treatment ends.
• Accepting a reduction that did not follow § 3.105(e).
• Submitting a single GFR value instead of a three-month pattern.
• Being rated on renal dysfunction when voiding dysfunction is the predominant problem, or the reverse.
• Letting VA skip the § 3.311 dose estimate when § 3.309(d) does not apply.

Bottom Line

The rating side of kidney cancer is straightforward: 100 percent while active, a mandatory examination at six months, then voiding or renal dysfunction, whichever is predominant, with renal scored on GFR bands that require three months of persistence. The service-connection side is where claims are won and lost. Check all three presumptive routes before falling back on a direct nexus opinion, and cite the statute rather than the fine-particulate-matter regulation when you claim the PACT Act lane.

Related Conditions and Tools

Compare kidney disease, kidney stones, bladder cancer, and prostate cancer, which shares DC 7528. Review DC 7528 and organize pathology, imaging, and lab records with the Statement Builder and the Evidence Checklists.

Legal sources: 38 CFR § 4.115a, § 4.115b, § 3.307, § 3.309, § 3.311, § 3.320, § 3.105, § 3.303, and 38 U.S.C. §§ 1119 and 1120, checked against the eCFR snapshot for August 14, 2026.