DC 7523 · 38 CFR 4.115b
Testis, Atrophy, Complete C&P Exam Prep
To document the severity of complete testicular atrophy affecting one or both testes, establish the degree of atrophy through physical examination, and assess any associated symptoms or secondary conditions for VA disability rating purposes under DC 7523.
- Format:
- Interview + Physical
- Typical duration:
- 20-30 minutes
- DBQ form:
- Male_Reproductive_Organ (Male_Reproductive_Organ)
- Examiner:
- Urologist or Physician
What the examiner evaluates
- Physical size of each testis compared to normal (complete atrophy defined as 1/3 or less of normal size)
- Consistency and texture of testicular tissue (softness or hardness relative to contralateral side)
- Presence of tenderness on palpation
- Whether atrophy affects one testis or both testes
- Associated epididymal abnormalities
- Presence of any urinary voiding dysfunction or obstructive symptoms
- Hormonal or functional consequences such as erectile dysfunction
- Etiology of atrophy (infection, trauma, radiation, congenital, unknown)
- Treatment history including medications, surgeries, or hormonal therapy
- Impact on daily functioning and quality of life
The exam will include a structured interview about your history and symptoms followed by a physical examination of the scrotum and testes. You will be required to disrobe from the waist down for the physical portion. 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 before the exam begins.
Measurements and tests
Testicular Size Assessment (Palpation)
What it measures: The physical volume of each testis compared to what is considered normal size, determining whether atrophy is complete (1/3 or less of normal), moderate (1/2 or less but more than 1/3 of normal), or mild.
What to expect: The examiner will manually palpate each testis and compare size bilaterally. They may use an orchidometer (a set of reference ellipsoids) to estimate volume. Normal adult testicular volume is approximately 15-25 mL per testis. Complete atrophy under DC 7523 means the testis is reduced to 1/3 or less of normal volume.
Critical thresholds
- Both testes with complete atrophy (each 1/3 or less of normal size) 20% disability rating under DC 7523
- One testis with complete atrophy (1/3 or less of normal size), other testis normal 0% disability rating under DC 7523 - but verify if secondary conditions (e.g., erectile dysfunction, hormonal deficiency) are separately ratable
Tips
- Be truthful about any scrotal discomfort or unusual sensations you notice during the exam
- If you have recent scrotal ultrasound reports showing testicular volume measurements, bring them - objective measurements in your medical record support accurate rating
- If you experience testicular pain or discomfort on most days, communicate this clearly before palpation begins
- Do not minimize the degree of size reduction - if you have noticed significant shrinkage, describe when it started and how much change you have observed
Pain considerations: If palpation is painful, immediately tell the examiner. Tenderness on palpation is separately documented on the DBQ and may indicate active orchitis or chronic epididymitis as a complicating factor. Pain associated with atrophy can support secondary conditions.
Testicular Consistency Assessment
What it measures: The firmness or softness of testicular tissue relative to the contralateral or normal testis, indicating degree of fibrosis, degeneration, or active inflammation.
What to expect: The examiner will note whether the atrophied testis is considerably softer (suggestive of degeneration) or harder (suggestive of fibrosis or prior infection/inflammation) than the contralateral side or than normal tissue.
Critical thresholds
- Considerably softer than contralateral or normal Supports documentation of complete atrophy; reflects loss of functional tubular tissue
- Considerably harder than contralateral or normal Supports documentation of fibrotic atrophy, often post-infectious or post-traumatic in etiology
Tips
- Describe any changes in consistency you have personally noticed over time
- If the testis feels 'shrunken and soft like a raisin' or 'hard like a marble,' use that language with your examiner
- Changes in consistency noted on prior imaging or exams should be referenced
Pain considerations: Fibrotic or hard testes may be less tender; very soft atrophied testes may be more uncomfortable. Accurately report your pain experience during palpation.
Scrotal Ultrasound Review (if available)
What it measures: Objective testicular volume in milliliters (mL), echogenicity, and blood flow, providing an objective measurement independent of physical exam alone.
What to expect: The C&P examiner may review prior imaging but is unlikely to order an ultrasound at the exam itself. Bring any prior ultrasound reports. Testicular volumes below 6 mL are generally considered atrophic; volumes of 4 mL or less may correspond to complete atrophy depending on individual baseline.
Critical thresholds
- Testicular volume - 4-6 mL on ultrasound Objective support for complete atrophy finding
- Bilateral atrophy documented on ultrasound Critical for establishing 20% rating vs. 0% unilateral rating under DC 7523
Tips
- Request a scrotal ultrasound from your treating physician before the C&P exam if one has not been performed recently
- Bring printed copies of any ultrasound reports to the exam
- Ensure your treating physician's notes specifically use the word 'atrophy' or 'atrophic' in documentation
Pain considerations: Ultrasound is non-invasive and painless. If you have had pain during prior ultrasounds due to tenderness, document that history.
Rating criteria by percentage
20%
Complete atrophy of BOTH testes. Both testes must be completely atrophied, meaning each testis is reduced to 1/3 or less of its normal volume. This is the maximum rating available under DC 7523.
Key symptoms
- Bilateral complete testicular atrophy confirmed on physical examination
- Each testis reduced to approximately 1/3 or less of normal size
- Soft or fibrotic consistency of both testes
- Possible associated hypogonadism symptoms (fatigue, decreased libido, erectile dysfunction)
- Possible hormonal deficiency requiring testosterone replacement therapy
- History consistent with bilateral causative event (bilateral orchitis, bilateral torsion, radiation, etc.)
From 38 CFR: 38 CFR 4.115b, DC 7523: 'Testis, atrophy complete: Both - 20.' The footnote (1) indicates that DC 7523 carries a note applicable to special monthly compensation (SMC) consideration for loss of use of a creative organ.
0%
Complete atrophy of ONE testis only, with the contralateral testis being normal or near-normal in size. A single completely atrophied testis rates 0% under DC 7523. However, veterans should be aware that if the one-testis condition was caused by a service-connected disease or injury, secondary conditions and SMC eligibility should still be evaluated.
Key symptoms
- Unilateral complete testicular atrophy confirmed on physical examination
- One testis reduced to 1/3 or less of normal size
- Contralateral testis normal or near-normal
- Possible associated chronic epididymitis or orchitis on affected side
- Possible minor hormonal impact if remaining testis has reduced function
From 38 CFR: 38 CFR 4.115b, DC 7523: 'Testis, atrophy complete: One - 0.' Veterans with unilateral complete atrophy should explore whether secondary conditions (erectile dysfunction under DC 7522, hormonal deficiency, chronic orchitis/epididymitis) are separately ratable.
Describing your symptoms accurately
Physical Appearance and Size Change
How to describe it: Describe accurately how you have noticed the testis or testes shrinking over time. Be specific about when you first noticed the change, how much smaller it appears now compared to its original size, and whether the shrinkage has been gradual or rapid. Use comparative language such as 'it used to be the size of a walnut but now it feels no larger than a marble' if that accurately reflects your experience.
Example: On my worst days I notice the atrophied testis feels almost completely absent - there is very little tissue palpable and it feels as though there is almost nothing there compared to the normal side. It has shrunk to a small fraction of its original size.
Examiner listens for: The examiner is looking to determine whether your subjective report of size reduction is consistent with objective physical findings, and whether the condition is bilateral or unilateral. They will document any history of trauma, infection, or other causative events.
Avoid: Do not say 'it seems a little smaller' if the atrophy is significant. Use accurate language - if it has substantially reduced in size, say so precisely. Do not assume the examiner will observe the full extent of the problem without your verbal confirmation.
Pain and Discomfort
How to describe it: Describe any scrotal or testicular pain you experience, including its frequency, severity on a 0-10 scale, character (aching, sharp, burning, dull), duration, and what makes it better or worse. Note whether pain is constant or intermittent, and whether it radiates to the groin, lower abdomen, or inner thigh.
Example: On my worst days I have a persistent dull ache in the scrotum that radiates into my groin. The pain is around a 6 out of 10 and prevents me from sitting comfortably for long periods. Physical activity like walking or lifting makes it significantly worse.
Examiner listens for: Whether tenderness on palpation corresponds to your reported pain history, and whether there is an associated diagnosis of chronic orchitis or epididymitis that should be separately documented and rated.
Avoid: Do not say 'it only hurts a little sometimes' if you have regular pain. Veterans frequently underreport pain during C&P exams. Report your typical worst-day pain level, not your best day.
Hormonal and Functional Consequences
How to describe it: Accurately describe any symptoms of hypogonadism or testosterone deficiency: fatigue, decreased libido, erectile dysfunction, decreased muscle mass, mood changes, depression, or hot flashes. If you are on testosterone replacement therapy (TRT), describe why it was prescribed and how you function without it. If you have erectile dysfunction secondary to the atrophy, describe it fully as it may be separately ratable under DC 7522.
Example: Without my testosterone medication, I experience severe fatigue where I can barely get out of bed, complete loss of libido, and inability to achieve an erection. My testosterone levels were confirmed low by blood tests. These symptoms significantly limit my ability to work and function in daily life.
Examiner listens for: Evidence that the bilateral atrophy has caused functional impairment of the hormonal axis, and whether separately ratable secondary conditions such as erectile dysfunction (DC 7522) should be claimed. The examiner will note any current medications including testosterone therapy.
Avoid: Do not omit erectile dysfunction or hormone deficiency symptoms when describing your condition. These may qualify for separate VA ratings and should be accurately and fully reported.
Impact on Daily Life and Occupational Function
How to describe it: Describe how the condition affects your ability to perform daily activities, work, and maintain relationships. Be specific about any activities you can no longer perform, have to modify, or that cause significant discomfort. Include psychological and emotional impacts if present.
Example: On my worst days the scrotal discomfort and fatigue from hormone deficiency mean I cannot complete a full workday, struggle to perform physical job duties, and the psychological impact of the condition has strained my relationship with my spouse.
Examiner listens for: Functional impairment that helps the examiner accurately complete the DBQ section on functional impact, which is critical to the overall nexus and severity assessment.
Avoid: Do not say 'it doesn't really affect me that much' if you are on testosterone therapy, have erectile dysfunction, or experience chronic pain. The examiner needs to understand the real burden of your condition.
Voiding and Urinary Symptoms
How to describe it: If you have any urinary symptoms such as frequency, urgency, hesitancy, weak stream, or nighttime awakenings to void, describe them accurately. These may indicate associated genitourinary complications and are captured on the DBQ. Note how many times you void during the day and how many times you wake at night to urinate.
Example: On my worst days I wake up three to four times at night to urinate, void every one to two hours during the day, and experience hesitancy and a weak stream that makes voiding feel incomplete.
Examiner listens for: Whether there is any voiding dysfunction associated with the reproductive organ condition, which may indicate a comorbid condition requiring additional rating consideration.
Avoid: Do not dismiss urinary symptoms as unrelated. If you have urinary issues, report them - they are part of the genitourinary DBQ and may indicate additional ratable conditions.
Common mistakes to avoid
Failing to specify whether atrophy is unilateral or bilateral
Why: The entire rating difference under DC 7523 hinges on whether ONE or BOTH testes are completely atrophied. Bilateral complete atrophy = 20%; unilateral complete atrophy = 0%. This single distinction controls the rating outcome.
Do this instead: Clearly state which testis or testes are affected at the very beginning of your history. If both are affected, emphasize that explicitly and ensure the examiner documents both. Bring any prior medical records, ultrasounds, or lab results that confirm bilateral involvement.
Impact: 20% vs. 0%
Not mentioning erectile dysfunction as a separate potential claim
Why: Erectile dysfunction caused by testicular atrophy (e.g., hypogonadism secondary to bilateral atrophy) may be separately ratable as 0% under DC 7522 but - critically - qualifies for Special Monthly Compensation (SMC-K) under 38 U.S.C. 1114(k) as loss of use of a creative organ. This SMC can be worth more than $100/month in addition to the regular rating.
Do this instead: Disclose any erectile dysfunction to the examiner and ensure it is documented on the DBQ. File a secondary claim for erectile dysfunction (DC 7522) if you have not already, and request an SMC-K evaluation. The footnote in DC 7523 specifically references the creative organ SMC provision.
Impact: SMC-K eligibility - significant monthly benefit
Describing symptoms as they are on a good day rather than a typical worst day
Why: M21-1 guidance requires examiners to document the full range of severity. Veterans who minimize symptoms on exam day often receive lower ratings than their condition warrants. The DBQ asks about the veteran's actual functional status, not their best-case presentation.
Do this instead: Before the exam, write down your worst-day symptoms - maximum pain level, worst functional limitations, worst hormonal symptoms - and report those accurately. Use the phrase 'on my worst days' to frame severe symptom descriptions.
Impact: All rating levels
Failing to report secondary hormonal deficiency symptoms and testosterone replacement therapy
Why: Complete bilateral testicular atrophy frequently causes hypogonadism (low testosterone). If you are on TRT, this confirms functional loss. Failing to report this misses documentation of the full disease burden and may cause the examiner to underestimate impairment.
Do this instead: Bring documentation of testosterone lab values, TRT prescriptions, and any endocrinology notes. Clearly state that the atrophy caused or contributed to your low testosterone and that you require medication to manage it.
Impact: Secondary conditions and SMC-K eligibility
Allowing the examiner to proceed without physically examining both testes
Why: If the exam is conducted without physical examination of both testes, the DBQ may be incomplete or the 'not examined' box may be checked, which weakens the claim. An inadequate exam can be challenged but is best avoided.
Do this instead: Consent to the physical examination of both testes. If you have any reason you prefer not to be examined, understand that opting out may result in the examiner documenting 'not examined per veteran's request' with a veteran self-report of normal - which could undermine your bilateral atrophy claim.
Impact: 20% bilateral rating
Not disclosing the etiology of atrophy or linking it to service
Why: The examiner is filling out an etiology field on the DBQ. If you do not provide a history connecting the cause of atrophy to your service (e.g., service-connected orchitis, traumatic injury, radiation therapy for a service-connected cancer), the examiner cannot document a nexus.
Do this instead: Prepare a clear, concise service connection narrative: what happened in service, when the atrophy began, and what your treating physicians have said about the cause. Bring your service treatment records showing the inciting event if possible.
Impact: Service connection establishment - affects all rating levels
Prep checklist
- critical
Obtain and bring all scrotal/testicular ultrasound reports
Request a scrotal ultrasound from your VA or private urologist if one has not been done in the past 1-2 years. Bring printed results showing testicular volume measurements in mL. Objective measurements under 6 mL per testis strongly support complete atrophy.
before exam
- critical
Gather testosterone lab results and TRT prescription records
If you have been diagnosed with hypogonadism or are on testosterone replacement therapy, collect all relevant lab results (total testosterone, free testosterone, LH, FSH) and prescription records. These document the functional consequence of bilateral atrophy.
before exam
- critical
Write a personal symptom statement covering worst-day severity
Write down your worst-day symptoms including: maximum pain level (0-10), frequency of pain episodes, hormonal symptoms (fatigue, libido loss, erectile dysfunction), urinary symptoms, and functional limitations. Review this before the exam so you do not forget key details under stress.
before exam
- critical
Identify and document the date of diagnosis and onset history
Know the approximate date you or your provider first diagnosed or documented the testicular atrophy. Know what caused it (e.g., orchitis, trauma, radiation, mumps, torsion) and when that causative event occurred, especially if in service.
before exam
- critical
Review whether bilateral vs. unilateral atrophy is clearly documented in your records
The 20% vs. 0% rating difference is entirely bilateral vs. unilateral. Before the exam, review your medical records and confirm which side(s) are documented as completely atrophied. If bilateral atrophy is documented, flag those records to bring.
before exam
- recommended
Research SMC-K eligibility for loss of use of creative organ
If you have erectile dysfunction as a result of the testicular atrophy (especially bilateral), you may be entitled to Special Monthly Compensation under 38 U.S.C. 1114(k). Discuss this with a VSO or accredited claims agent. DC 7523 footnote (1) specifically references this provision.
before exam
- recommended
Collect records of any prior surgical procedures on the testes
If you have had any scrotal surgery (orchiopexy, biopsy, epididymectomy, varicocelectomy, etc.), bring those operative reports. Surgery dates and procedures will be asked about on the DBQ.
before exam
- recommended
List all current medications taken for reproductive or hormonal conditions
Prepare a current medication list including testosterone replacement therapy (injections, gels, patches), phosphodiesterase-5 inhibitors for ED, antibiotics for chronic epididymitis, and any hormonal medications. The examiner will document these.
before exam
- recommended
Identify any related secondary conditions to discuss
Consider whether you have erectile dysfunction (DC 7522), chronic epididymitis (DC 7525), chronic orchitis, or urinary voiding dysfunction that may be secondary to the testicular atrophy and separately ratable. Discuss all of these with the examiner.
before exam
- recommended
Arrive early and notify the examiner if you intend to record the exam
Most states permit veterans to record their C&P exam. Arrive 15 minutes early, inform the front desk and the examiner that you will be recording, and set up your recording device before the exam begins. Do not record covertly.
day of
- critical
Bring all medical records and documentation in an organized folder
Bring: ultrasound reports, lab results (testosterone levels), TRT prescriptions, prior urology notes, service treatment records showing causative event, and your personal symptom statement. Organize by date for easy reference.
day of
- recommended
Do not take pain medication before the exam that would mask your typical symptoms
The exam should reflect your typical day-to-day condition. If you normally take pain medications that reduce your discomfort, you may take them as usual - but be prepared to describe your symptoms without medication as well.
day of
- optional
Request a same-sex examiner or chaperone if desired
You have the right to request a same-sex examiner or to have a chaperone present during the physical examination portion. Make this request when you check in if applicable.
day of
- critical
Clearly state whether atrophy is in one or both testes at the start of the interview
The single most important fact for rating under DC 7523 is whether atrophy is unilateral or bilateral. State this clearly and early in the interview: 'I have complete atrophy of both/one testis/testes.' Ensure the examiner documents this accurately.
during exam
- critical
Report all symptoms accurately - do not minimize
Report your worst-day pain, all hormonal symptoms, erectile dysfunction, urinary symptoms, and functional limitations fully and accurately. Do not downplay symptoms out of embarrassment or a desire to appear strong.
during exam
- critical
Disclose erectile dysfunction if present
If you have erectile dysfunction, report it to the examiner. Explain that it began after or is related to the testicular atrophy. This may support a separate DC 7522 claim and SMC-K eligibility.
during exam
- critical
Consent to physical examination of both testes
Allow the physical examination of both testes to proceed. Opting out risks the examiner documenting 'not examined per veteran's request - veteran reports normal,' which would severely undermine a bilateral atrophy claim.
during exam
- critical
Describe your worst-day functional limitations clearly
When asked how the condition affects your daily life, describe the worst days - not the average or best days. Use specific examples: 'On my worst days I cannot sit comfortably for more than 20 minutes' or 'I was unable to work a full shift due to fatigue from low testosterone.'
during exam
- recommended
Confirm the examiner has noted bilateral involvement before leaving
At the end of the exam, you may politely ask the examiner: 'Have you noted that both testes are completely atrophied?' This is the critical determinant of the 20% vs. 0% rating and should not be left ambiguous.
during exam
- critical
Request a copy of the completed DBQ
You are entitled to a copy of the completed DBQ. Submit a written request to the VA Regional Office or ask the examiner/clinic to provide a copy. Review it for accuracy, particularly confirming bilateral atrophy is documented.
after exam
- critical
File a CUE or request a supplemental claim if the DBQ contains errors
If the DBQ inaccurately documents unilateral instead of bilateral atrophy, or omits key symptoms you reported, contact your VSO or accredited attorney immediately. You can submit a supplemental claim with new and relevant evidence to correct the record.
after exam
- recommended
Consider filing secondary claims if not already done
If you have not yet filed for erectile dysfunction (DC 7522), chronic epididymitis, hypogonadism, or urinary voiding dysfunction as secondary to the testicular atrophy, consult a VSO or accredited claims agent about filing those separately.
after exam
- recommended
Document your recollection of the exam in writing immediately afterward
As soon as the exam is complete, write down everything you reported and everything the examiner said and documented. This contemporaneous record is invaluable if you need to challenge an inadequate exam finding.
after exam
Your rights during a C&P exam
- You have the right to request a same-sex examiner for the physical examination portion of the C&P exam.
- You have the right to request a chaperone be present during the physical examination.
- You have the right to record your C&P examination in most states - notify the examiner before the exam begins and do not record covertly.
- You have the right to obtain a copy of the completed DBQ after the examination.
- You have the right to submit a request for a new or supplemental C&P exam if you believe the original exam was inadequate, incomplete, or contained errors.
- You have the right to submit your own private medical opinion (independent medical examination or nexus letter) from a treating or reviewing physician to supplement or rebut the C&P examiner's findings.
- You have the right to be treated respectfully and professionally during the exam regardless of the sensitive nature of the condition.
- You have the right to bring a VSO representative or accredited claims agent to the exam to observe, though they typically cannot speak during the medical examination portion.
- You have the right to request that the VA consider your condition under the most favorable applicable diagnostic code - under DC 7523 or potentially DC 7524 if surgical removal is involved, and under DC 7522 for associated erectile dysfunction.
- You may be entitled to Special Monthly Compensation (SMC-K) under 38 U.S.C. 1114(k) if bilateral atrophy has caused loss of use of a creative organ (erectile dysfunction). DC 7523 footnote (1) specifically references this SMC provision.
- You have the right to appeal any rating decision you believe is inaccurate through the supplemental claim, Higher Level Review, or Board of Veterans' Appeals lanes under the AMA appeals process.
- You have the right to a fully reasoned rating decision that explains how the evidence was weighed - if the decision does not explain why bilateral atrophy was rated as unilateral or otherwise mischaracterizes the evidence, you can challenge that finding.
Related conditions
- Testis, Removal (Orchiectomy) DC 7524 covers removal of one or both testes (orchiectomy). If the completely atrophied testis is later surgically removed, the claim should be re-evaluated under DC 7524. Notably, DC 7524 rates removal of one testis at 0% but includes a special provision: if one testis is removed due to a service-connected condition and the other is absent or nonfunctioning for a non-service-connected reason, the service-connected removal is rated at 30%.
- Erectile Dysfunction DC 7522 covers erectile dysfunction with or without penile deformity, rated at 0% but qualifying for SMC-K (Special Monthly Compensation) under 38 U.S.C. 1114(k). Bilateral testicular atrophy causing hypogonadism frequently results in erectile dysfunction. This should be claimed as a secondary condition to DC 7523 and is critical for SMC-K eligibility, which provides significant additional monthly compensation.
- Epididymitis, Chronic Chronic epididymitis (DC 7525) is a common comorbidity and potential causative factor in testicular atrophy. Post-infectious atrophy following chronic or recurrent epididymitis is well-documented. If both conditions are present, separate rating consideration may apply.
- Orchitis, Chronic (Unilateral or Bilateral) Chronic orchitis is a recognized cause of testicular atrophy and is separately ratable. If orchitis preceded and caused the atrophy, both conditions should be documented. The DBQ specifically includes chronic orchitis as a diagnosis option.
- Hypogonadism / Testosterone Deficiency Bilateral complete testicular atrophy commonly results in primary hypogonadism (low testosterone production). While not separately rated under the genitourinary schedule in all cases, the functional consequences - fatigue, depression, decreased libido, erectile dysfunction - may support additional ratings or SMC considerations. Testosterone replacement therapy requirements document the severity of hormonal functional loss.
- Prostatitis / Prostatic Conditions The Male Reproductive Organ Conditions DBQ covers both testicular and prostatic conditions. If you have a concurrent service-connected prostate condition (prostatitis, BPH with voiding dysfunction), this may be documented on the same DBQ and rated separately under appropriate diagnostic codes.
- Varicocele / Hydrocele Varicocele is a known risk factor for testicular atrophy due to venous blood pooling and elevated scrotal temperature. If a service-connected varicocele caused the atrophy, this establishes secondary service connection. Hydrocele may also accompany atrophy in some clinical presentations and is documented on the same DBQ.
Get a personalized prep packet
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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.