The Female Reproductive System

Topics:

Removal of the Breast
Removal or Loss of Use of the Reproductive Organs
Diseases and Injuries
Displacement of the Uterus
Complications of Pregnancy
Endometriosis
Cancer and Tumors of the Breast and Reproductive System
Other Reproductive System Conditions
DBQs for Reproductive System Conditions
Principles that Apply

 

Reminder: The VA will give a Military Disability Rating for each service-connected condition a service member has, but the DoD will only rate service-connected conditions that make a service member Unfit for Duty.

Note: Normal menstruation, menopause, pregnancy and childbirth are not conditions that can be rated as disabilities. Only abnormalities and complications can be rated.

 


Removal of the Breast

the removal of the breast from a female reproductive system gynelogical conditionCode 7626: The removal of the entire or a portion of the breast is rated based on the extent of the surgery. A radical mastectomy is the removal of the entire breast, including the pectoral muscle underneath and the lymph nodes up to the coracoclavicular ligament. This radical surgery is not performed very often. If only one breast is removed, it is rated 50%. If both breasts are removed, it is rated 80%.

A modified radical mastectomy in one breast is rated 40%. Both breasts are rated 60%.

A simple or total mastectomy in one breast is rated 30%. Both breasts are rated 50%.

A wide local excision is the removal of only a portion of the breast tissue. This includes lumpectomies, partial mastectomies, and quadrantectomies. If the wide local excision causes the size and shape of the breast to change significantly, then it is rated 50% for both breasts and 30% for one breast. If there is no significant change in shape or size, then it is rated 0% whether one or both breasts are involved.

If your condition is rated under one of these codes, it may also qualify for additional compensation from the VA.

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Removal or Loss of Use of the Reproductive Organs

Code 7617: The complete removal of the uterus and both ovaries is rated 100% for the first 3 months after the surgery. After the 3-month period, it is then rated 50%.

Code 7618: If the entire uterus is removed, it is rated 100% for the first 3 months after surgery. After the 3-month period, it is rated 30%.

Code 7619: The removal of one or both ovaries is rated 100% for the first 3 months after surgery. After that period, the complete removal of both ovaries is rated 30%. Anything less than the complete removal of both ovaries is rated 0%.

Code 7620: If both of the ovaries are not removed, but are completely non-functional, then it is rated 20%.

If your condition is rated under one of these codes, it may also qualify for additional compensation from the VA.

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Diseases and Injuries

There is a basic rating system for all diseases, injuries or adhesions of the reproductive system. Simply, if the symptoms cannot be controlled by constant treatment, it is rated 30%. If the symptoms can be controlled by constant treatment, it is rated 10%. If the symptoms do not require constant treatment, then it is rated 0%.

Here are the codes and conditions that are rated by this system:

Code 7610: Diseases or injuries of the vulva. Vulvovaginitis is rated under this code.
Code 7611: Diseases or injuries of the vagina.
Code 7612: Diseases or injuries of the cervix
Code 7613: Diseases, injuries or adhesions of the uterus.
Code 7614: Diseases, injuries or adhesions of the fallopian tubes.
Code 7615: Diseases, injuries or adhesions of the ovaries.

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Displacement of the Uterus

Code 7621: If the uterus slips down completely through the vagina, then it is rated 50%. If it slips down only partially through the vagina, then it is rated 30%.

Code 7622: If the uterus does not slip down, but is significantly out of place, then it is rated under this code. If the displacement causes constant or frequent problems with menstrual periods, then it is rated 30%. If the displacement causes adhesions, and the menstrual periods are irregular, then it is rated 10%.

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Complications of Pregnancy

Code 7623: If pregnancy causes the wall between the vagina and the rectum to tear, resulting in a rectocele, or if it causes the wall between the bladder and the vagina to tear, resulting in a cystocele, it is rated 50%. If the pregnancy causes the vagina to be loose or gaping, then it is rated 10%.


Codes 7624 and 7625 can be complications of pregnancy, but can also be caused by accident or trauma. A fistula is an abnormal passageway that is often caused by trauma or surgery when pregnant. This is not the same as a tear in the walls of an organ, but is an actual passageway that forms between two areas that do not usually connect. They are very rare in the US, but can be common in areas with inadequate health care.

Code 7624: A rectovaginal fistula is a passageway between the vaginal wall and the rectum. If there is poo from the rectum leaking through the vagina at least once a day, it is rated 100%. If poo does not leak through the vagina every day, but does more than 4 times a week, then it is rated 60%. If it leaks through the vagina 1-3 times a week, it is rated 30%. If it leaks less than once a week, it is rated 10%, and if it does not leak through the vagina at all, it is rated 0%.

Code 7625: An urethrovaginal fistula is an abnormal passageway between the vaginal wall and the urethra, and a vesicovaginal fistula is an abnormal passageway between the bladder and the vagina. If there is more than one fistula, then the condition is rated 100%. If there is only one fistula, but the condition is severe enough that a device, like a catheter, or absorbent cloths that must be changed more than 4 times a day must be used, then it is rated 60%. If the absorbent cloths must be changed 2-4 times a day, it is rated 40%. If the cloths must be changed less than 2 times a day, then it is rated 20%.

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Endometriosis

Code 7629: Endometriosis is a condition where the cells that line the uterus grow in other places in the body. A diagnosis of endometriosis is only ratable if it is confirmed by a laparoscopy test.

If the condition affects the bowel or the bladder, causes problems with going to the bathroom, and causes uncontrolled pain in the pelvic region or bleeding, then it is rated 50%. A 30% rating is given if there is pain in the pelvic region and there is irregular bleeding that cannot be controlled by treatments. If the pain or bleeding can be controlled by continuous treatment, then it is rated 10%.

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Cancer and Tumors of the Breast and Reproductive System

Cancer and tumors are made up of the growth of abnormal cells. These cells can be benign—they do not attack the good cells around them (tumors)—or they can be malignant—they attack the cells around them (cancers).

Code 7628: Tumors affecting the breast or the reproductive organs are rated based on how they affect the systems around them. For example, if the condition interferes with the ability to urinate, then it would be rated under that symptom. The final code for this condition will be a hyphenated analogous code that would look like this: 7628-3009. The first four-digit code tells us that the condition is benign cancer of the reproductive system, and the second four-digit code is the code the condition is actually rated under.

Code 7627: Cancer that is active is rated 100%. This 100% rating will continue for the first 6 months after the last treatment. The condition will then be reevaluated. If it is no longer active, then it will be rated on any lasting symptoms just like any benign condition.

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Other Reproductive System Conditions

All other breast or female reproductive system conditions will be rated analogously (see the Analogous and Equivalent Codes page) with the above ratings. The bottom line rule is to rate any condition under the code that BEST describes it, even if it is not exact.

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DBQs for Reproductive System Conditions

Here are the Disability Benefits Questionnaires (DBQs) used for female reproductive conditions: Breast Conditions DBQ and Gynecological Conditions DBQ.

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Principles that Apply

Special Monthly Compensation: The loss of or loss of use of a reproductive organ or breast tissue may qualify for the VA’s Special Monthly Compensation.

Pyramiding: A single condition can only be rated once! However, if another condition exists that is additional to the female reproductive condition (not simply caused by it), then it can also be rated.

Probative Value: If two exams record the condition differently, the exam with the most thorough data and performed by the most qualified person in that specialty will be the exam the rating is based on.

A Tie Goes to the Veteran: If there are two equally strong exams with conflicting information, or if the condition can be equally rated under two different codes, then the one that gives the highest rating will be assigned. Every conflict should be resolved in favor of the higher rating.

Accurate Measurements: It is essential that the necessary information to rate your condition is recorded by the physician in your exam. With the information on this page, you should know what needs to be measured and recorded. Make sure this happens correctly to ensure that you receive a proper rating.

Hospital or Convalescent Ratings: Some conditions require periods of hospitalization or constant medical care (at-home nurse, etc.). Any condition that requires this is rated 100% during this intensive treatment. Once it ends, then the 100% rating will continue for a certain period. This period is 3 months unless another length (6 months, 1 year, etc.) is directly specified in the condition ratings. Some patients may need more time to recover than others, so the physician or Rating Authorities can lengthen this time period if they see fit.

Please see the VASRD Principles page for further guidance.

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