Gynecological conditions and disorders of the breast, including endometriosis, surgical residuals, and pelvic organ prolapse.
How Women's Health conditions are rated
The schedule at 38 CFR §4.116 covers gynecological conditions and disorders of the breast. Its first note says "natural menopause, primary amenorrhea, and pregnancy and childbirth are not disabilities for rating purposes," while "chronic residuals of medical or surgical complications of pregnancy may be disabilities for rating purposes."
Disease, injury, or adhesions of the female reproductive organs (DCs 7610 through 7615) share one General Rating Formula with three levels: 0% for "symptoms that do not require continuous treatment," 10% for "symptoms that require continuous treatment," and 30% for "symptoms not controlled by continuous treatment." The formula looks at treatment and control rather than at the particular diagnosis, so records of what treatment has been prescribed, for how long, and whether symptoms continued despite it tend to carry these claims. A note places ovarian dysfunction affecting the menstrual cycle, "such as dysmenorrhea and secondary amenorrhea," under DC 7615.
Endometriosis has its own code, DC 7629. It is rated 10% when pelvic pain or heavy or irregular bleeding requires continuous treatment for control, 30% when those symptoms are not controlled by treatment, and 50% when there are also lesions involving the bowel or bladder confirmed by laparoscopy, with bowel or bladder symptoms. The note adds that the diagnosis "must be substantiated by laparoscopy."
Surgical removal is rated by what was removed and when. Removal of the uterus and both ovaries (DC 7617), of the uterus (DC 7618), or of an ovary (DC 7619) is rated 100% for three months after removal. After that the levels are fixed: 50% for complete removal of the uterus and both ovaries, 30% for removal of the uterus, 30% for removal of both ovaries, and 0% for removal of one ovary. Where one ovary is lost to a service-connected injury or disease and the other is absent or nonfunctioning for reasons unrelated to service, a note assigns 30%. Pelvic organ prolapse (DC 7621) is rated 10%, and any genitourinary, digestive, or skin symptoms are evaluated separately and combined with it.
Breast surgery (DC 7626) is rated by the type of procedure and whether one or both breasts are involved, from 80% for radical mastectomy of both breasts down to 0% for wide local excision "without significant alteration of size or form." The note defines each procedure; a modified radical mastectomy, for example, removes the entire breast and axillary lymph nodes but leaves the pectoral muscles intact. Malignant neoplasms of the breast (DC 7630) and of the gynecological system (DC 7627) are rated 100%, continuing beyond the end of treatment until a mandatory VA examination six months later, with any change subject to §3.105(e). Breast residuals are then rated by impairment of function due to scars, lymphedema, or disfigurement, and/or under DC 7626.
Note 2 directs the rater, for any claim "involving loss or loss of use of one or more creative organs or anatomical loss of one or both breasts," to §3.350 to determine whether the veteran may be entitled to special monthly compensation. Footnotes mark the codes that potentially qualify, and the note adds that "almost any condition in this section might, under certain circumstances, establish entitlement." A decision on one of these codes that does not address special monthly compensation may be worth a second look.