Benign Breast Tumors and Breast Injuries — VA Rating (DC 7631)
Diagnostic Code 7631 · 38 CFR §4.116
What Is It?
Under the current 38 CFR §4.116, DC 7631 is titled benign neoplasms of the breast and other injuries of the breast. It is a breast code, not a gynecological one — the benign gynecological growths are DC 7628, and it is worth being precise about that, because claims filed under the wrong number get evaluated against the wrong criteria. DC 7631 covers fibroadenomas, breast cysts, intraductal papillomas, fat necrosis, and traumatic injury to the breast, including injuries from a fall, a vehicle accident, or blunt trauma during service. What it does not do is assign a percentage. The entry directs that chronic residuals be rated according to impairment of function due to scars, lymphedema, or disfigurement — the regulation gives examples: limitation of arm, shoulder, and wrist motion, loss of grip strength, loss of sensation, or residuals from harvesting of muscles for reconstructive purposes — and, where applicable, under DC 7626, which is the code for surgery of the breast. So the evaluation is built from the functional consequences and from what any surgery left behind, each rated under the code that fits, then combined under 38 CFR §4.25.
Rating Criteria
| Rating | Criteria |
|---|---|
| See pathways | DC 7631 assigns no percentage. Under 38 CFR §4.116 it directs that chronic residuals be rated according to impairment of function due to scars, lymphedema, or disfigurement — the regulation's own examples are limitation of arm, shoulder, and wrist motion, loss of grip strength, loss of sensation, and residuals from harvesting of muscles for reconstructive purposes — and/or under DC 7626, surgery of the breast. The practical routes are therefore: (1) DC 7626 where breast surgery has been performed, which grades on whether the surgery was wide local excision, simple mastectomy, modified radical, or radical, and on whether one or both breasts were involved; (2) scars under DC 7801-7805, including DC 7804 where scars are painful or unstable; (3) limitation of arm, shoulder, or wrist motion under the musculoskeletal codes; (4) lymphedema under the cardiovascular codes; (5) loss of sensation under the neurological codes. Separate evaluations are combined under 38 CFR §4.25. Benign gynecological growths belong under DC 7628, not this code. |
Evidence Needed
Start with the pathology or the imaging that establishes the lesion is benign — a mammogram, ultrasound, or MRI report, plus the biopsy result. Then document function, because function is what is being rated. If surgery was performed, get the operative report describing exactly what was removed and whether muscle was taken for reconstruction, since harvesting of muscle is named in the regulation. Range of motion measurements for the shoulder, elbow, and wrist on the affected side, and grip strength testing, convert the impairment into the units the musculoskeletal codes use. Arm circumference measurements at fixed points on both sides document lymphedema. Photographs of scars and of any asymmetry or disfigurement, with measurements and something for scale, support the scar and disfigurement routes. Note any numbness, and where it is.
C&P Exam Tips
Make sure the examination covers more than the breast. The evaluation under this code comes from function — shoulder and arm motion, grip strength, sensation, and swelling — so ask whether range of motion is being measured on the affected side and whether grip strength is being tested. If your arm swells, ask that both arms be measured at the same points and the numbers recorded. Describe numbness by location and whether it is constant. If you have had surgery, say whether muscle was taken for reconstruction, because that is named in the regulation as a ratable residual. Ask that scars be measured and that any that are painful or unstable be noted in those terms, since painful and unstable are the words the scar criteria use. Bring photographs.
How to File
File on VA Form 21-526EZ naming the specific breast condition — a fibroadenoma, a breast cyst, fat necrosis, or an injury to the breast — under DC 7631, and separately name every residual you are claiming: shoulder or arm limitation of motion, loss of grip strength, lymphedema, painful scars, loss of sensation, and any psychiatric condition. Attach the imaging, the pathology, the operative report, range of motion measurements, arm circumference measurements, and photographs of scars. If surgery of the breast was performed, ask expressly for consideration under DC 7626 as well, since the regulation names it. If you are claiming a benign gynecological growth rather than a breast condition, file under DC 7628, which is the correct code for that.
Common Mistakes
The first mistake is a filing error rather than an evidentiary one: DC 7631 is a breast code and DC 7628 is the gynecological one, and claims filed under the wrong number are evaluated against criteria that do not fit. The second is expecting a percentage for the lesion itself; the code assigns none and routes entirely to functional residuals. The third is going to an examination where only the breast is examined, which leaves the shoulder motion, the grip strength, the sensation, and the arm swelling — the actual rating criteria — undocumented. The fourth is not asking for consideration under DC 7626 where breast surgery has been performed, since the regulation names that code directly. The fifth is leaving painful scars unmentioned, when DC 7804 evaluates scars precisely on whether they are painful or unstable.
Frequently Asked Questions
Is DC 7631 a breast code or a gynecological code?
A breast code. Under the current 38 CFR §4.116 it is titled benign neoplasms of the breast and other injuries of the breast. The benign gynecological growths — ovarian cysts, benign ovarian tumors, endometrial and cervical polyps — belong under DC 7628. The two are adjacent in the schedule and are confused often. If your claim for a gynecological growth was filed under DC 7631, ask for it to be considered under DC 7628 instead, because the criteria and the routing differ.
Why is there no percentage under this code?
Because a benign breast lesion is not itself a functional impairment. The entry directs that chronic residuals be rated according to impairment of function due to scars, lymphedema, or disfigurement, and gives examples: limitation of arm, shoulder, and wrist motion, loss of grip strength, loss of sensation, and residuals from harvesting of muscles for reconstructive purposes. It also points to DC 7626 for breast surgery. The percentage comes from those codes, and the evidence they need is measurements rather than a diagnosis.
What if I had surgery for a benign breast tumor?
Ask for evaluation under DC 7626, surgery of the breast, which the regulation names directly, alongside the functional residuals. Bring the operative report describing what was removed and whether muscle was harvested for reconstruction. Then document the consequences separately: shoulder and arm motion, grip strength, numbness, arm swelling, and the scars. Each is evaluated under its own code and the separate evaluations are combined under 38 CFR §4.25 rather than added together.
Can a breast injury from service be service connected?
Yes. The code title says other injuries of the breast, so blunt trauma from a fall, a vehicle accident, equipment, or an assault during service falls squarely within it. What the claim needs is the service record documenting the injury, current medical documentation of the residuals such as fat necrosis, scarring, or a palpable mass, and a medical opinion linking them. If the injury occurred in circumstances involving military sexual trauma, note that VA accepts a broader range of supporting evidence for those claims.
Do men get rated under this code?
Yes. Although 38 CFR §4.116 is titled for gynecological conditions and disorders of the breast, the breast codes are not limited by sex. Men develop fibroadenomas, gynecomastia-related changes, breast cysts, and breast injuries, and male breast conditions are evaluated under the same criteria. If a claim is denied on the basis that the code does not apply to men, that reasoning is worth challenging directly in a supplemental claim.