Secondary Conditions to Hysterectomy
What is a Hysterectomy?
A hysterectomy is an operation which is performed to remove the uterus. The uterus is a female reproductive organ located between the bladder and the rectum. Removing the uterus means that the individual will no longer be able to become pregnant. This procedure is very common in the United States.
Why Might A Hysterectomy Be Performed?
Hysterectomies can be used to treat a variety of health conditions, such as:
- Uterine fibroids (i.e., most common reason for a hysterectomy)
- Endometriosis (i.e., the lining of the uterus grows outside of the uterus)
- Pelvic support problems (e.g., uterine prolapse)
- Abnormal uterine bleeding
- Chronic pelvic pain
- Gynecologic cancer
Types of Hysterectomy
- Total Hysterectomy— This form of hysterectomy removes the entire uterus, including the cervix. The cervix is the tissue that connects the vagina and the uterus.
- Partial Hysterectomy— A hysterectomy that removes the upper part of the uterus but leaves the cervix in place.
- Radical Hysterectomy— A form of total hysterectomy that may also involve the removal of structures around the uterus. This may be performed if cancer is present.
Establishing Service Connection for Hysterectomy
In most cases, there are three things needed to establish service connection:
- A current diagnosis by a medical professional;
- An in-service cause or event;
- A nexus that establishes a clear connection between the diagnosed condition and the veteran’s in-service cause or event
With a hysterectomy, the diagnosis will typically be the medical diagnosis which required the hysterectomy to be performed. For example, a diagnosis of cervical cancer may require a hysterectomy.
As for an in-service cause or event, an example, in the instance of cervical cancer, could be exposure to certain toxins such as burn pits, Agent Orange, or ionizing radiation. Another example may be a gunshot wound to the abdomen that causes damage to the uterus or surrounding structures.
How VA Rates Hysterectomy
A hysterectomy is rated under 38 CFR § 4.116, Diagnostic Codes 7617 and 7618. Ratings are assigned based on the type of hysterectomy performed and the amount of time that has passed since the surgery.
For women veterans who have had both their ovaries and uterus removed, VA will use Diagnostic Code 7617 and the following criteria:
- 100% – for three months after removal
- 50% –thereafter
For women veterans who have had the uterus removed during the hysterectomy, VA will use Diagnostic Code 7618 and the following criteria:
- 100% – for three months after removal
- 30% –thereafter
For general diseases, injuries, or adhesions of the female reproductive organs, VA will use Diagnostic Code 7615.
Establishing Secondary Service Connection
Secondary service connection is another form of service connection available to veterans who may have a condition that was caused or aggravated by an already service-connected condition. Conditions that are secondary service connected are compensated in the same way as primary service-connected conditions.
An example of a condition secondary to a hysterectomy may be depression. For example, if a veteran intended to become pregnant after their service but had to have a hysterectomy due to their service, that veteran may become depressed as a result. The veteran then may be able to receive VA disability benefits for depression secondary to a hysterectomy.
Common Secondary Conditions Related to Hysterectomy
Several conditions can be caused or aggravated by a hysterectomy. Additionally, a hysterectomy may be secondary service connected to another condition. Below is a non-exhaustive list of some of the most common examples of both forms of secondary service connection:
Depression Secondary to Hysterectomy
As mentioned above, depression can be related to a hysterectomy because of the way it relates to childbearing. If a veteran desires to become pregnant post-service, and can no longer as the result of a service-connected hysterectomy, they may become depressed.
Some studies have found that women who have had a hysterectomy have a higher risk of depressive symptoms than those who have not. Of course, every situation is different and the circumstances for why a person may need a hysterectomy varies.
PTSD Secondary to Hysterectomy
PTSD, like depression, can also be linked to a hysterectomy. For example, if the hysterectomy causes symptoms of PTSD, such as intrusive thoughts, reduced interest in favorite activities, nightmares, or self-isolation, they may be eligible for disability benefits for PTSD secondary to a hysterectomy.
As mentioned above, another example could be if a female veteran was shot in the abdomen, damaging the female reproductive organs and causing the need for a hysterectomy. The veteran would be eligible for PTSD secondary to a hysterectomy if the trauma of being shot caused the veteran to develop PTSD, as well as the need for a hysterectomy.
Another potential cause of a hysterectomy in female veterans could relate to military sexual trauma (MST). Research published in Military Medicine has indicated that MST and PTSD exposure were associated with a higher of a hysterectomy in female veterans. Female veterans who are survivors of MST may face increased gynecologic symptoms, such as pelvic pain, which could explain why they are at a higher risk for hysterectomy. If a veteran experiences PTSD as a result of MST which required a hysterectomy, the veteran could receive benefits for PTSD secondary to a hysterectomy.
Hysterectomy Secondary to Uterine Fibroids
Fibroids are a form of tumor that can develop in the ovaries (ovarian cysts or fibroids) or the uterus (uterine fibroids). Sometimes a veteran who has cysts or uterine fibroids may need to undergo a partial or total hysterectomy. As a result, veterans who require a hysterectomy because of cysts or uterine fibroids may be eligible to receive benefits for a hysterectomy secondary to cysts or uterine fibroids.
Hysterectomy Secondary to Endometriosis
Endometriosis is a disorder that affects the female reproductive system. Specifically, it occurs when the endometrial tissue is present outside of the uterus. If a person has endometriosis, a hysterectomy may be performed to remove the uterus.
If a veteran’s service-connected endometriosis requires a hysterectomy, then they may be awarded benefits for a hysterectomy secondary to endometriosis.
TDIU and Secondary Service Connection for Hysterectomy
Total disability based on individual unemployability, or TDIU, is a monthly benefit available to veterans who are unable to obtain or maintain substantial employment on account of their service-connected disability or disabilities. This benefit compensates veterans at the 100 percent rating, even if their combined rating does not meet 100 percent.
VA outlines TDIU regulations under 38 CFR § 4.16, which includes subsections (a) and (b). In order to qualify for TDIU under 38 CFR § 4.16(a), or schedular TDIU, a veteran must have:
- One service-connected condition rated at 60% or higher; or
- Two or more service-connected conditions, one of which is rated at 40% or higher, with a combined rating of 70% or higher.
The ratings given to secondary service-connected conditions can also apply to the criteria for schedular TDIU. Essentially, this means that any rating given to a hysterectomy and a rating given to the secondary service-connected condition can apply to help veteran’s reach the combined rating of 70 percent or higher.
While the rating percentage immediately following a hysterectomy is 100 percent, the ratings typically get reduced after three months. As such, any ratings for secondary service-connected conditions can help a veteran reach the criteria for TDIU and receive the 100 percent pay rate after their initial hysterectomy rating has been reduced. For example, if a veteran is service connected for PTSD secondary to a hysterectomy, they may have a rating of 30 percent for a hysterectomy and 50 percent for their PTSD. With these ratings, the veteran could then meet the criteria for schedular TDIU.
Veterans who do not meet the schedular requirements under 38 CFR § 4.16(a) may still be considered for extraschedular TDIU under § 4.16(b). VA will determine if their case should be referred to the Director of Compensation Service for extraschedular consideration.
Getting Help with Secondary Service Connection for a Hysterectomy
Sometimes accredited representation may be beneficial to veterans who need help getting secondary service connected. If your claim for a secondary condition to hysterectomy, or even service connection for a hysterectomy, was denied, the experienced team at CCK may be able to help. Contact our office today for a free case evaluation.
