VA Disability Benefits for Gynecological Conditions

CCK Law: Our Vital Role in Veterans Law

What Are Gynecological Conditions?

A gynecological condition is one that affects the female reproductive organs: the breasts and organs in the abdominal and pelvic area including the uterus, ovaries, fallopian tubes, vagina, and vulva.  Many women experience gynecological problems in their lifetime, and some can be quite serious.  The following are some common gynecological conditions:

• Cervical dysplasia – A precancerous condition of the cervix, caused by the human papillomavirus (HPV).
• Menstrual disorders – e.g., endometrial cancer, endometrial polyps, endometriosis, polycystic ovarian syndrome, dysfunctional uterine bleeding (heavy or prolonged menstrual bleeding).
• Pelvic prolapse – The pelvic organs (vagina, bladder, rectum, and uterus) are held in place by connective tissue and ligaments within the pelvis.  The physical stress of pregnancy, childbirth, and the weakening of tissue can lead to the walls of the vagina breaking down.
• Chronic pelvic pain – Persistent pain between the belly button and pubic bone that lasts for longer than six months.
• Polycystic ovary syndrome – A hormonal disorder resulting in infrequent or prolonged menstrual periods or excess male hormone (androgen) levels.  The ovaries may develop numerous small collections of fluid and fail to regularly release eggs.
• Uterine fibroids – Benign tumors that develop in the uterus most typically during the childbearing years.
• Urinary incontinence – The involuntary leakage of urine.

VA Adds Gynecological Conditions to Rating Schedule in May 2018

In September 2017, VA began updating its Schedule for Rating Disabilities.  On May 13, 2018 the new rating schedule for gynecological conditions and disorders of the breast became effective.

While no conditions were removed from the new rating schedule, several new diagnostic codes were added and others were re-titled, restructured, or updated.  The new rating schedule guarantees both men and women veterans are evaluated equally in this regard.

Service Connection for Gynecological Conditions

Women veterans with a gynecological conditions may be entitled to VA disability benefits if the condition is related to their military service.  First, they must establish service connection for their condition by providing evidence of the following:

• A current diagnosis of a gynecological condition;
• An in-service event, injury, or illness; and
• A medical nexus linking the current, diagnosed gynecological condition to the in-service event.

C&P Exams for Gynecological Conditions

In many cases, veterans who file a claim for a gynecological condition will attend a compensation & pension (C&P) examination.  This allows VA to assess the cause and/or severity of their condition.

During the exam, a VA gynecologist or healthcare professional will ask the veteran questions about their condition and what they are experiencing.  In certain cases, the examiner will perform tests in order to rule out other potential conditions.  Once a diagnosis is established, the VA examiner will provide an opinion as to whether the veteran’s condition is “at least as likely as not” due to their time in service.

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How VA Rates Gynecological Conditions

Once service connection is established, VA will assign a disability rating.  VA rates gynecological conditions under 38 CFR § 4.116, Schedule of Ratings – Gynecological Conditions and Disorders of the Breast.  Ratings range from 0 to 100 percent, with individual rating criteria for each gynecological condition. 

For example, for endometriosis under diagnostic code 7629, a veteran can be rated at a 10, 30, or 50 percent, depending on the severity of the endometriosis.  A veteran with “lesions involving bowel or bladder confirmed by laparoscopy, pelvic pain or heavy or irregular bleeding not controlled by treatment, and bowel or bladder symptoms” would receive a 50 percent rating, while a veteran with “pelvic pain or heavy or irregular bleeding requiring continuous treatment for control” would be assigned a 10 percent.

Special Monthly Compensation

Veterans who have experienced the loss of or loss of use of a creative organ due to a service-connected gynecological condition may be eligible for Special Monthly Compensation (SMC) under 38 U.S.C. 1114(k).  For example, veterans who underwent a hysterectomy may qualify for SMC(k).

As of 2022, the rate for SMC(k) is $118.33, which is added to a veteran’s standard disability pay.

Other VA Services for Women

VA offers several services for eligible veterans, including infertility services and breast imaging.

VA Infertility Services

Through VA health care, enrolled veterans have access to many different types of fertility treatments, procedures, and services, including:

• Infertility counseling
• Laboratory blood testing
• Genetic counseling
• Sperm testing
• Ultrasounds
• Surgery
• Reversal of a vasectomy or tubal ligation
• Medication
• And more.

It important to note that veterans cannot be directly service connected for infertility.

Veterans with certain service-connected conditions that result in infertility, and their spouses, may be eligible for in vitro fertilization (IVF) or another form of assisted reproductive technology services.  According to VA, coverage is determined case by case, based on an infertility evaluation at a VA medical center.  Qualified veterans or their spouses may be eligible for up to three IVF treatment cycles.  To qualify for this benefit:

• The veteran must be legally married;
• The veteran must have a service-connected condition causing infertility;
• The veteran or spouse must have an intact uterus and at least one functioning ovary or own cryopreserved eggs; and
• The veteran or spouse must be able to produce sperm or own cryopreserved sperm.

VHA Breast Imaging Services

In an effort to improve access to breast screening, VA has expanded access to onsite mammograms by 62 percent since 2010.  As of 2019, VHA has 67 mammography programs.  Some facilities offer mammograms to walk-in patients and same-day ultrasounds.  All eligible women veterans have access to mammograms either on-site or through care in the community.

VA’s performance measurements show that women veterans are much more likely to receive age-appropriate breast cancer screenings than women in private-sector health care.  In 2015, VA screened 86 percent of its women veteran patients aged 50 to 74, compared with the private sector at 73 percent.

Was Your Disability Claim Denied?

If VA denied your claim for your service-related gynecological condition, Chisholm Chisholm & Kilpatrick may be able to help you appeal the decision.  The veterans’ advocates at CCK have helped many veterans secure rightfully earned benefits for their service-related injuries.  We also have decades of demonstrated success in representing veterans before VA and the Court of Appeals for Veterans Claims.

Reach out to CCK today to schedule a free consultation.