VA Disability Ratings for Gynecological Conditions
Emma Peterson: Welcome to another edition of CCK Live. Today we’re going to be talking about VA disability for gynecological conditions. My name is Emma Peterson, and I’m joined today by my colleagues Kaitlyn Degnan and Kayla D’Onofrio.
So, we’re just going to jump right in. So, a gynecological condition is one that affects female reproductive organs. It includes, also, the breasts and organs in the abdominal and pelvic area. Areas might include the uterus, the ovaries, fallopian tubes, vagina, or vulva, and many women experience gynecological problems in their lifetime and some can be quite serious.
Kayla, can you walk us through some common conditions?
Kayla D’Onofrio: Sure. So, some of the more common gynecological conditions that we see are cervical dysplasia, which is a precancerous condition of the cervix caused by the Human Papilloma Virus, or HPV. Another one is menstrual disorders, which include a whole bunch of different disorders under that umbrella, including things like endometrial cancer, endometrial polyps, endometriosis, polycystic ovary syndrome, or PCOS, which I’ll talk about a little bit more later, or dysfunctional uterine bleeding, which would be heavier, prolonged menstrual bleeding.
Another one is pelvic prolapse, which is a weakening of the tissue that’s caused by the physical stress of pregnancy or childbirth and can lead to the walls of the vagina breaking down which then causes the pelvic organs that are held in place by those now weakened tissues and ligaments within the pelvis to slip out of place. Chronic pelvic pain is another common condition, which is characterized by persistent pain between the belly button and pubic bone that lasts for longer than six months.
I mentioned before polycystic ovary syndrome, or PCOS. This is a hormonal disorder resulting infrequent or prolonged menstrual periods or excess levels of the male hormone androgen. The ovaries may develop numerous small collections of fluid or cysts and fail to regularly release new eggs.
Uterine fibroids is another common condition which is a benign tumor that develops in the uterus, most typically during childbearing years. And the last one that we’ll talk about is urinary incontinence, which is the involuntary leakage of urine.
Emma: Thanks, Kayla. So, Kaitlyn how does VA go about rating these various conditions?
Kaitlyn Degnan: So, VA actually just started updating its rating schedules back in September of 2017. So, back on May 13th, 2018, a new rating schedule for gynecological conditions and disorders of the breasts became effective. These changes included several new diagnostic codes, it retitled some of the old diagnostic codes, restructured some of the codes, or just updated them. And the reason for these changes is to really try and ensure that both men and women veterans are evaluated equally.
Emma: So, for veterans that are seeking service connection for these conditions, they still need the standard three elements for service connection. They’re going to need a current diagnosis of a condition, an in-service event or injury, and a nexus linking the two. So, in many cases, veterans are going to need to attend a C&P examination for VA to assess the cause and severity of the disability. And a VA gynecologist, OBGYN, other health care professional will ask questions about the condition and what symptoms.
In other cases, the examiner is going to have to perform tests to rule out other potential conditions. And then once the examiner has landed on a particular diagnosis, we’re going to have to use the ‘at least as likely as not’ standard to determine whether or not the condition is related to veterans’ time in service. Once service connection is established, VA uses the rating schedule that Kaitlyn was just talking about, and it’s under 38 CFR 4.116, to determine what rating you would be assigned based on the severity of your disability.
Kayla, is there anything that veterans can get in terms of Special Monthly Compensation (SMC) due to gynecological conditions?
Kayla: Yeah, absolutely. So, section, or title 38 of the United States code under Section 1114k has a list of different conditions that may be compensated under this rate. Basically what VA would be paying you for would be loss of use of what they call a creative organ, which would mean if you have a service-connected condition where you now have the removal of one or both of your ovaries, a hysterectomy, something like that, or you have the loss of 25 percent or more of the tissue from one or both of your breasts, they’ll pay you at this rate. As of December 1st, 2021, that rate is $118. And this is a rate that’s paid in addition to your regular monthly compensation, even if your rating is 0%.
Emma: And does VA offer any other services for veterans with gynecological conditions?
Kayla: Yes. So, in addition to just the regular compensation, they do have infertility services. So, basically through VA Healthcare enrolled veterans have access to many different types of fertility treatments, procedures, services, including infertility counseling, laboratory blood testing, genetic counseling, sperm testing, ultrasound surgery, reversal of a vasectomy, or tubal ligation, access to different medications, and more.
As a note, before I go any further, I just want to note that infertility in and of itself is not a condition that VA is able to grant service connection for. They may grant you service connection for an underlying condition that has led to infertility, but infertility in and of itself is not something that they’ll pay you any sort of a compensable rating for.
If a veteran with a certain service-connected condition has infertility, or they or their spouses may also be eligible for in vitro fertilization, or IVF treatments, or another form of assisted reproductive technology services. Coverage for these types of services are determined on a case-by-case basis. They will send you to a VA Medical Center and perform an infertility evaluation, and then the results of that evaluation will kind of determine what coverage you may be eligible for.
In order to qualify for this benefit, the veteran must be legally married. They must have a service-connected condition that causes the infertility. The veteran or their spouse must have an intact uterus and at least one functioning ovary, or cryopreserve eggs. Or the veteran or their spouse must have, must be able to produce sperm or have their own cryopreserved sperm.
Kaitlyn: VA will also provide breast imaging services. So, VA’s performance measurements have shown that women veterans are much more likely to receive age-appropriate breast cancer screenings, than women using private sector healthcare. And 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 at VA or through care in the community.
Emma: Great. Thank you both. Any final thoughts, Kayla, just about veterans seeking service connection for these conditions or things you’ve seen in your experience as an advocate.
Kayla: I would just say that we kind of see disproportionate rates of female veterans or women veterans being compensated for these, versus our male veterans. I think it’s really important that VA is now kind of considering these conditions and have restructured their rating schedule that Kaitlyn was talking about in a way that compensates them a little bit more fairly.
If you are seeking service connection for any of these conditions, as always, we do encourage attending any exams that might be scheduled and being honest with your conditions. But if you are not really sure what to do, definitely feel free to reach out to another accredited representative, a VSO, or an attorney. They may be able to point you in the right direction.
Emma: Great. Thanks. Kaitlyn, any final thoughts?
Kaitlyn: So, I just would like to echo what Kayla said about attending your examinations. A lot of times with these kinds of conditions, you might not realize that it’s something that is related to a service-connected disability or something that you could even get compensated for. And the only reason that… The only way you’re going to be able to put that to VA’s attention is if you are telling your examiner about this, making sure these issues are evaluated. So, it really is so so important to be specific and be very honest with your VA examiner to make sure all the possible effects that are resulting from a service-connected condition are recorded in an examination so that you can kind of explore what your options are.
Emma: I agree, and I think it’s important to remember that a service-connected disability doesn’t have to be due to some specific event in service. It just has to arise coincident with service. A lot of service members out there are young and perhaps of childbearing years. So, if you happen to have had a child during service and any of these conditions resulted, while you’re on active duty or active service, you may be entitled to benefits. So, it might not be something that you necessarily think of as being something service-connected but, in fact, it could happen to you in service. You may very well be, so be sure to reach out and explore your options.
So, that wraps up our discussion for today. Short and sweet, but hopefully gave you some good information about VA ratings for gynecological disabilities. More information about this and other VA benefits can always be found on our website, and please be sure to check out our other videos and subscribe to our channel. Thanks again for watching.
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