Overview of VA Gynecological Ratings

Gynecological conditions affect the female reproductive system and can significantly impact a veteran’s quality of life, ability to work, and overall health. Military service can contribute to or aggravate gynecological conditions through various factors including physical demands, stress, environmental exposures, delayed medical treatment, and service-related injuries or surgeries.

The VA rates gynecological conditions under 38 CFR § 4.116, Schedule of Ratings—Gynecological Conditions and Disorders of the Breast. This section provides detailed guidance on how the VA evaluates these conditions and what evidence you need to support your claim.

Important Notes About Gynecological Ratings

The VA has specific guidelines for rating gynecological conditions:

Special Monthly Compensation (SMC) Eligibility

When evaluating any claim involving loss or loss of use of one or more reproductive organs, or anatomical loss of one or both breasts, you may be entitled to Special Monthly Compensation under 38 CFR § 3.350. This provides additional monthly payment beyond your disability rating.

General Rating Formula for Female Reproductive Organs

Overview of Female Reproductive Organ Conditions

The VA uses a general rating formula for diseases, injuries, or adhesions affecting the female reproductive organs. This formula applies to conditions rated under diagnostic codes 7610 through 7615, which include:

• DC 7610: Vulva or clitoris, disease or injury of (including vulvovaginitis)
• DC 7611: Vagina, disease or injury of
• DC 7612: Cervix, disease or injury of
• DC 7613: Uterus, disease, injury, or adhesions of
• DC 7614: Fallopian tube, disease, injury, or adhesions of (including pelvic inflammatory disease)
• DC 7615: Ovary, disease, injury, or adhesions of

General Rating Formula for Disease, Injury, or Adhesions of Female Reproductive Organs (Diagnostic Codes 7610-7615)
Rating	Criteria
30%	Symptoms not controlled by continuous treatment
10%	Symptoms that require continuous treatment
0%	Symptoms that do not require continuous treatment

Vulva or Clitoris Conditions (DC 7610)

This diagnostic code covers diseases or injuries affecting the vulva (external female genitalia) or clitoris, including vulvovaginitis (inflammation of the vulva and vagina).

Common conditions rated under DC 7610 include:

• Vulvovaginitis: Inflammation or infection of the vulva and vagina
• Lichen sclerosus: Skin condition causing white patches and thinning skin
• Vulvar vestibulitis: Pain in the vestibule (opening) of the vagina
• Traumatic injuries: Service-related injuries to the vulva or clitoris

Vaginal Conditions (DC 7611)

This diagnostic code covers diseases or injuries of the vagina.

Common conditions rated under DC 7611 include:

• Vaginal atrophy: Thinning and inflammation of vaginal walls
• Vaginal stenosis: Narrowing of the vaginal canal
• Chronic vaginitis: Ongoing inflammation or infection
• Traumatic injuries: Service-related vaginal injuries
• Adhesions: Scar tissue causing vaginal tissues to stick together

Cervical Conditions (DC 7612)

This diagnostic code covers diseases or injuries of the cervix (the lower part of the uterus that opens into the vagina).

Common conditions rated under DC 7612 include:

• Cervicitis: Inflammation of the cervix
• Cervical dysplasia: Abnormal cell growth on the cervix (not cancer)
• Cervical incompetence: Weakening of the cervix
• Cervical stenosis: Narrowing of the cervical opening
• Traumatic injuries: Service-related cervical injuries

Uterine Conditions (DC 7613)

This diagnostic code covers diseases, injuries, or adhesions of the uterus (womb).

Common conditions rated under DC 7613 include:

• Chronic endometritis: Ongoing inflammation of the uterine lining
• Adenomyosis: Uterine lining grows into the muscular wall
• Uterine adhesions (Asherman’s syndrome): Scar tissue inside the uterus
• Uterine prolapse: See separate section on Pelvic Organ Prolapse (DC 7621)

Uterine Fibroids

Uterine fibroids (also called leiomyomas or myomas) are noncancerous growths in the uterus. They can cause heavy bleeding, pelvic pain, and pressure symptoms.

While fibroids themselves are benign neoplasms rated under DC 7628, the symptoms they cause (pain, heavy bleeding, pelvic pressure) are rated under DC 7613 using the general rating formula based on whether symptoms require continuous treatment.

Pelvic Inflammatory Disease (PID) (DC 7614)

Pelvic Inflammatory Disease (PID) is an infection of the female reproductive organs, usually caused by bacteria spreading from the vagina to the uterus, fallopian tubes, or ovaries. PID can cause chronic pelvic pain, scarring, and fertility problems.

PID is specifically mentioned in DC 7614 (Fallopian tube, disease, injury, or adhesions of) and is rated using the general rating formula.

Ovarian Conditions and Cysts (DC 7615)

This diagnostic code covers diseases, injuries, or adhesions of the ovaries, including ovarian cysts.

Common conditions rated under DC 7615 include:

• Ovarian cysts: Fluid-filled sacs on the ovaries
• Polycystic ovary syndrome (PCOS): Hormonal disorder causing enlarged ovaries with cysts
• Ovarian torsion: Twisting of the ovary (medical emergency)
• Chronic oophoritis: Inflammation of the ovaries
• Ovarian adhesions: Scar tissue on or around the ovaries

Hysterectomy

Overview of Hysterectomy

A hysterectomy is the surgical removal of the uterus. There are different types of hysterectomy:

• Partial (subtotal) hysterectomy: Removal of the upper part of the uterus, leaving the cervix in place
• Total hysterectomy: Removal of the entire uterus including the cervix
• Total hysterectomy with bilateral salpingo-oophorectomy: Removal of the uterus, cervix, both fallopian tubes, and both ovaries
• Radical hysterectomy: Removal of the uterus, cervix, upper vagina, and surrounding tissues (usually for cancer)

The VA provides specific ratings for hysterectomy based on what was removed and when the surgery occurred.

Service Connection for Hysterectomy

To establish service connection for hysterectomy, you must demonstrate:

1. Current Diagnosis: Medical records documenting that you had a hysterectomy
2. In-Service Event or Condition: The underlying condition that required the hysterectomy was caused or aggravated by service
3. Medical Nexus: A medical link between the hysterectomy and your military service

Common reasons for service-connected hysterectomy include:

VA Disability Ratings for Hysterectomy

The VA provides different ratings depending on whether both ovaries were removed along with the uterus:

Diagnostic Code 7617 – Uterus and Both Ovaries, Removal of, Complete
Rating	Criteria
100%	For three months after removal
50%	Thereafter (permanent rating)

Diagnostic Code 7618 – Uterus, Removal of, Including Corpus
Rating	Criteria
100%	For three months after removal
30%	Thereafter (permanent rating)

Evidence Needed for Hysterectomy Claims

To support your claim for hysterectomy, gather the following evidence:

Tips for Successful Hysterectomy Claims

• Identify the Correct Diagnostic Code: Determine whether both ovaries were removed (DC 7617) or if ovaries were preserved (DC 7618). Your surgical records will specify this.
• Document All Complications: Keep detailed records of any ongoing problems after the surgery including pain, adhesions, hormonal issues, or emotional effects.
• Establish Service Connection for Underlying Condition: Show that the condition requiring hysterectomy (endometriosis, fibroids, abnormal bleeding, etc.) was caused or aggravated by service.
• Get a Strong Nexus Letter: If the hysterectomy occurred years after service, a medical opinion explaining how your service-connected condition led to the need for surgery is crucial.
• File for Secondary Conditions: Don’t forget to claim any secondary conditions such as depression, chronic pain, or other complications resulting from the hysterectomy.
• Check SMC Eligibility: Ask your VSO about Special Monthly Compensation eligibility for loss of reproductive organs.

Ovary Removal

Overview of Ovary Removal

Removal of one or both ovaries (oophorectomy) may be necessary due to various conditions including ovarian cysts, cancer, endometriosis, or chronic pelvic pain. The ovaries produce hormones (estrogen and progesterone) that regulate the menstrual cycle and affect overall health.

Types of ovary removal:

• Unilateral oophorectomy: Removal of one ovary
• Bilateral oophorectomy: Removal of both ovaries
• Partial oophorectomy: Removal of part of an ovary

Service Connection for Ovary Removal

Service connection for ovary removal follows the same three-part test as other conditions. Common scenarios include:

• Ovary removal during service for ovarian cysts, torsion, or other acute conditions
• Ovary removal after service for a condition that began or was aggravated during service
• Removal due to service-connected endometriosis or other gynecological conditions
• Removal due to ovarian cancer related to service exposures

VA Disability Ratings for Ovary Removal

Diagnostic Code 7619 – Ovary, Removal of
Rating	Criteria
100%	For three months after removal
Thereafter:
30%	Complete removal of both ovaries
0%	Removal of one with or without partial removal of the other

Diagnostic Code 7620 – Ovaries, Atrophy of Both, Complete
Rating	Criteria
20%	Complete atrophy (wasting away) of both ovaries

Evidence Needed for Ovary Removal Claims

Tips for Successful Ovary Removal Claims

• Clarify What Was Removed: Your surgical records should clearly state whether one or both ovaries were removed. This determines your rating.
• Document Menopausal Symptoms: If both ovaries were removed, document the effects of surgical menopause including hot flashes, mood changes, sleep problems, and bone density loss.
• Consider Hormone Replacement Therapy (HRT) Records: If you need HRT, this demonstrates the ongoing impact of ovary removal.
• Claim Secondary Conditions: File separate claims for conditions caused by ovary removal such as osteoporosis, cardiovascular changes, or mental health effects.
• Address the Special Rule: If you had one service-connected ovary removed and the other is nonfunctional (not service-connected), ensure the VA applies the special 30% rating rule.
• Check SMC Eligibility: Loss of both ovaries may qualify for Special Monthly Compensation.

Endometriosis

Overview of Endometriosis

Endometriosis is a condition where tissue similar to the lining of the uterus (endometrium) grows outside the uterus. This tissue can be found on the ovaries, fallopian tubes, outer surface of the uterus, bowel, bladder, or other pelvic organs.

Common symptoms of endometriosis include:

• Pelvic pain: Especially during menstrual periods, which may be severe
• Heavy or irregular bleeding: Heavy periods or bleeding between periods
• Pain during intercourse: Deep pelvic pain during or after sex
• Pain with bowel movements or urination: Especially during menstrual periods
• Infertility: Endometriosis can affect fertility
• Fatigue: Chronic fatigue is common
• Digestive problems: If endometriosis affects the bowel

Service Connection for Endometriosis

Establishing service connection for endometriosis can be challenging because symptoms often begin during reproductive years (which overlap with typical military service age) and the condition may not be diagnosed until years after symptoms start.

Ways to establish service connection:

VA Disability Ratings for Endometriosis

Endometriosis has its own specific diagnostic code (DC 7629) with a unique rating schedule:

Diagnostic Code 7629 – Endometriosis
Rating	Criteria
50%	Lesions involving bowel or bladder confirmed by laparoscopy, pelvic pain or heavy or irregular bleeding not controlled by treatment, and bowel or bladder symptoms
30%	Pelvic pain or heavy or irregular bleeding not controlled by treatment
10%	Pelvic pain or heavy or irregular bleeding requiring continuous treatment for control

Evidence Needed for Endometriosis Claims

Tips for Successful Endometriosis Claims

• Obtain Laparoscopy Records: The VA requires laparoscopic confirmation. If you don’t have these records, request them from the surgeon who performed the procedure.
• Document Treatment Failures: For 30% or 50% ratings, show that your symptoms are NOT controlled by treatment. Keep records of medications tried, side effects, and lack of symptom relief.
• Detail Bowel/Bladder Involvement: If your endometriosis affects your bowel or bladder, this can qualify you for the 50% rating. Document all related symptoms (painful bowel movements, rectal bleeding, urinary frequency, pain with urination, etc.).
• Address Service Connection Challenges: If your endometriosis wasn’t diagnosed until after service, provide buddy statements or personal statements showing you had symptoms during service, even if they weren’t fully evaluated at the time.
• Claim Related Conditions Separately: File separate claims for conditions caused by or related to endometriosis, such as:
  • Depression or anxiety (common with chronic pain)
  • Irritable bowel syndrome (may be secondary)
  • Bladder pain syndrome/interstitial cystitis (may overlap)
  • Infertility complications
• Get a Strong Nexus Opinion: A gynecologist’s opinion explaining how your service (stress, delayed treatment, physical demands) caused or aggravated your endometriosis can be very helpful.
• Consider Surgical Records: If you had a hysterectomy or ovary removal due to endometriosis, file claims for those surgeries as well using DC 7617, 7618, or 7619.

Pelvic Organ Prolapse

Overview of Pelvic Organ Prolapse

Pelvic organ prolapse occurs when a pelvic organ (bladder, urethra, uterus, vagina, small bowel, or rectum) drops (prolapses) from its normal place in the abdomen and pushes against the walls of the vagina. This happens when the muscles and tissues supporting the pelvic organs become weak or loose.

Types of pelvic organ prolapse include:

• Cystocele: Bladder drops into the vagina
• Urethrocele: Urethra drops into the vagina
• Uterine prolapse (or vaginal vault prolapse if no uterus): Uterus or top of vagina drops into the vaginal canal
• Rectocele: Rectum bulges into the back wall of the vagina
• Enterocele: Small intestine bulges into the vagina

Common symptoms include:

• Feeling of pressure or fullness in the pelvis
• Feeling like something is falling out of the vagina
• Visible bulge at the vaginal opening
• Problems with urination (leaking, urgency, difficulty emptying bladder)
• Problems with bowel movements (constipation, difficulty emptying bowels)
• Lower back pain
• Pain during intercourse

Service Connection for Pelvic Organ Prolapse

Ways to establish service connection for pelvic organ prolapse:

VA Disability Ratings for Pelvic Organ Prolapse

Diagnostic Code 7621 – Complete or Incomplete Pelvic Organ Prolapse Due to Injury, Disease, or Surgical Complications of Pregnancy
Rating	Criteria
10%	Any pelvic organ prolapse (complete or incomplete)

Evidence Needed for Pelvic Organ Prolapse Claims

Tips for Successful Pelvic Organ Prolapse Claims

• Document All Associated Symptoms: Don’t just claim the prolapse itself. File separate claims for urinary incontinence, bowel problems, chronic pelvic pain, or other related symptoms.
• Link to Service Activities: Explain the physical demands of your military service (heavy lifting, obstacle courses, combat gear, parachuting) and how these contributed to your prolapse.
• Address Childbirth if Relevant: If you had pregnancy complications while on active duty that contributed to prolapse, document this thoroughly.
• Include Surgical Repairs: If you’ve had prolapse repair surgery, document all procedures, complications, and residual effects.
• Secondary Conditions: Consider secondary connection if your prolapse was caused by chronic cough from service-connected asthma, constipation from service-connected IBS, or other service-connected conditions.
• Quality of Life Impact: Describe how prolapse affects your ability to exercise, work, have intimate relationships, and perform daily activities.

Menstrual Disorders

Overview of Menstrual Disorders

Menstrual disorders encompass a range of conditions affecting the menstrual cycle. These conditions are rated under DC 7615 (Ovary, disease, injury, or adhesions of) when they result from ovarian dysfunction.

Common menstrual disorders include:

• Dysmenorrhea: Painful menstrual periods
  • Primary dysmenorrhea: Painful periods without underlying disease
  • Secondary dysmenorrhea: Painful periods caused by conditions like endometriosis or fibroids
• Menorrhagia: Abnormally heavy or prolonged menstrual bleeding
• Metrorrhagia: Irregular bleeding between periods
• Secondary amenorrhea: Absence of periods for 3+ months in women who previously had regular periods (not including natural menopause or pregnancy)
• Oligomenorrhea: Infrequent or irregular periods
• Premenstrual syndrome (PMS) and Premenstrual dysphoric disorder (PMDD): Severe physical and emotional symptoms before menstruation

Service Connection for Menstrual Disorders

Establishing service connection for menstrual disorders:

VA Disability Ratings for Menstrual Disorders

Menstrual disorders resulting from ovarian dysfunction are rated under DC 7615 using the general rating formula:

Diagnostic Code 7615 – Ovary, Disease, Injury, or Adhesions of (Including Menstrual Disorders Due to Ovarian Dysfunction)
Rating	Criteria
30%	Symptoms not controlled by continuous treatment
10%	Symptoms that require continuous treatment
0%	Symptoms that do not require continuous treatment

Evidence Needed for Menstrual Disorder Claims

Tips for Successful Menstrual Disorder Claims

• Document the Ovarian Connection: Make sure your medical evidence shows that your menstrual disorder is due to ovarian dysfunction, not other causes.
• Show Continuous Treatment: For a 10% or higher rating, document ongoing treatment including medications, hormone therapy, or pain management.
• Demonstrate Lack of Control: For a 30% rating, show that despite continuous treatment, your symptoms are not controlled (persistent pain, heavy bleeding, etc.).
• Connect to Service: If your menstrual problems began or worsened during service, document the change in pattern with service medical records or buddy statements.
• Consider Underlying Conditions: If you have PCOS, ovarian cysts, or endometriosis, file separate claims for those conditions as well.
• Secondary Connection Options: If stress, PTSD, thyroid issues, or other service-connected conditions affect your menstrual cycle, pursue secondary service connection.

Fistulas (Rectovaginal and Urethrovaginal)

Overview of Fistulas

A fistula is an abnormal connection between two body parts. Gynecological fistulas create abnormal openings between the vagina and other organs:

• Rectovaginal fistula: Abnormal connection between the vagina and rectum, allowing stool and gas to pass from the rectum into the vagina
• Urethrovaginal fistula: Abnormal connection between the urethra and vagina, causing urine to leak into the vagina
• Vesicovaginal fistula: Abnormal connection between the bladder and vagina (less common, not specifically rated under DC 7625)

Fistulas can result from:

• Complications from childbirth (prolonged labor, traumatic delivery)
• Surgical complications (gynecological, colorectal, or urological surgery)
• Radiation therapy
• Severe infection or inflammatory disease
• Trauma or injury to the pelvic area
• Inflammatory bowel disease (Crohn’s disease)

Service Connection for Fistulas

Ways to establish service connection for fistulas:

VA Disability Ratings for Fistulas

Diagnostic Code 7624 – Fistula, Rectovaginal
Rating	Criteria
100%	Vaginal fecal leakage at least once a day requiring wearing of pad
60%	Vaginal fecal leakage four or more times per week, but less than daily, requiring wearing of pad
30%	Vaginal fecal leakage one to three times per week requiring wearing of pad
10%	Vaginal fecal leakage less than once a week
0%	Without leakage

Diagnostic Code 7625 – Fistula, Urethrovaginal
Rating	Criteria
100%	Multiple urethrovaginal fistulae
60%	Requiring the use of an appliance or the wearing of absorbent materials which must be changed more than four times per day
40%	Requiring the wearing of absorbent materials which must be changed two to four times per day
20%	Requiring the wearing of absorbent materials which must be changed less than two times per day

Evidence Needed for Fistula Claims

Tips for Successful Fistula Claims

• Document Leakage Frequency: Keep a detailed diary of leakage episodes to establish the rating level. Note dates, times, and severity.
• Save Receipts for Supplies: Keep receipts for pads, absorbent materials, or appliances as evidence of the frequency of changes needed.
• Include Failed Repair Attempts: If you’ve had surgery to repair the fistula that was unsuccessful, document this thoroughly.
• Address Quality of Life Impact: Describe the social isolation, emotional distress, and limitations that fistulas cause. This supports the overall claim even though it doesn’t directly affect the rating percentage.
• Claim Secondary Conditions: File separate claims for skin conditions, recurrent infections, or mental health conditions caused by the fistula.
• Get Specialist Confirmation: Have a colorectal surgeon or urogynecologist document the fistula and its characteristics.

Female Sexual Arousal Disorder (FSAD)

Female Sexual Arousal Disorder (FSAD) is rated under DC 7632. According to current VA regulations, FSAD receives a 0% rating.

Diagnostic Code 7632 – Female Sexual Arousal Disorder (FSAD)
Rating	Criteria
0%	Female sexual arousal disorder

FSAD may be service-connected if it results from:

• Service-connected gynecological conditions or surgeries
• Service-connected PTSD or other mental health conditions
• Service-connected injuries affecting sexual function
• Medications for service-connected conditions that affect sexual arousal

Malignant and Benign Neoplasms

The VA has specific rating codes for cancers and benign tumors of the gynecological system and breasts:

Malignant Neoplasms of Gynecological System (DC 7627)

Diagnostic Code 7627 – Malignant Neoplasms of Gynecological System
Rating	Criteria
100%	During active treatment (surgery, radiation, chemotherapy) and continuing for 6 months after treatment ends
Varies	After the 6-month period, rate chronic residuals (scars, lymphedema, disfigurement, impairment of function) under appropriate diagnostic codes

Benign Neoplasms (DC 7628)

Benign (non-cancerous) neoplasms of the gynecological system are rated based on their chronic residual effects. The benign neoplasm itself does not receive a separate rating; rather, the symptoms it causes are rated under the appropriate diagnostic codes.

For example:

• Uterine fibroids causing pain and bleeding → rate under DC 7613
• Ovarian cysts causing chronic pain → rate under DC 7615
• Benign tumor requiring surgical removal → rate any residuals from the surgery

Remember

Gynecological conditions often lead to secondary conditions that should be claimed separately, including:

• Mental health conditions: Depression, anxiety, PTSD related to chronic pain or gynecological trauma
• Sleep disorders: Insomnia due to chronic pelvic pain
• Digestive conditions: IBS or constipation related to endometriosis or adhesions
• Genitourinary conditions: Bladder problems, urinary incontinence, recurrent UTIs
• Sexual dysfunction: Pain with intercourse, relationship difficulties
• Chronic pain syndromes: Fibromyalgia, chronic fatigue may be secondary to gynecological conditions

Consider filing for these secondary conditions to maximize your overall disability rating and ensure you receive appropriate compensation for all effects of your service-connected gynecological condition.