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Monday, March 2, 2015

Proposed Changes to the Ratings for the Female Reproductive System Are Now Open to Comments

Last Friday, the 27th, Congress published their proposed changes to the Military Disability Ratings for the Female Reproductive System. The entire VASRD is currently being updated and rewritten, one section at a time, in order to update the criteria to current medical standards and to provide better, more accurate and fair compensation. The rewrites are scheduled to be completed sometime in 2016. The Female Reproductive System is the second section posted so far. The Mental Disorders section was updated in August 2014.

Comments are currently being accepted regarding the proposed changes to the Female Reproductive System. The deadline for submitting comments is April 28, 2015. We will be compiling and submitting comments on your behalf, so if you would like for your voice to be heard, please comment on this blog or Contact Us directly through our site before April 15, 2015. This is a great opportunity for us to make positive changes for the future, so please share your thoughts with us, especially you female veterans who deserve proper compensation for your conditions.

After April 28th, the rule makers will review all of the comments and determine if any additional changes should be made based on the arguments received. They will then post the final version of the new ratings for the Female Reproductive System, along with an official date for the new ratings to take affect. Once the changes are official, we’ll get that info to you as soon as possible. 

Below are the proposed changes. Not every condition/code has been changed, so if it is not listed below, then it will remain the same and can be found on our current Female Reproductive System page. I’ve started by listing the current code as it is right now. The proposed changes to each code are discussed directly after.

Code 7610: Diseases or injuries of the vulva (the part of the female genitals that are on the outside of the body).

The proposed change to code 7610 is super simple: to specify that this code includes the clitoris. The clitoris is already a part of the vulva, and all clitoris conditions should already be rated here, but I guess some people have been getting all confused. Thus the word “clitoris” is being specifically added in addition to “vulva” to get rid of any confusion. The ratings stay the same.

Code 7615: Diseases, injuries or adhesions of the ovaries.

The only change to this code will be a note specifying that dysmenorrhea (severe pain during menstruation) or secondary amenorrhea (the normal menstrual cycle is interrupted and menstruation stops completely for at least 6 months) caused by any of these problems with the ovaries will be rated under this code. The ratings stay the same.

Code 7619: the removal of one or both ovaries is rated 100% for the first 3 months after surgery. After that period, the complete removal of both ovaries is rated 30%. Anything less than the complete removal of both ovaries is rated 0%.

The change to this code is pretty awesome and too long in coming, if I say so myself. The change was made in order to make the female ratings for loss of the ovaries equal with the male ratings for loss of the testicles. It was acknowledged that the risk of future health problems due to the loss of the ovaries is just as severe as the risk of future health problems for men, so the ratings should be comparable. The new code with the changes will read as follows:

Code 7619: the removal of one or both ovaries is rated 100% for the first 3 months after surgery. After that period, the complete removal of both ovaries is rated 30%. A 30% rating is also given if a single service-connected ovary is removed and the other ovary has also been removed or doesn’t function at all, even if the problems with the second ovary are not related to service. Anything less than the complete removal or loss of use of both ovaries is rated 0%.

Code 7621: If the uterus slips down completely through the vagina, then it is rated 50%. If it slips down only partially through the vagina, then it is rated 30%.
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Code 7622: If the uterus does not slip down, but is significantly out of place, then it is rated under this code. If the displacement causes constant or frequent problems with menstrual periods, then it is rated 30%. If the displacement causes adhesions (scar tissue that causes the organs to stick together), and the menstrual periods are irregular, then it is rated 10%.
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Code 7623: If pregnancy causes the wall between the vagina and the rectum to tear, resulting in a rectocele (the rectum bulges into the vagina), or if it causes the wall between the bladder and the vagina to tear, resulting in a cystocele (the bladder bulges into the vagina), it is rated 50%. If the pregnancy causes the vagina to be loose or gaping, then it is rated 10%.

All three of these codes deal with the same basic thing: at least one of the pelvic organs (uterus, bladder, or rectum) is out of place and bulging into the vagina. Because of this, they are combining all three codes into a single code. Code 7622 and 7623 will not longer exist, and code 7621 will be changed as follows:

Code 7621: If any of the pelvic organs (the uterus, bladder, or rectum) are prolapsed (out of place) because of a disease, injury, or complications of pregnancy, it is rated under this code. This includes tears and bulges into the uterus or vagina, cystocele (the bladder bulges into the vagina), urethrocele (the urethra bulges into the vagina), rectocele (the rectum bulges into the vagina), enterocele (the small intestines and peritoneum bulge into the vagina), a perineal deficiency (the perineal muscles bulge into the vagina), or any combination. The ratings are based on how far the prolapsed organ protrudes into the vagina.

The severity of the prolapse is determined during examination by the Pelvic Organ Prolapse (POP) classification system as severe, moderate, or mild.

A 50% rating is given for a severe POP score where the prolapsed organ protrudes to within 2 cm of the vaginal opening.

A 30% rating is given for a moderate POP score where the prolapsed organ protrudes more than 1 cm past the hymen, but is more than 2 cm from the vaginal opening.

A 10% rating is given for a mild POP score where the prolapsed organ is within 1 cm below the hymen to 1 cm past the hymen.

Code 7627: Cancer of the female organs and breasts that is active is rated 100%. This 100% will continue for the first 6 months after the last treatment. The condition will then be reevaluated. If it is no longer active, then it will be rated on any lasting symptoms just like any benign condition.
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Code 7628: Benign tumors of the female organs and breasts are rated based on how they affect the systems around them….

Both of these codes consider breast cancer to be a female-only condition, but men can also get breast cancer. To fix this, codes 7627 and 7628 will only be for cancer and tumors of the female organs (not including the breasts).

Two new codes, 7630 and 7631, will be added for all breast cancer, male or female:

Code 7630: Cancer of the breasts that is active is rated 100%. This 100% will continue for the first 6 months after the last treatment. The condition will then be reevaluated. If it is no longer active, then it will be rated on any lasting symptoms just like any benign condition.

Code 7631: Tumors and other injuries of the breast are rated based on any remaining symptoms or on how they affect the systems around them. This includes scars, disfigurement, muscle loss, nerve damage, and any other complications.

I want to draw your attention to the fact that code 7631 not only includes benign tumors, but also any and all other injuries of the breast, like blast-trauma, or any complications to other parts of the body due to breast surgery. These codes will NOT replace code 7626 for removal of the breast.

Another new code is also being proposed to get female ratings more in line with the male ratings:

Code 7632: Female sexual arousal disorder (FSAD) is the inability get and stay aroused during sex. It is rated 0% unless there is physical damage to the genitals, in which case, it is rated under the codes for damaged parts. FSAD may be entitled to additional compensation under Special Monthly Compensation K.

These are all of the proposed changes to the Female Reproductive System. Again, let us know your thoughts, and we’ll send in a report with suggested changes to the committee. We’ll also let you know when all the changes are finalized and in effect.

31 comments:

  1. Now that FSAD may be recognized, what effect will it have as supporting evidence of MST, if any? As far as SMC(k), FASD should be considered the same way ED in men is. Yes, both vets may still be fertile, but the inability to perform is just as real in women as men. Additionally, the issue of repeated miscarriage from unknown etiology while on Active Duty should be considered as potentially ratable, and award SMC (k).

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    1. Thanks for your comment. You make some very valid points. With these new codes/ratings, FSAD will definitely be treated the same sexual dysfunction in men, which is far too long in coming. We'll add repeated miscarriages to our list of comments to submit. It's true that it is not currently being addressed at all, but could be a potentially significant issue. It'll be interesting to see how they respond to it if they do.

      As for FSAD being used as supportive evidence of MST, this is another great issue that they have not yet addressed. We'll make sure to ask this question, and will let you know if/when we get a response.

      Thank you so much for your excellent questions and issues to raise. We highly value the response of our veterans, and hope by encouraging this type of interaction, we might be able to affect change.

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    2. This is not true. Women will never be treated the same for sexual dysfunction. I was diagnosed with FSAD by my Dr., yet I had to get "approval" from a male psychiatrist in order to get my VA claim approved. This quack had NO idea what FSAD was - he spent 25 minutes of MY appt time looking up what FSAD was on his phone and then wrote in his summary that although I was diagnosed by someone else, he felt that I just had an emotional instability. OMG. And they wonder why no one wants to go get help.

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    3. I'm sorry to hear about your negative experience. While this is clearly still an issue, the VA is making changes to hopefully correct circumstances like yours. There is definitely still a ways to go, but changing the laws to ensure that the conditions are rated the same is a significant step. Hopefully through our encouragement, even bigger steps will be taken to ensure that each veteran is given the proper care.

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  2. I am trying to find information on uterine fibroids. Can anyone help me out?

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    1. Fibroids are considered "injuries" of the uterus for rating purposes and so are rated under code 7613.

      http://www.militarydisabilitymadeeasy.com/femalereproductive.html#diseases

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  3. Trying to find information about ectopic pregnancy.

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    1. Ectopic pregnancies are rated on whatever remaining symptoms that they cause. So if the fallopian tube is damaged or removed, it is rated under code 7614.

      http://www.militarydisabilitymadeeasy.com/femalereproductive.html#f

      Any other symptoms can be rated under the code that best covers the symptom.

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  4. I was diagnosed with cancer in the right breast and currently receiving 100% until I finish treatment. I wan to know what it will reduce to after treatment? The right breast had axillary sentienl node dissection only one node with a simple mastectomy. The left breast had a simple mastectomy.

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    1. A simple ("total") mastectomy is rated 50% for both breasts. It's rated under code 7626:

      http://www.militarydisabilitymadeeasy.com/femalereproductive.html#removal

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  5. Thank you Dr. Johnson,
    The reason I asked the question is I had axillary sentinel node removed in the right breast during my mastectomy does that change the rating to modified mastectomy rating?

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    1. Usually not. The removal of the sentinel lymph node is still considered a simple mastectomy. It usually only qualifies a modified radical mastectomy if all or most of the axillary lymph nodes are removed.

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  6. I had a hysterectomy which the VA approved for me to have done but refuse to rate me for. Should I submit the claim under Organ Removal instead? Fibroids were discovered during my first C&P after getting out of the military but didn't know this could be claimed. Can I submit a claim for that also?

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    1. Even though the VA approved you for the hysterectomy doesn't mean that it is service-connected and thus eligible for benefits.

      Since the fibroids were diagnosed within the first year after discharge, the VA will probably determine that those are service-connected. Were the fibroids the cause of the hysterectomy? If so, then you can submit a claim for "fibroids" and "hysterectomy secondary to fibroids", and you'll probably be successful with both.

      If, however, the fibroids were not the cause of the hysterectomy, then the hysterectomy probably will not be considered service-connected, no matter how you claim it.

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  7. Hi, I had partial hip surgery "impingement" would this be eligible for any disability; also what about an ablation prior to a hysterectomy? I also had a bladder sling? And a c- section?

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    1. All of your conditions are eligible, but only if they meet the requirements for service-connection. Either they had to be diagnosed while on active duty or they have to have another direct connection to your military service. Check out our Service-Connected page to see if your conditions meet the requirements. If so, they are eligible.

      http://www.militarydisabilitymadeeasy.com/service-connected.html

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  8. After gulf war, and being a chemical officer (2003 to 2004) in a smoke platoon, I had an ectopic two miscarriages and another ectopic where I lost the tube. I had a benign mass, and have had severe pain in ovaries often. Then in 2007 I finally was able to get pregnant after extensive infertility testing. I was an angel while pregnant (folic acid, three ultrasounds, etc.) Our daughter was born with numerous birth defects and a life threatening disorder. Is there info on if that would be accepted by VA. Had no previous issues prior to military. Thanks.

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    1. Oh, and it ended with a ablation Jan 2013. Luckily no hysterectomy

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    2. Most smoke screen chemicals are directly related to respiratory conditions, skin conditions, vision conditions, etc., but there is not as much evidence connecting smoke screens to fertility issues and birth defects.

      The type of smoke and the levels of exposure you experienced will dictate whether or not the VA will consider your conditions service-connected.

      If you have records regarding your exposures and the exact type, you can look up the type and determine whether or not any reproductive conditions are a result of your exposure.

      https://www.ncbi.nlm.nih.gov/books/NBK224729/

      You would have to show proof that you were exposed to the chemical above the safe exposure level.

      Regardless, it may be worth submitting a claim for it anyway. The VA may have additional data that would support your claim, depending on the chemicals involved. Just make sure you include the exact exposure evidence they'd need to determine this.

      Based on previous experience, it is unlikely that your claim will be successful, but there is always a chance.

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  9. Hi, I had a hysterectomy February 2014 and had everything removed except One ovary so I thought due to heavy menstruation and fibroids. I had Breast cancer while on active duty. I had a mastectomy of my right breast August 2011. I retired Dec 2014. I recently began having pain on the left side of my lower abdomen and went in and found that I had cysts over my ovaries as well as appendicitis. My appendix were removed. I do not think my appendicitis is service related. I just had all cysts removed along with my two ovaries. My doctor removed them for preventive measures due to my breast cancer. Can I be rated on the removal of my ovaries now because of it being linked to my cancer while I was on active duty? I was told one of my ovaries was removed during the hysterectomy but found recently that it was never removed. My doctor now does not think my ovaries and cysts are Connected to the hysterectomy. Wheras, I'm thinking had an ovary been removed I would not have all of these cysts again. Should I put in a claim for the removal of my ovaries and connect them to my cancer?

    ReplyDelete
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    1. Hi Avril -

      Unless your doctor will claim that the cysts were directly caused by your breast cancer or hysterectomy, the VA most likely will not consider them secondary to these issues. And since he is saying that they are not, then I don't think a claim will be successful. The connection to breast cancer is preventative, not causal, so again, the VA won't consider this caused by the breast cancer. Ultimately, I don't think a claim will be successful, but you could always try.

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  10. Hi,

    I was Dx with for pelvic pain and mittlesmertz in the military, got out in 2006, Dx with dysmenorrhea in 2007 by the va. Had already put a claim in for the pelvic pain and mittlesmertz and got denied. Years later, I've still had so much issues,treatments, fibroids issues, cysts issues and mennorghoria issues so I decided to repoeon my claims and put it under as menstual disorders. I also provided my va Dx from 2007 showing dysmenorrhea. I have done research recently and saw that it is an approved disorder. When the BA looks at it, if I get a rating, will they have my effective date of when dysmenorrhea was approved?

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    1. Dysmenorrhea is actually not a ratable condition. It can be considered service-connected, but does not qualify under the current ratings for anything more than a 0% rating unless it requires constant treatment (not just once a month when menstruating).

      The ratings noted above are proposed changes that have not gone into effect yet. And at present, there is not final date that they will, if ever.

      That being said, if the VA grants service-connection, then they will increase the rating if the law changes and allows it to be rated at a higher level.

      Cysts and fibroids are similar in that they will only qualify for a rating above 0% if they require constant treatment.

      http://www.militarydisabilitymadeeasy.com/femalereproductive.html#diseases

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  11. i had a hysterectomy while on mission Title 10 in DC for Op Noble Eagle.... several months later while still Title 10 I hurt my back- i was back at work one month later; very physical work; completing mission with less members than normal. i believe my back pain and injuries that i have been dealing with since is all related yet am having serious backlash from the VA or to get disability. i can barely move anymore, my core is entirely messed up. 3 back procedures and no disc with chronic pain at L5/S1... have you seen a relation to the two

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    1. The key is the original back injury. If it is something that could lead to degeneration, it might have caused it, but if it was just muscle strain, probably not. If it is connected, the VA normally assumes that it will show up (be diagnosed) within a year or so of the initial injury. When did the initial injury occur, when were you separated, and when did the degenerative issues in your spine first begin? If it is more than a few years between injury and diagnosis, then it will be incredibly difficult, if not impossible, to convince the VA that they are connected.

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  12. The proposal is nice but the problem I have is men get 20% for erectile dysfunction and SMC. This only gives women SMC. I also have a few questions I need help with. 1. I was service-connected for endometriosis. I had a hysterectomy in 2015 and we left one ovary. In 2017 I had to have the other ovary removed. My question is can I have file for the three months at 100% for the surgery in 2017 to remove my last ovary? My next question, when he comes to filing for special monthly compensation for losing a creative Organ or loss of use of creative Organ can you file for more than one I. e. uterus and ovaries or is it just one special monthly compensation. My last question is can you file for IBS/constipation secondary Narcotics and depression medicine used for a service-connected disability? Thanks

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    1. You don't technically file for SMC--it is given automatically if you qualify. So all you need to do is submit for the loss of the ovaries. The rules for SMC specify the specifics for testicles, and since they are extended many of the same considerations to women, they may judge your case similarly. If so, then they will rate you for each ovary separately.

      You can submit for the 2017 surgery but depending on the circumstances of it (service-connection, done by VA approval, etc.) they may not grant it.

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  13. I had uterine prolapse that I ended up having my uterus and cervix removed for. They also fixed a rectocele in the process. The surgery was the only solution to the problem. Now that I am getting ready to retire, will that rate loss of organ or the prolapse? Or loss of organ due to the prolapse? Since the "fixed" the rectocele (I still have issues) will that be rated? THis is all so confusing...

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    1. You'll be rated for the uterus removal under code 7618.

      http://www.militarydisabilitymadeeasy.com/femalereproductive.html#c

      Since you no longer have a prolapse or rectocele, those will not be rated. However, you mention you still have issues. Any symptoms that you still have can be rated.

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  14. Hello. I was checking my medical records and noticed that while I was in service there was several occasion that I went to sick call for abdominal pain. On 3 occasions the doctor did an ultrasound and found that I had cysts on my ovaries as well as fibroids on my uterus. I was never told this information by my doctor and I was never treated while in service for the cysts or fibroids. When I got out of the military in 2005 the abdominal pain continued and I ended up having a myomectomy to remove the fibroids in my uterus in 2010. I currently have abdominal pain on my left side that has been going on for the past few years. My doctor says it's Mittledmertz however since it has been giving me a lot of pain for a few years he is sending me to get an ultrasound to see if I have cysts on my ovaries and if I have fibroids have returned. My question is since this was diagnosed while I was in the military and I was never treated for it, will I be able to file a claim not only for the cysts but for the myomectomy to remove the fibroids?

    Thank you for your time.

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    1. Since it has been so long since you were separated, you will only be receive compensation back to your date of application. The cysts and fibroids are service-connected since they were diagnosed while on active duty, so they can be rated, but you'll again only receive compensation back to your date of application (which won't include any previous treatments, but will cover things in the future).

      Service-connection: http://www.militarydisabilitymadeeasy.com/service-connected.html

      Back pay:
      http://www.militarydisabilitymadeeasy.com/vadisabilitybackpay.html

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