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Wednesday, April 15, 2015

You Spoke, We Listened—The Comments Submitted on Your Behalf Regarding the Female Reproductive System Changes

At the beginning of March, we reported that the VA had made public their Proposed Changes to the Ratings for the Female Reproductive System. Full details about their proposed changes can be found in that article.

Whenever the VA makes changes like this, they always allow for comments on the proposed changes. We asked for feedback from you, our veterans, so that we could compile and submit a report detailing the main issues that you brought up. We had many people participate and submit comments, and we are excited to now report that we have submitted the following comments to the VA.

Thank you to all who replied. There were many great circumstances and arguments raised, and we feel that there is a good chance that our comments could make changes to the laws and have a hand in ensuring more fair and accurate ratings for our female veterans. We hope to be able to soon report a successful outcome after the VA has taken all comments into consideration and made the final ruling on the proposed changes. We’ll keep you updated.

The VA is rewriting the entire VASRD over the course of 2015 (it will most likely spill into 2016 as well), so many more opportunities will be coming to comment and make your voice be heard. As soon as each section of proposed changes is published, we’ll get a blog up and invite comments, so check back regularly to make sure that you have the chance to make a difference in your life and the lives of other disabled veterans.

Here is the report we filed with the VA in full:


As a national veterans’ organization, we at www.MilitaryDisabilityMadeEasy.com have the great opportunity to interact with a large number of disabled veterans, many of which are female. After blogging about the proposed changes to the Gynecological Conditions and Disorders of the Breast, we received numerous comments and opinions about the proposed changes. The following comments are compilations of the main issues our veterans brought to our attention. Thank you for taking our comments into consideration.

Item #1:

We would like to propose adding a new code or adjusting the proposed codes to include infertility due to the loss or loss of use of other organs besides the uterus and ovaries. While the uterus and ovaries provide the main source of female reproductive capabilities, the malfunctioning of other parts of the female reproductive system can also cause similar outcomes and significantly affect the ability of a woman to conceive and bear children.

While the use of analogous ratings could provide fair ratings for veterans, we have been familiarized with the stories of many veterans who have been denied a fair rating because of this flaw in the VASRD rating criteria.

In one particular instance, a veteran developed a severe infection while on active duty that resulted in the removal of one fallopian tube and the complete loss of use of the other. She was declared infertile at age 19. After leaving the military, she applied for disability benefits, but was only awarded a 0% rating under code 7614 for injury of the fallopian tubes. The rating criteria under this code only provides a compensable rating if there are active symptoms, but doesn’t take into account the loss of reproductive abilities. Looking at the codes (7617 – 7620) for loss or loss of use of the uterus or ovaries, the minimum rating for a condition that causes infertility is 20%. This rating does not take into account any symptoms at all, just whether or not the organs are able to function reproductively. As such, it would only make sense to have any damage to any part of the female reproductive system that causes infertility to be rated at least 20%. After 25 years and repeated appeals, this veteran is still only receiving a 0% rating for a condition that made her infertile, while many other veterans with the exact same symptoms, just different organs damaged, have ratings of 20% or more.

Item #2:

Although not directly related to the rating criteria, we would like to propose adding repeated miscarriages to the presumptive list for female veterans who have been exposed to radiation, herbicides, or other environments that could negatively impact the ability of a fetus to properly develop and carry to full term.

There is a large amount of direct evidence that exposure to radiation and other agents can have a huge impact on the life of an unborn child, even years after the mother was exposed. The largest cache of supportive data for this argument is undoubtedly the massive amount of birth defects found in children of Vietnamese mothers and female Vietnam veterans who had been exposed to Agent Orange. While the VA offers benefits for children born with birth defects of such female veterans, there are no direct benefits offered to veterans who are unable to bear children at all after the same exposure.  

Item #3:

One of our veterans argued the issue that “repeated miscarriages from an unknown etiology while on Active Duty should be considered as potentially ratable, and awarded Special Monthly Compensation (k).”


Item #4:

Finally, a question: With female sexual arousal disorder now recognized, how powerful will it be as supporting evidence for military sexual trauma?

2 comments:

  1. Clarity on code 7626, specifically as it relates to 'wide local excision with significant alteration of size or form' and reduction mammaplasty. The language in the CFR does not omit reduction mammaplasty commonly referred to as a breast reduction. However, after reading appeals on this common condition, it seems as if personal opinion influences the rater's decision. I've seen comments that note it as an elective surgery and the condition of the large breast exited upon entry into the military. Back and shoulder pain are the most common reason service members select to have this surgery performed. And if a competent military doctor makes a medical recommendation and performs the procedure (military covered procedures) why wouldn't it be rated? I see this being similar to those who come in wearing glasses, elect to have eye correction surgery and have residual affects from it. Please let me know your thoughts.


    7626 Breast, surgery of:

    Following radical mastectomy:

    Both 801
    One 501

    Following modified radical mastectomy:

    Both 601
    One 401

    Following simple mastectomy or wide local excision
    with significant alteration of size or form:

    Both 501
    One 301

    Following wide local excision without significant
    alteration of size or form:

    Both or one 0

    Note: For VA purposes:

    (1) Radical mastectomy means removal of the entire breast, underlying pectoral muscles, and regional lymph nodes up to the coracoclavicular ligament.

    (2) Modified radical mastectomy means removal of the entire breast and axillary lymph nodes (in continuity with the breast). Pectoral muscles are left intact.

    (3) Simple (or total) mastectomy means removal of all of the breast tissue, nipple, and a small portion of the overlying skin, but lymph nodes and muscles are left intact.
    (4) Wide local excision (including partial mastectomy, lumpectomy, tylectomy, segmentectomy, and quadrantectomy) means removal of a portion of the breast tissue.

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    Replies
    1. Hi Latasha -

      You are hitting on a very interesting point, and unfortunately, there is no set guidance on exactly how the VA should deal with breast reductions.

      Generally, breast reductions are thought to be cosmetic, but you are correct in that the majority are done to relieve back pain and other medical problems. As such, it should be treated as a medical procedure, not a cosmetic procedure. I personally agree that if the breast reduction is performed in order to relieve pain and other medical conditions that they cause, it should be considered a medical, not cosmetic procedure. Now, that does not mean that I personally feel that they should qualify for disability compensation as I will address below.

      Again, the VA has no strict rules or regulations pertaining to this topic. Because of this, the final decision on whether or not a breast reduction is ratable is left up to each individual rating authority who is reviewing each case.

      Now some arguments against rating a breast reduction:

      First, it IS a preexisting condition. The size of the breasts has nothing to do with a military career. It is a genetic predisposition. It did exist prior to service and is not exacerbated by a military career. Just because you decide to address the condition while you are in the military does not mean that it is a condition caused by your military service.

      Similarly, disability compensation is NOT given for a condition that is successfully treated. Ever. You mentioned laser eye surgery. Laser eye surgery is not ratable since the disability is fixed. After the surgery, there is no lose of vision, so there is no disability. No compensation is given if there is no disability. This is the case with every condition. If a procedure is performed and the condition is successfully resolved with no complications or leftover symptoms, then there is no disability and no compensation is given. In the majority of breast reduction cases, the original problems are satisfactorily resolved. There is no more back pain, etc. Thus, there is no longer a disability. No disability = no compensation.

      When you compare a breast reduction to a mastectomy, the huge difference is that a mastectomy usually causes disfigurement of some kind, especially if implants are not able to be used, while a breast reduction will normally leave the patient with no physical impairment.

      So, in most cases, a breast reduction cannot and should not be rated when compared to standard, fair practice.

      Now, are there some instances where a breast reduction should be rated? Possibly. And that is again left up to the judgement of the rating authority reviewing that particular case.

      One particular example would be if there are complications following the surgery. If any procedure authorized and performed by military or VA personnel causes any complications or other conditions, then those are automatically eligible for disability compensation, for in these cases, the military DID cause them. The procedure went wrong. The military personnel made a mistake, thus the military is responsible.

      Ultimately, the majority of breast reductions, in my opinion, should not be ratable based on EPTS and the lack of a remaining disability post-treatment. There are, however, some circumstances where a rating is necessary and fair. Again, though, since there isn't any firm regulation beyond the ones I've noted above, each case is up to the judgement of the individual rating authorities.

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