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Friday, April 13, 2018

Official Changes to the Ratings for the Female Reproductive System

On April 9th, 2018, the VA published their final changes to the ratings for the Female Reproductive System. Of the nine sets of changes that have been proposed as part of the VA’s complete rewrite of the VASRD, this is the fourth to be made official and final. 

The other finalized changes were to the ratings for Dental and Oral Conditions and the Endocrine System made last fall, and the Mental Disorders made in 2014. Other proposed changes include the Hemic and Lymphatic System, The Eyes, the Skin, the Genitourinary System, and the Musculoskeletal System

The following changes will go into effect May 13, 2018, and we’ll officially update all the information on our website at that time. Any Female Reproductive System conditions rated on or after May 13th will be based on these new ratings.

Below are the final changes for the ratings of the Female Reproductive System.

Not every condition/code is changing, 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 coming changes to each code are discussed directly after.
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Code 7610Diseases or injuries of the vulva(the part of the female genitals that are on the outside of the body). 

-New-Code 7610Diseases or injuries of the vulva and clitoris(the part of the female genitals that are on the outside of the body).

The only change to this code is to specify that it includes the clitoris. The clitoris is already a part of the vulva, and all clitoris conditions should already be rated here, but the VA wants to be clear. Thus the word “clitoris” is being specifically added in addition to “vulva” to get rid of any confusion. The ratings stay the same.
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Code 7615Diseases, injuries or adhesions of the ovaries

-New-Code 7615Diseases, injuries, or adhesions of the ovaries

NOTE: The VA will not rate menstrual cycle conditions that are natural (like severe cramps, abnormal menstrual cycles, menopause, etc.) or not caused directly by an injury or disease. Thus, conditions like dysmenorrhea (severe cramps or pain with menstruation) and secondary amenorrhea (the normal menstrual cycle is interrupted and menstruation stops completely for at least 6 months) are not ratable unless they are directly caused by an injury or disease of the ovaries. If the ovaries no longer function properly and cause issues with menstruation, then it is rated under code 7615. 

The only change to this code will be a note specifying that dysmenorrhea or secondary amenorrhea causedby problems with the ovaries will be rated under this code. The ratings stay the same.
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Code 7619: the removal of one or both ovariesis 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%.

-New-Code 7619: the removal of one or both ovariesis 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%.

The change to this code was made in order to make the female ratings for loss of the ovaries equal to 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. 
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Code 7621: If the uterus slips downcompletely 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 uterusdoes 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 thewall 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 is out of place and pushing on the walls of the vagina. Because of this, they are combining all three codes into a single code. Codes 7622 and 7623 will no longer exist, and code 7621 is changing as follows:

-New-Code 7621: If any of the pelvic organs(the uterus, bladder, small intestine, urethra, or rectum) are completely or partially 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. 

Any type or severity of pelvic organ prolapse is rated 10% under this code. Additional ratings can be given for how the prolapse affects the other body systems. So if it causes digestive symptoms, genitourinary symptoms, etc., they can be rated separately under the appropriate system code. 

The VA altered this code significantly from what they originally proposed last year. They originally proposed rating it based on the severity of the prolapse, with the highest rating possible 50% under this code. This rating option, however, did not allow for separate ratings to be given under the affected systems. Since ratings higher than 50% could be given for similar symptoms under the digestive or genitourinary systems, the VA decided to allow for symptoms to be rated separately instead of all combined and limited under this one code. This code will now offer a baseline 10% to cover any mild symptoms caused by prolapse, and then all other more significant symptoms can be rated in addition under other codes. 
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Code 7627Cancer of the female organs and breaststhat is active is rated 100%. This 100% will continue for the first 6 months after the last treatment. The condition will then be re-evaluated. 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 7628Benign tumors of the female organs and breastsare rated based on how they affect the systems around them….

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

-New-Code 7627Cancer of the female organs that is active is rated 100%. This 100% will continue for the first 6 months after the last treatment. The condition will then be re-evaluated. If it is no longer active, then it will be rated on any lasting symptoms just like any benign condition.

-New-Code 7628Benign tumors of the female organs are rated based on how they affect the systems around them….

Two new codes, 7630 and 7631, are then being added for all breast cancer, male or female:

-New-Code 7630Active cancer of the breastsis rated 100%. This 100% will continue for the first 6 months after the last treatment. The condition will then be re-evaluated. If it is no longer active, then it will be rated on any lasting symptoms or complications, like removal of the breast, nerve damage, etc.

-New-Code 7631Tumors and other injuries of the breastare rated on any chronic symptoms or on how they affect the systems around them. This includes scars, disfigurement, removal of the breast, 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 injuriesof the breast, like blast-trauma, or any complications to other parts of the body due to breast surgery. These codes do NOT replace code 7626 for removal of the breast.
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Another new code is also being added to get female ratings more in line with the male ratings: 

-New-Code 7632Female sexual arousal disorder (FSAD)is the inability to 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 the affected parts. FSAD may be entitled to additional compensation under Special Monthly Compensation K but only if it qualifies as loss of use of the reproductive organs, leading to infertility.


14 comments:

  1. So do women still get 50% for a hysterectomy???

    ReplyDelete
    Replies
    1. Yes, the complete removal of the uterus and both ovaries is rated 50%.

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

      Delete
  2. I have been diagnosed by the VA with both an ovarian cyst and adenomyosis and will be having a hysterectomy next month. My original rating is for only dysmenorrhea at 0%. Can I get a rating increase for this? I have record of complaints of the dysmenorrhea which is most likely caused by the adenomyosis. I have also seen ratings for endometriosis but nothing for adenomyosis. I have had trouble with this for the last 17 years including the entire time I was active duty.

    ReplyDelete
    Replies
    1. If you can clearly link the current cysts and adenomyosis to the service-connected dysmenorrhea, then you could potentially have the hysterectomy rated. Having your gynecologist write a letter stating that your current conditions are "more likely than not" caused by your service-connected conditions could strengthen your case.

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  3. I was diagnosed while in service with cervical dysplasia and had multiple cone biopsies which are in my records and I provided it with my claim. I had to have a complete hysterectomy in 2001. I was denied that it was service connected. I am trying to do a NOD so please advise.

    ReplyDelete
  4. I was out of the service when the hysterectomy was done.

    ReplyDelete
    Replies
    1. The only way to get service-connection granted for the hysterectomy is for it to have been done directly because of the cervical dysplasia or as a side-effect of the biopsies. If you can directly link it to those conditions, then they should grant it. A NEXUS from your gynecologist stating that the hysterectomy was due to these service-connected conditions would help.

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  5. Hi Dr. Johnson,

    My situation is a mess. I was in the AF from 1987-2000. While I was in, I had major problems with my stomach that they had sent me to several specialists for but I left the military w/o a diagnosis. The symptoms continued as I was in/out of hospitals/emergency room after I departed the service. Some time later, it was determined I had GERD w/hiatal hernia which I received a 10% service connected disability rating for.

    Since then, I've developed PTSD symptoms, major depression, avoidance, nightmares, w/suicidal ideations. I've been hospitalized 2x, been homeless, and for the past 3 years, I've been unemployable due to my conditions. During my stay in the military, I was in theatre 2x. Each time, there were incidents where someone was killed.


    Also, while I was homeless, a letter was apparently sent to me at my previous address, suggesting a decrease in my 10% rating. I did not respond and my rating was reduced to 0%.

    At wit's end unable to work, I contacted a Voc/Rehab specialist. After looking over my records, he determined that the education benefits I qualified for were outdated and thus not available. However, because he was able to prove a serious employment handicap", He was able to obtain a waiver for me to go to school.

    I have recently filed a claim for an increase in the GERD/Hiatal Hernia and new claim for PTSD.

    My question is, should I have filed the unemployability form along with my claim or should I wait to see if I do get a service connection disability for PTSD before I file the unemployability form? Please help??

    ReplyDelete
    Replies
    1. You can go ahead and apply for unemployability, but they won't be able to make a judgement on it until the PTSD is rated since that is the condition which is causing the unemployability. The PTSD is not only going to have to be service-connected, but also rated at at least 40%-60%, depending on your hernia rating, in order for you to qualify for unemployability. Because of this, it may be better to just wait and see if you will even qualify before applying.

      http://www.militarydisabilitymadeeasy.com/permanentandtotalunemployability.html#iu

      Delete
  6. Dr. Johnson,

    I have been given a 40% rating for RA. I have recently filed for an increase due to more than 4 incapaciting episodes per year. I also filed a secondary for an ulcer that developed due to NSAIDS I take for my RA. I, obviously, do not go to the doctor for every incapacitating episode as we have worked out a pain management schedule and when I have break-through's, which I often do, I take a sick day, stay in bed, and resort to my regimen. My question is, would my sick leave at work suffice for the time I took off for incapaciting episodes or do I need a "Nexus" letter from the doctor indicating that because of my illness it is likely that I would have up to these many episodes per year? Please advise...

    ReplyDelete
    Replies
    1. "Incapacitating exacerbations" is not clearly defined for RA by the VA, but in standard practice usually means a period when the symptoms are severe enough to make it impossible to perform your job or function well in daily life.

      So, it should be enough for the VA to have clear evidence that your sick leave is due to your RA, especially if it is detailed how it affects your daily life during these episodes. However, if they do request further support, a physicians note should be sufficient.

      Delete
  7. Hello Dr. Johnson,

    I was medically discharged from the Air Force in 2004 for several episodes of Rhabdomyolysis. Since that time I have had various other hospitalizations and muscle biopsy's and all come back inconclusive. I was sent to see a geneticist because my Neurologist was telling me it was a metabolic myopathy that's causing the rhabdo. The geneticist came back with no clear conclusion. I am currently SC for the rhabdo and tried putting in a claim for aggravation of metabolic myopathy only to be denied. The metabolic myopathy is an assumption by the neurologist. I'm not quite sure what to put in a claim for without a definitive diagnosis! I currently experience body aches and pains, headaches, insomnia(SC), and also have sleep apnea. Please advise sir and thank you.

    Service Connected:
    Anxiety/Depression
    Scars from biopsy
    Insomnia
    Tinnitus
    Hearing Loss
    Rhabdomyolysis

    ReplyDelete
    Replies
    1. Without a definite diagnosis, there isn't really anything to claim. The VA needs clear proof of a diagnosed condition and that the condition is caused by your service-connected condition in order for them to assign a rating. Until you are able to get further clarity on the issues, there isn't much that can be done disability-wise.

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  8. I am already 100% DV, however two months ago they found a 12 cm tumor that was High grade Serous Carcinoma. I've had a complete hysterectomy, and recently two weeks ago an omentum and staging surgery. I have just had one chemo treatment and next one is scheduled for a week from now. My problem is that I have Hypogammaglobulinemia which caused RA and Lupus and a host of other issues to include this cancer. The main disease makes us highly susceptible to cancer. During chemo I am literally incapable of doing anything, I am in bed suffering from the side effects unable to function for two weeks after. Then I have one decent week, then it starts again. The cancer has thrown my lupus and RA into overdrive as well. Is SMC available to me? Im going broke paying for a caretaker or my husband loses money staying home from work. Any help would be appreciated. The cancer I have is the fastest growing and has the worst survival rates.

    Suzanne C Sippel

    ReplyDelete