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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.


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