What is the VA Rating for Endometriosis?

Looking for Expert-Level VA Claim Help?📱Call Us Now! 737-295-2226

VA disability ratings for endometriosis range from 10% to 50%, with an interim break at 30%.

The rating depends on the severity of symptoms, such as chronic pelvic pain and heavy or irregular bleeding, the effectiveness of treatment in managing these symptoms, and the overall impact on a veteran’s daily life, work, and social functioning.

The VA evaluates endometriosis under 38 CFR § 4.116, Diagnostic Code 7629, which accounts for factors like pelvic pain, the need for continuous treatment, and the presence of adhesions or abnormal bleeding patterns.

For veterans, the condition can be exacerbated by the physical and emotional stress of military service, leading to severe symptoms that significantly disrupt daily life.

Okay, let’s explore how the VA rates endometriosis, what symptoms and factors influence your rating, and the steps you can take to ensure you receive the benefits you deserve for serving our country.

Summary of Key Points

• VA Ratings for Endometriosis: Endometriosis is rated by the VA under Diagnostic Code 7629, with disability ratings of 10%, 30%, or 50%. Ratings depend on symptom severity, including chronic pelvic pain, heavy or irregular bleeding, and the degree to which these symptoms are managed by treatment.

• Other Related VA Conditions to Endometriosis: Several related conditions to endometriosis may qualify for separate VA disability ratings under distinct diagnostic codes, including pelvic adhesions (Diagnostic Code 7613), uterine fibroids (Diagnostic Code 7615), chronic pelvic pain syndrome, polycystic ovary syndrome (Diagnostic Code 7615), pelvic prolapse (Diagnostic Code 7621), and malignant or benign neoplasms of the gynecological system (Diagnostic Codes 7627 and 7628). These conditions, when present alongside endometriosis, can impact a veteran’s overall disability rating and require clear medical evidence to differentiate each condition to avoid pyramiding.

• Understanding Service Connection for Endometriosis: Veterans can establish service connection for endometriosis directly, secondarily, or via aggravation by linking the condition to their military service or to an existing service-connected disability. Documentation of symptoms and medical evidence are critical to substantiating a claim.

• VA Secondary Conditions for Endometriosis: Endometriosis can lead to or coexist with a variety of other conditions that may qualify for separate VA disability ratings. Common secondary conditions include chronic pelvic pain syndrome, irritable bowel syndrome (IBS), bladder pain syndrome/interstitial cystitis, depression and anxiety, pelvic adhesions, infertility, sciatica and lower back pain, fibromyalgia, and anemia.

What is Endometriosis?

Endometriosis is a chronic and often painful condition in which tissue similar to the lining of the uterus, known as the endometrium, grows outside the uterus.

This tissue can be found on the ovaries, fallopian tubes, and other pelvic organs.

Unlike the normal endometrial tissue that sheds during menstruation, this displaced tissue has no way to exit the body, leading to inflammation, scarring, and the formation of adhesions.

Endometriosis can cause severe pain, especially during menstruation, and may lead to fertility issues.

Causes of Endometriosis

The exact cause of endometriosis is not fully understood, but several theories exist.

Possible causes include:

• Retrograde Menstruation: This occurs when menstrual blood flows backward through the fallopian tubes and into the pelvic cavity instead of exiting the body.

• Embryonic Cell Transformation: Hormones such as estrogen may transform embryonic cells into endometrial-like cell implants during puberty.

• Immune System Disorders: Problems with the immune system might make the body incapable of recognizing and destroying endometrial-like tissue growing outside the uterus.

• Genetics: Endometriosis can run in families, indicating a genetic predisposition.

• Environmental Factors: Exposure to toxins, such as dioxins, may increase the risk of developing endometriosis.

Symptoms of Endometriosis in Veterans

Endometriosis can cause a variety of symptoms, which can significantly impact a veteran’s daily life.

Common symptoms include:

• Chronic Pelvic Pain: Often worse during menstruation.

• Painful Periods (Dysmenorrhea): Severe cramping and pain before and during menstruation.

• Pain During Intercourse: Pain during or after sex is common.

• Pain with Bowel Movements or Urination: More likely to occur during menstrual periods.

• Heavy Menstrual Bleeding (Menorrhagia): Including bleeding between periods.

• Infertility: Endometriosis is found in about one-third of women who have trouble conceiving.

• Fatigue, Diarrhea, Constipation, Bloating, and Nausea: Especially during menstrual periods.

Veterans experiencing these symptoms should seek medical evaluation and treatment, as early diagnosis can help manage the condition more effectively.

Endometriosis Risk Factors in Military Veterans

Certain factors can increase the risk of developing endometriosis, particularly in the military population.

These include:

• Delayed Childbearing: Women in the military often delay pregnancy due to deployment or career commitments, which can increase the risk.

• High Stress Levels: The physical and emotional stress associated with military service can exacerbate symptoms.

• Exposure to Environmental Toxins: Service members may be exposed to chemicals or toxins that could contribute to the development of endometriosis.

• Physical Strain: The physically demanding nature of military duties may exacerbate symptoms or contribute to the onset of the condition.

What are the VA Ratings for Endometriosis?

Endometriosis VA ratings range from 10% to 50%, with a break at 30%.

The rating is based on the severity of symptoms, such as chronic pelvic pain, heavy or irregular bleeding, and the presence of pelvic adhesions.

The VA rating criteria also considers how effectively these symptoms are managed through treatment and the extent to which they impact a veteran’s work, life, and social functioning to include any functional impairment or loss.

38 CFR Diagnostic Code 7629, Endometriosis VA Ratings From 10% to 50%

The VA rates endometriosis under 38 CFR § 4.116, Diagnostic Code 7629, based on the presence of and severity of symptoms such as pelvic pain, irregular bleeding, and the need for continuous treatment.

Here’s a breakdown of the rating criteria:

• 50% VA Rating: This is assigned when endometriosis causes lesions involving the bowel or bladder, confirmed by laparoscopy, along with pelvic pain or heavy or irregular bleeding that is not controlled by treatment. Additionally, there must be symptoms affecting the bowel or bladder.

• 30% VA Rating: This rating is given when there is pelvic pain or heavy or irregular bleeding that persists despite treatment and is not effectively controlled.

• 10% VA Rating: This is the lowest rating and is assigned when there is pelvic pain or heavy or irregular bleeding that requires continuous treatment for symptom management.

Important Note: A diagnosis of endometriosis must be confirmed by laparoscopy, a surgical procedure used to view the organs inside the pelvis, to be eligible for a VA disability rating under this diagnostic code.

Other Related Conditions and Diagnostic Codes for Endometriosis

Endometriosis can often co-exist with or lead to other gynecological conditions, which can be rated separately by the VA under distinct diagnostic codes:

Pelvic Adhesions (Diagnostic Code 7613)

Pelvic adhesions involve scar tissue that causes organs in the pelvic region to stick together, leading to pain and complications such as infertility. These adhesions often result from endometriosis or pelvic surgeries and can significantly impact a veteran’s quality of life. The VA rates this condition based on the severity of symptoms and the need for continuous treatment.

Uterine Fibroids (Diagnostic Code 7615)

Uterine fibroids are noncancerous growths in the uterus that can cause heavy menstrual bleeding, pelvic pain, and pressure. Veterans with service-connected uterine fibroids can be rated under Diagnostic Code 7615. The severity of symptoms and the extent of treatment required determine the disability rating.

Chronic Pelvic Pain Syndrome (Analogous to Diagnostic Code 7629)

Chronic pelvic pain syndrome can be rated if it is linked to a service-connected condition like endometriosis. Although not a standalone diagnostic code, chronic pelvic pain can contribute to the overall disability rating when it affects a veteran’s daily functioning and quality of life.

Polycystic Ovary Syndrome (Diagnostic Code 7615)

A hormonal disorder that can cause irregular periods, excessive androgen levels, and cysts on the ovaries. PCOS is rated under Diagnostic Code 7615 if it results in complications like ovarian dysfunction.

Pelvic Prolapse (Diagnostic Code 7621)

This condition occurs when pelvic organs drop from their normal position, often due to weakened support structures in the pelvis. Symptoms can include urinary incontinence and pelvic pressure.

Malignant and Benign Neoplasms of the Gynecological System (Diagnostic Codes 7627 and 7628)

These codes cover cancerous and non-cancerous tumors in the gynecological system. Ratings depend on the type of tumor, treatment required, and any residual symptoms.

Note: Veterans may receive separate ratings for these conditions if they are distinct from the symptoms of endometriosis.

However, it is essential to provide medical evidence that clearly differentiates each condition to avoid pyramiding, where the same symptoms are rated under multiple diagnostic codes.

For more detailed information on each of these conditions and their specific rating criteria, you can refer to the VA’s Schedule of Ratings for Gynecological Conditions and Disorders of the Breast under 38 CFR § 4.116.

How to Establish Service Connection for Endometriosis

To receive a VA disability rating for endometriosis, a veteran must establish service-connection.

This can be done through three primary avenues: direct service connection, secondary service connection, or service connection via aggravation:

1. Direct Service Connection for Endometriosis

Direct service connection applies when endometriosis is directly linked to an event, injury, or exposure that occurred during military service. To establish this connection, a veteran must provide medical evidence showing that their endometriosis began or was diagnosed during their time in service. This often includes service treatment records documenting symptoms like pelvic pain or irregular bleeding and a subsequent diagnosis of endometriosis.

2. Secondary Service Connection for Endometriosis

Secondary service connection may apply if endometriosis develops or worsens due to an existing service-connected condition. For example, if a veteran has a service-connected hormonal disorder or pelvic adhesions that contribute to the development or exacerbation of endometriosis, they can file a claim for secondary service connection. A detailed nexus letter from a medical professional is crucial in these cases to demonstrate how the primary condition has led to or aggravated the endometriosis.

3. Service Connection via Aggravation for Endometriosis

If a pre-existing condition of endometriosis is exacerbated due to service-related activities or other service-connected conditions, the veteran may be eligible for service connection via aggravation. For instance, if a veteran’s pre-existing endometriosis symptoms were manageable before service but worsened due to the physical demands or stress of military duties, the VA may grant a service connection based on the aggravation of the condition. Similarly, a service-connected disability like chronic pelvic pain could aggravate non-service-connected endometriosis, qualifying the veteran for a rating based on the increased severity.

List of VA Secondary Conditions to Endometriosis

Secondary VA conditions to endometriosis are those conditions that are proximately due to or aggravated by the primary endometriosis diagnosis.

Veterans suffering from endometriosis may experience a range of associated conditions that can also be considered for VA disability compensation if they can be linked as secondary conditions.

Here’s a list of common secondary conditions associated with endometriosis:

1. Chronic Pelvic Pain Syndrome

Endometriosis can cause severe and persistent pelvic pain, which may continue even after treatment or surgery. Chronic pelvic pain syndrome can be a standalone condition, and if it persists or worsens due to endometriosis, it may be eligible for a separate rating.

2. Irritable Bowel Syndrome (IBS)

Endometriosis often affects the gastrointestinal tract, leading to symptoms similar to IBS, such as abdominal pain, bloating, and changes in bowel habits. IBS can develop or worsen due to the inflammation and adhesions caused by endometriosis.

3. Bladder Pain Syndrome/Interstitial Cystitis

The proximity of endometrial lesions to the bladder can lead to symptoms such as urinary frequency, urgency, and bladder pain. This condition can become chronic and severely impact the quality of life.

4. Depression and Anxiety

Living with chronic pain and other debilitating symptoms of endometriosis can lead to mental health conditions such as depression and anxiety. These conditions may be considered secondary if they are directly linked to the veteran’s primary diagnosis of endometriosis.

5. Pelvic Adhesions

Endometriosis can lead to the formation of scar tissue (adhesions) in the pelvic region, which can cause organs to stick together, resulting in additional pain and complications. This condition can be rated separately if it causes significant functional impairment.

6. Infertility

Severe endometriosis can impact fertility, making it difficult or impossible to conceive. While infertility itself is not typically compensable, the emotional and psychological impacts related to infertility caused by endometriosis can be considered for secondary mental health conditions like depression or anxiety.

7. Sciatica and Lower Back Pain

Endometriosis lesions affecting the pelvic and lower abdominal area can lead to nerve pain, causing sciatica or chronic lower back pain. This is particularly true if the endometriosis involves the sacral nerve roots.

8. Fibromyalgia

Endometriosis has been linked to a higher prevalence of fibromyalgia, a chronic condition characterized by widespread musculoskeletal pain, fatigue, and tender points. If a veteran develops fibromyalgia as a result of the chronic pain and stress from endometriosis, it may be considered a secondary condition.

9. Anemia

Severe and chronic bleeding due to endometriosis can lead to anemia, a condition where the body lacks sufficient red blood cells. This can result in fatigue, weakness, and other health complications that could be considered for a separate rating.

Endometriosis VA Claim Tips: How to Maximize Your VA Rating

Here’s some pro tips to maximize your VA rating for endometriosis:

• Document Symptoms Thoroughly: Keep detailed records of all symptoms, treatments, and their impact on your daily life. Make sure your symptoms are documented in your medical records.

• Seek Medical Treatment: Regularly visit your healthcare provider to document the persistence and severity of symptoms. Continuity of care is important.

• Get a Nexus Letter: If you’ve been out of the military for more than 12-months (and aren’t already service connected) or if your endometriosis is a secondary condition, a nexus letter from a qualified healthcare provider can establish the connection to your primary service-connected disability.

• File for Secondary Conditions: If you have related conditions like depression, chronic pain, or irritable bowel syndrome due to endometriosis, file for these secondary conditions. Make sure you get a nexus letter for a secondary condition.

• Appeal if Necessary: If your initial rating is lower than expected, consider filing an appeal with additional evidence to support your claim.

Conclusion & Wrap-Up

Understanding how the VA rates endometriosis and related conditions can significantly impact your ability to receive the benefits you deserve.

By thoroughly documenting your symptoms and establishing a clear method of service connection, you can maximize your VA rating for endometriosis and ensure you receive appropriate compensation.

If you need assistance with your claim, reach out to a VA disability expert who can guide you through the process.

WE GOT YOUR SIX!

About the Author