Gynecological Conditions Rating Guide

Conditions of the female reproductive system are rated under 38 CFR § 4.116. The codes differ from one condition to the next, but a small set of shared ideas decides most claims. Learn these and the individual rating tables make sense.

1. One code family is rated on whether treatment controls the symptoms

The General Rating Formula for diagnostic codes 7610 through 7615 turns on one question: does continuous treatment control the symptoms? A condition that requires continuous treatment, or that is not controlled by continuous treatment, is rated higher than one that needs no treatment. For those codes the treatment record is the center of the claim. Removal, prolapse, fistula, endometriosis, neoplasms, breast surgery, and FSAD sit outside that formula and use their own criteria.

2. Removal or loss of a reproductive organ has set ratings and can bring extra compensation

When a reproductive organ is removed or lost, the schedule assigns set ratings for that loss. On top of the schedular rating, some organ losses qualify for special monthly compensation (SMC) for the loss of a creative organ. That extra payment is separate from and added to the regular rating, and it is easy to miss.

3. Each condition has its own code and scale within the section

Conditions like endometriosis, uterine and ovarian disorders, and pelvic conditions each have their own diagnostic code and their own rating scale inside 38 CFR § 4.116. There is no single number that covers the whole system, so the exact levels depend on the specific condition.

4. Symptoms of another condition are rated under their own codes

As with other body systems, symptoms that a mental-health or other condition produces are rated under their own codes, not folded into the gynecological rating. That separation matters, because it is what lets a related condition, such as depression tied to chronic pain, be claimed and rated on its own.

The continuous-treatment question is the General Rating Formula for diagnostic codes 7610 through 7615, not the rule for the whole section. This part of the schedule also covers disorders of the breast, and each lane below reads a different record:

Condition detail: FSAD, SMC, and the cancer claims guide.

Cancer treatment, organ removal, and breast surgery each move a claim through several states, and more than one question can be open at the same time:

1. Underlying condition: identify the exact gynecological or breast diagnosis and the rating formula it uses.
2. Active treatment or temporary period: cancer, organ removal, or other procedures may use a code-specific total-rating period.
3. Mandatory follow-up: where the code requires an examination after treatment, that record decides whether active disease remains.
4. Chronic residuals: scar, lymphedema, disfigurement, bowel or bladder impairment, arm or shoulder limitation, nerve or sensation changes, and other distinct residuals may be evaluated under their own codes.
5. Special monthly compensation review: loss or loss of use of a creative organ and qualifying anatomical breast loss are separate SMC questions. SMC is not a substitute for rating distinct chronic residuals.

The rules above apply across the board. This body system does not yet have a dedicated per-condition guide, so the directory below routes you to the closest related guide and to the condition lookup page for the exact numbers:

For endometriosis, uterine, ovarian, and other conditions, open the condition lookup page for the rating levels and Board data.

Gynecological conditions rarely stand alone. Because they can flow from another disability, or drive one, several secondary claims are common:

• Conditions secondary to another disability. A gynecological condition can arise as secondary to another service-connected condition or to its treatment.
• Mental health from chronic pain or infertility. A separate mental-health condition may be considered when the record supports a diagnosis and a link to the service-connected condition, subject to the anti-pyramiding rule; it is not automatic.
• Special monthly compensation for organ loss. The loss of a reproductive organ can support special monthly compensation for the loss of a creative organ, separate from the schedular rating.
• Conditions following cancer treatment. Conditions that follow gynecological cancer treatment can be claimed in their own right. See secondary conditions.

The official gynecological and breast examination forms ask for a specific set of findings. A complete record covers the same ground:

• Exact diagnosis: the specific gynecological or breast condition, since the lane it falls in decides which facts matter.
• Treatment and response: whether treatment is continuous and whether it actually controls the symptoms, the point the 7610 through 7615 family turns on.
• Laparoscopy where the code requires it: the operative or laparoscopic record substantiating endometriosis.
• Pelvic, bowel, and bladder findings: examination results plus any anemia or other condition-specific testing.
• Cancer status and dates: pathology, treatment dates, the operative report, and the required follow-up examination.
• Surgical and breast residuals: scars, lymphedema, disfigurement, arm or shoulder range of motion, grip, and sensory changes documented as distinct findings.
• Ordinary functional impact: what the condition and its treatment change about work, sleep, and daily activity.

Documentation of loss or loss of use of a creative organ, or of qualifying anatomical breast loss, supports the separate special monthly compensation question. The matching DBQ prompts an examiner to capture these findings in the schedule's own terms.