How to file VA claims for women's health conditions — gynecological and breast conditions under 38 CFR 4.116, MST-related claims under 3.304(f)(5), and where women veterans get care
Women veterans file the same VA Form 21-526EZ as anyone else, but several conditions have their own rating rules. Diseases, injuries or adhesions of the female reproductive organs (DC 7610–7615) are rated 0%, 10% or 30% by whether symptoms require, or are not controlled by, continuous treatment; endometriosis (7629) 10%, 30% or 50% and must be confirmed by laparoscopy; removal of the uterus or ovaries (7617–7619) 100% for three months then 30% or 50%; breast surgery (7626) by the extent of the mastectomy; breast cancer (7630) 100% during treatment and six months after. Pregnancy complications, pelvic floor injury and conditions aggravated by service are claimed on the same evidence rules as other conditions. PTSD based on military sexual trauma has a special evidence rule: records from counselors, clergy, family or friends and evidence of behavior changes can corroborate the assault, and VA may not deny the claim without first telling you this evidence is acceptable (38 CFR 3.304(f)(5)). VA's Women Veterans Call Center and the Women Veterans Program Manager at each medical center help with access to care, and MST-related care is free regardless of discharge or service connection.
What you'll need
- VA Form 21-526EZ; VA Form 21-0781 (Statement in Support of Claimed Mental Health Disorder(s) Due to an In-Service Traumatic Event) for PTSD or another mental health condition based on MST
- Service treatment records, including gynecological, obstetric and sick-call entries, and any Women's Health or MST coordinator records
- Current diagnosis and treatment records (laparoscopy report for endometriosis; surgical reports; oncology records)
- For an MST claim: counseling records, statements from people you told or who saw changes, and any records of transfer requests, performance changes or medical visits after the event
- Women Veterans Call Center 855-829-6636 (call or text), Monday–Friday 8:00 a.m.–10:00 p.m. ET, Saturday 8:00 a.m.–6:30 p.m. ET
- A free accredited representative (CVSO or VSO); you may ask for a woman representative or examiner
Step-by-step
Step 1: Identify the conditions and their rules
Common service-connected conditions for women veterans include pelvic pain and menstrual disorders, endometriosis, uterine fibroids, ovarian cysts, pelvic floor and urinary conditions after injury or childbirth, hysterectomy or oophorectomy for a service-connected cause, breast conditions and breast cancer, infertility from a service-connected cause, PTSD or depression related to military sexual trauma, and musculoskeletal injuries from ill-fitting equipment. Each needs a current diagnosis and a link to service — direct (shown in service records or within the presumptive year for some conditions), secondary to another service-connected condition (3.310), or presumptive (breast cancer is presumptive for radiation-exposed veterans under 3.309(d), for Camp Lejeune service under 3.307(a)(7), and — as a reproductive cancer — on VA's list of presumptive cancers related to burn pit exposure under the PACT Act; it is not an Agent Orange presumptive).
Step 2: MST-related claims — use the special evidence rule
For PTSD based on in-service personal assault, 38 CFR 3.304(f)(5) lets VA accept evidence outside service records to corroborate the event: law enforcement, rape crisis center, counseling, hospital or physician records; pregnancy or STD tests; and statements from family, roommates, fellow service members or clergy. Evidence of behavior changes after the assault — a request for transfer, a drop in performance, substance use, depression, panic or anxiety without another cause, or unexplained social or economic changes — is itself relevant evidence. VA must tell you this before denying and may send the evidence to a mental health professional for an opinion. File VA Form 21-0781 with the claim; you do not need to have reported the assault at the time. Vet Center MST counseling records are kept separately from VA medical records and are released only with your consent.
Step 3: Know the 38 CFR 4.116 criteria
Disease, injury or adhesions of the female reproductive organs (DC 7610–7615): 30% for symptoms not controlled by continuous treatment, 10% for symptoms that require continuous treatment, 0% otherwise; ovarian dysfunction affecting the menstrual cycle is rated under 7615. Endometriosis (7629): 50% for lesions involving bowel or bladder confirmed by laparoscopy with pelvic pain or bleeding not controlled by treatment and bowel or bladder symptoms; 30% for pelvic pain or heavy or irregular bleeding not controlled by treatment; 10% when continuous treatment controls them; the diagnosis must be substantiated by laparoscopy. Removal of the uterus and both ovaries (7617): 100% for three months, then 50%; uterus alone (7618): 100% for three months, then 30%; ovaries (7619): 100% for three months, then 30% for both or 0% for one. Breast surgery (7626): radical mastectomy 80% (both) or 50% (one); modified radical 60% or 40%; simple mastectomy or wide local excision with significant alteration 50% or 30%; wide local excision without significant alteration 0%. Malignant neoplasm of the breast (7630): 100% during treatment and for six months after it ends, then rated on residuals. Several of these carry review for special monthly compensation under 3.350.
Step 4: File and prepare for the exam
On VA Form 21-526EZ list each condition by diagnosis (and "secondary to service-connected [condition]" where that applies) and attach the records; for mental health conditions based on MST include VA Form 21-0781. File online, by mail to the Claims Intake Center (PO Box 4444, Janesville, WI 53547-4444), in person or through a free accredited representative. You can ask that the gynecological or mental health examiner be a woman. If VA denied a condition before, a Supplemental Claim (VA Form 20-0995) with new and relevant evidence reopens it.
Reference: https://www.va.gov/disability/file-disability-claim-form-21-526ez/
Step 5: Get care while the claim is pending
VA women's health services include primary care, reproductive health (contraception, preconception counseling, menopause care), cervical and breast cancer screening, maternity care, mental health care, and free, confidential treatment for conditions related to MST — which is available regardless of discharge characterization, length of service or service connection, and without a report at the time. Enroll in VA health care, then ask for the Women Veterans Program Manager at your medical center or call or text the Women Veterans Call Center at 855-829-6636 to be connected. Veterans not enrolled can still get MST-related care and Vet Center counseling.
Reference: https://www.va.gov/health-care/health-needs-conditions/womens-health-needs/
Critical tips
- An endometriosis claim without a laparoscopy report will be rated under a different code or denied; ask your clinician about the diagnostic basis before filing.
- Conditions caused by treatment of a service-connected condition — for example surgical menopause after a service-connected hysterectomy, or neuropathy after chemotherapy for service-connected breast cancer — are secondary claims under 3.310.
- Veterans with service-connected infertility may qualify for VA fertility treatment and adoption reimbursement; ask the Women Veterans Program Manager.
- The Women Veterans Call Center can also help with claims questions, homelessness and intimate partner violence resources.
- A county veterans service officer can file the claim for free: warriorsfund.org/find-cvso.
- In crisis: dial 988 then press 1, or text 838255.
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