Sorry for the mess!

The site is undergoing a massive update. All the content on the site still works but things just might look a little messy and disorganized. Most of the upgrades will probably be don by the end of the month. Thank you for your understanding!

Updated Nov 08, 2021

In This Section
This section contains the following topics:
Topic
Topic Name
1
2

1.  Female Sexual Arousal Disorder (FSAD)

Introduction

 This topic contains information about evaluating FSAD, including

Change Date

 May 19, 2020

V.iii.8.A.1.a. Definition:  FSAD
Female Sexual Arousal Disorder (FSAD) refers to the continual or recurrent physical inability of a woman to accomplish or maintain an ample lubrication-swelling reaction during sexual intercourse.  Decreased blood flow to the genital area is believed to contribute to FSAD similar to the role of vascular disease in male erectile dysfunction.  Other causes may include nerve and/or tissue damage.
Important:
  • FSAD is a physical disorder characterized by physiological findings/damage to the gynecological system.  It is not a psychiatric condition found in the Diagnostic and Statistical Manual, fifth version (DSM-5) for mental disorders.  DSM-5 does include a diagnosis of female sexual interest/arousal disorder, which is a different disorder and is not synonymous with FSAD.
  • A diagnosis of FSAD cannot be rendered or confirmed by a mental health examiner.  When a mental health examination or mental health treatment records suggest a diagnosis of FSAD, including FSAD secondary to medication for a psychiatric disorder, the diagnosis must be confirmed in other medical evidence by a qualified medical professional.

V.iii.8.A.1.b. Requesting Examinations for FSAD Claims
The Gynecological Conditions Disability Benefits Questionnaire (DBQ) is the appropriate DBQ to order when a Department of Veterans Affairs examination is necessary to assist in substantiating a claim of FSAD or other female sexual dysfunction.
Notes:
  • If the Veteran claims service connection (SC) for FSAD or other sexual dysfunction and the exam threshold described in 38 CFR 3.159(c)(4) is met, request the examination using the Gynecological Conditions Disability Benefits Questionnaire.
  • The Gynecological Conditions Disability Benefits Questionnaire includes a specific section concerning FSAD that includes a request for the examiner to identify whether
    • the Veteran has FSAD, and
    • FSAD, if present, is at least as likely as not attributable to another condition.
  • In all cases, if an examiner diagnoses FSAD, the Gynecological Conditions Disability Benefits Questionnaire must be completed, or sufficient alternative evidence (such as private medical evidence submitted in lieu of an examination) must be of record.
  • When a claimed gynecological issue is examined using an examination other than the Gynecological Conditions Disability Benefits Questionnaire, such as an examination of scars following cesarean section using the Scars/Disfigurement Disability Benefits Questionnaire, also request the Gynecological Conditions Disability Benefits Questionnaire to evaluate the underlying gynecological issue, including FSAD.

V.iii.8.A.1.c.  Within Scope Determinations for FSAD
If SC for FSAD is not expressly claimed, consider FSAD within scope of the claim in the circumstances described in the table below.
When …
Then consider FSAD within scope of the …
the Gynecological Conditions Disability Benefits Questionnaire indicates that FSAD is attributable to the claimed gynecological disorder
claimed gynecological disorder.
Note:  When a gynecological disorder is claimed, the examiner must address whether FSAD is present and if it is related to the claimed gynecological disorder as noted in M21-1, Part V, Subpart iii, 8.A.1.b.
a mental health examination indicates a diagnosis of FSAD is present and provides possible nexus information linking it to medication or treatment for a mental health disorder
claimed mental health condition.
Note:  The diagnosis of FSAD must be confirmed by an appropriate non-mental health examiner.  Analyze the evidence of record to determine whether the criteria under 38 CFR 3.159(c)(4) are satisfied to request further examination of FSAD.
other evidence submitted with the claim leads to a within scope determination for FSAD as described at M21-1, Part V, Subpart ii, 3.A.2.c
claimed condition.

V.iii.8.A.1.d. Evaluating FSAD
When the requirements are met, SC for FSAD will be awarded as a stand-alone gynecological disability using 38 CFR 4.116, diagnostic code (DC) 7632 with a 0-percent evaluation.  This is the maximum evaluation available for FSAD.
Note:  The original clarification that FSAD is a disorder subject to SC was not a regulatory change.  Consequently, the provisions of 38 CFR 3.114 do not apply for assignment of the effective date.  Subsequent updates to 38 CFR 4.116, including the addition of DC 7632 for FSAD, effective May 13, 2018, are, similarly, not liberalizing.

V.iii.8.A.1.e.  Considering SMC Associated With FSAD
Entitlement to SMC (k) for loss of use of a creative organ will be inferred and awarded whenever SC for FSAD is granted.
Note:  If SC was previously established for FSAD but SMC was not awarded, place entitlement to SMC at issue and grant.  The effective date for the award of SMC will be the date SC for FSAD was established.

2.  Other Gynecological Disorders

Introduction
This topic contains information about evaluating other gynecological disorders, including

Change Date

 November 8, 2021

V.iii.8.A.2.a.  SC for Disorders of Menstruation
A disease or injury resulting in ovarian dysfunction affecting the menstrual cycle, such as dysmenorrhea and secondary amenorrhea, can be service-connected (SC).  Evaluate using 38 CFR 4.116, DC 7615.
Notes:
  • SC cannot be established for primary amenorrhea or dysmenorrhea.  By definition, neither disorder would be incurred in or aggravated by service.
  • SC can be established for secondary amenorrhea or dysmenorrhea when the evidence shows that they are due to an ovarian disability or any other female reproductive organ disorder or other SC disability.

V.iii.8.A.2.b.  Evaluating Pelvic Organ Prolapse
Apply the principles below to evaluate pelvic organ prolapse.
  • Do not assign multiple evaluations under 38 CFR 4.116, DC 7621 for prolapse of multiple pelvic organs.
  • When prolapse is incomplete or complete, assign a 10-percent evaluation.  In addition, evaluate residual disabilities or symptoms under the corresponding DC and combine, as usual, under 38 CFR 4.25.
Example:  SC is warranted for pelvic organ prolapse.  Examination shows that, as a result of complete prolapse, the Veteran also experiences urinary incontinence requiring the wearing of absorbent materials that must be changed twice daily, impairment of sphincter control resulting in slight leakage, and localized dermatitis affecting less than five percent of body area that is treated with topical therapy.  The following evaluations will be established for the pelvic organ prolapse and residuals:
Note:  Prior to the changes to 38 CFR 4.116, effective May 13, 2018, these conditions were evaluated under 38 CFR 4.116, DC 7621 to 7623.
References:  For more information on

V.iii.8.A.2.c.  Malignant Neoplasms of the Gynecological System
Separate 100-percent evaluations will be assigned for both active gynecological cancer and active breast cancer.  Metastasis of a gynecological cancer or breast cancer to a different body system will also be evaluated separately.
Consider corresponding entitlement to SMC.
References:  For more information on

V.iii.8.A.2.d.  Disfigurement Due to Benign or Malignant Neoplasms
Do not evaluate disfigurement due to benign or malignant neoplasms of the gynecological system analogous to 38 CFR 4.118, DC 7800.  DC 7800 is for evaluation of disfigurement of the head, face, or neck only.

V.iii.8.A.2.e. Cervical Dysplasia
Do not routinely award SC for cervical dysplasia, also referred to as cervical intraepithelial neoplasia (CIN).  Cervical dysplasia/CIN is not a disease or injury.  It is a cellular abnormality of the cervix revealed by Papanicolaou (Pap) smear testing that generally resolves without treatment or residuals.  In these cases, there is an abnormal laboratory finding but no disability, and SC is not warranted.
SC may be warranted if cervical dysplasia/CIN
  • requires treatment that leaves residuals, or
  • is linked to the subsequent development of cervical cancer.
Use the table below to determine the appropriate actions to take when SC is claimed following an in-service confirmed finding of cervical dysplasia/CIN.
If medical evidence shows the subsequent development of …
Then award SC for …
Additional Information to Consider
  • chronic or severe dysplasia/CIN requiring treatment, and
  • chronic residuals of the required treatment
residuals of cervical dysplasia/CIN.
Common procedures for treatment of chronic or severe dysplasia/CIN include
  • cauterization
  • laser surgery
  • cryosurgery, or
  • loop electrosurgical excision procedure (LEEP).
  • cervical cancer, and
  • a link between the in-service dysplasia/CIN and the cancer
cervical cancer and/or residuals.
In-service cervical dysplasia that resolved without residuals is less likely to be related to later-developing cervical cancer.  However, these cases require a medical opinion to determine whether a relationship exists between the conditions.
Note:  Cervical dysplasia is often associated with human papillomavirus (HPV) infection.  There are over 60 types of HPV infection, and only certain types are associated with high-grade cervical dysplasia and cancer.

V.iii.8.A.2.f.  HPV
Do not routinely award SC for HPV infection.  Usually, HPV infections are asymptomatic and identified only as a finding on a Pap smear.  Most resolve spontaneously without residuals requiring only periodic pap smears for follow-up.  In these cases, there is an abnormal laboratory finding but no disability, and SC is not warranted.
SC may be warranted if a disability develops as a result of an in-service HPV infection.  Two circumstances that may warrant SC are
  • genital warts that are shown in service or by nexus to be associated with the HPV infection, and
  • HPV resulting in persistent infection that progresses to cervical dysplasia and subsequently to cervical cancer.
Important:  A medical nexus is required to establish an association between genital warts and in-service HPV infection or between cervical cancer and in-service HPV infection.
Note:  There are multiple varieties of HPV infection which can cause common warts, plantar warts, and other findings.  HPV is not limited to sexual transmission.
References:  For more information on considering claims for SC associated with sexually transmitted diseases, see

V.iii.8.A.2.g.  Changes in the Rating Schedule for Gynecological Conditions and Disorders of the Breast
The rating criteria for gynecological conditions and disorders of the breast have undergone historical changes.  Recent full-scale historical revisions were effective on the following dates:
  • May 13, 2018, and
  • May 22, 1995.
Note:  These changes in the rating criteria
  • are not considered liberalizing, and
  • should not be the basis for a reduction in disability rating unless medical evidence establishes that the disability has actually improved.