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Welcome to The Veterans Disability Nexus, where we provide unique insights and expertise on medical evidence related to VA-rated disabilities. Leah Bucholz, a US Army Veteran, Physician Assistant, & former Compensation & Pension Examiner shares her knowledge related to Independent Medical Opinions often referred to as “Nexus Letters” in support of your pursuit of VA Disability every Tuesday & Wednesday at 7AM Central.
Take control of your medical evidence related to your benefits and visit https://podcast.prestigeveteranmctx.info/veteran/ for more information and to connect directly with us!
Hey guys, it's Leah Bee from Prestige Veteran Medical Consulting. I am a US Army veteran, physician assistant, and former compensation and pension examiner. So today I wanna come on and discuss a topic that many veterans are service connected for, many women veterans and that's endometriosis. So what is endometriosis? How can that be related to service?
Leah:And just some of the facts about that is what we're gonna talk about today. So a lot of people don't even really know that this is something that they can be service connected for. And a lot of people are receiving benefits for this already. So let's just jump right in. So what is endometriosis?
Leah:So endometriosis happens when the tissue similar to the lining of your uterus grows outside of the uterus. It can cause intense pelvic pain, heavy periods, infertility, even bowel or bladder problems. And for many veterans, especially women who served under physically demanding conditions, endometriosis can be linked to their military service. So how does VA rate endometriosis? The VA rates endometriosis under diagnostic code 7629 using three different levels.
Leah:So at ten percent, the symptoms are controlled by continuous treatment. At thirty percent, the symptoms may persist despite treatment with significant pain or organ dysfunction. And at fifty percent, severe cases can be seen at fifty percent with extensive lesions and disabling symptoms that are unresponsive to treatment. So what is some evidence that you can use, right? So to build a strong claim, you will probably wanna have a current diagnosis from your healthcare provider, medical records showing when your symptoms began, a nexus opinion showing that link to service.
Leah:Now that nexus opinion doesn't necessarily have to come from an external source. It can come from the CMP examiner. It can come from your treating provider. It can come from whoever. You don't have to have, like a robust statement I'm sorry, a robust letter explaining these things, but the nexus is required.
Leah:That relationship to service is a requirement. But again, that's something that you can obtain for no cost at your VAC and P exam if the examiner agrees that there is a relationship between your endometriosis and your service. So evidence showing any functional limitations may be beneficial. So missed work, impact on your daily life, ongoing treatments, things like that. So for service connection, veterans can be service connected for this condition on a primary or a secondary basis.
Leah:So let's talk about service connection specifically when one of those two things may be related to your service or on a primary basis or on a secondary basis. So primary service connection means your endometriosis started while you were on active duty or during service and can be directly linked to something that happened while you were in the uniform. Maybe you started experiencing symptoms, but you didn't get a full diagnosis until after discharge. That can still count if you can show continuity of symptomatology, right? Now that may be a little bit tricky if you're a reservist or a National Guardsman, because generally speaking, unless you're activated or whatever, most of your time in that component is as a civilian, right?
Leah:So there are some key things there that you may wanna talk to an accredited claims agent or an attorney or a BSO or or whatever about. And I always like to throw that disclaimer out. I'm a medical professional, so I like to highlight a lot of these things from a medical aspect, give you guys some research that may be beneficial to you. But if you need any kind of legal advice or help filing an appeal or a claim, you might wanna hop on over to va.gov and use their accreditation search tool so that you can find somebody in your local area or really anywhere in The US that you feel comfortable with that can help you with your claim. So secondary service connection means that the endometriosis was caused or worsened or aggravated by another condition.
Leah:For example, you may have some depression or some other kind of And we're gonna go over some of this literature that can make your endometriosis worse. There are a lot of inflammatory conditions that can be worsened by mental health conditions. Also, maybe you had surgery, maybe your endometriosis was really well contained, but you had some kind of surgery on active duty that cut through and spread some of that tissue. Maybe you had a C section on active duty and then all of that endometrial tissue got seeded into your belly, okay? So that is an example of how maybe a surgery for something else, or maybe you had some other kind of abdominal surgery and some of that tissue got displaced, right?
Leah:Primary or secondary pass can lead to compensation if you have medical evidence that supports it, right? So you can also, if you get service connected for endometriosis, endometriosis, you can have a variety of secondary conditions that can be related to your service connected endometriosis. So it doesn't just affect the reproductive system. It can lead to secondary disabilities and many veterans don't even realize that these can be claimed. So you can have somatic symptom disorder or a chronic pain type syndrome.
Leah:Endometriosis can cause ongoing pelvic pain, abdominal pain, lower back pain, leading to chronic pain disorders, depression, anxiety, chronic pain and infertility struggles can trigger serious mental health conditions. You have bowel or bladder dysfunction like interstitial cystitis, IBS, bladder dysfunction. They're all common in advanced endometriosis. Infertility endometriosis is the leading cause of infertility and infertility itself can be rated by VA if it causes emotional distress. Sexual dysfunction, pelvic pain can lead to painful intercourse or avoidance, which is another ratable condition.
Leah:Post surgical complications, if you've had surgeries like a hysterectomy or a bowel resection or bladder surgery related to endometriosis, these kind of complications from any complications from those kind of procedures can also be rated. So if you experience any of these, you might wanna talk to your doctor about writing you a Nexus letter if they're willing to do them, trying to tie them directly to your service connected endometriosis, if you have endometriosis, right? And some of those other things happen. So I always like to give some literature to you guys and some supporting documentation so that you can maybe look over it yourself, talk to your medical doctor about it, and see if they're willing to support you with a statement. Again, that's not always required, but it can be helpful if your personal doctor is gonna give you some information supporting your claim.
Leah:Right? So this medical literature can back up some of your claim in some cases. So military medicine in 2020 found higher rates of endometriosis in active duty women. The Journal of Women's Health in 2018 found veterans with endometriosis suffer higher rates of chronic pain, anxiety and depression. So for some of those secondary conditions.
Leah:The American Journal of Obstetrics and Endometriosis Linked to Occupational Impairments is discussed. Frontiers in Global Women's Health highlights long diagnostic delays and severe outcomes in military women, Including references to research, can sometimes help you support that link. Again, if you have any questions, focusing on talking to one of those accredited legal professionals can be very helpful in the appeals process and the filing and things like that. They can help you to make sure you're turning in the correct documentation to support your claim. You're never required to use a legal professional.
Leah:You can VA tries to make it very easy for you to do this on your own. They have some great help documents on help on va.gov, so you might wanna check those out. I have a little sample statement that might be helpful that you could just think about and talk with your doctor about if they would be willing to say something like this. So magic VA language, it's at least as likely as not that the veterans diagnosed endometriosis began during active duty military service. This opinion is supported by studies, including a 2020 publication in military medicine documenting higher rates of endometriosis among service women due to occupational environmental factors unique to military life.
Leah:Then they can reference back to any like lab results or any complaints of abdominal pain, maybe abnormal bleeding and things like that that you had in your service, right? For secondary claims, they might could write something like it's at least as likely as not that the veterans diagnosed major depressive disorder was caused by their service connected endometriosis, consistent with findings in the Journal of Women's Health in 2018 showing increased psychiatric comorbidities among women veterans with endometriosis. So in closing, endometriosis can severely impact your quality of life and the VA often will recognize that. So if you found this helpful, please like and subscribe and hit the notification bell so you don't miss future tips on the medical aspects of how some of these things work. Thank you for watching and as always, thank you for your service.
Leah:And if you guys have any questions or comments or feedback, I always love to see those in the comments and I try to answer them almost every day and answer them myself. So again, thank you for watching and thank you for your service.