Many women veterans assume the rating schedule was never built with their conditions in mind. 38 CFR 4.116 says otherwise: it rates gynecological and breast conditions on their own criteria, the PACT Act made breast and the other reproductive cancers presumptive for qualifying service, and a 0 percent rating like female sexual arousal disorder can still pay every month through SMC-K. Knowing which door to use is most of the work.
The short version
VA has a rating schedule written specifically for gynecological conditions and disorders of the breast, found at 38 CFR 4.116. The PACT Act made breast cancer and the other reproductive cancers presumptive for veterans with qualifying service. Claims tied to military sexual trauma follow more flexible evidence rules. And one of the most overlooked ratings in the whole schedule, female sexual arousal disorder, pays nothing on its face but can carry monthly compensation through SMC-K.
This page walks through how the pieces fit together and where the records are.
The rating schedule written for women's health
The 4.116 schedule rates conditions of the reproductive system and the breast on their own criteria, separate from the general schedules. Our condition library covers these pages, each with its rating table and the evidence VA usually reviews:
- Endometriosis, uterine fibroids, PCOS, pelvic inflammatory disease, and premature ovarian failure
- Hysterectomy and uterine prolapse
- Female sexual arousal disorder
- Breast cancer, mastectomy residuals, and fibrocystic breast disease
- Cervical cancer, ovarian cancer, and endometrial cancer
- Premenstrual dysphoric disorder, which is rated under the mental health formula
One boundary worth knowing: the schedule treats natural menopause and pregnancy by themselves as normal life events, not disabilities. Complications and conditions that arise from them can still be rated.
The 0 percent rating that still pays
Female sexual arousal disorder, diagnostic code 7632, was added to the schedule in 2018. The schedule offers exactly one level: 0 percent. That looks like nothing, but it works the same way erectile dysfunction does for men. The 0 percent rating establishes service connection, and VA must then consider Special Monthly Compensation at the K rate for loss of use of a creative organ, paid every month on top of your combined rating.
The same SMC-K review applies after a hysterectomy. Removal of the uterus is rated 100 percent for three months after surgery, then 30 percent, or 50 percent when both ovaries were also removed. Run the numbers in our SMC explorer.
FSAD needs a diagnosis from a medical provider, and the cause matters: medication side effects, pelvic injury or surgery, and conditions connected to military sexual trauma are common paths to service connection.
Breast cancer is now a presumptive cancer
The PACT Act added reproductive cancer of any type to the presumptive list for veterans who served in qualifying locations. VA's guidance for women veterans confirms this includes breast cancer, along with cervical, ovarian, uterine, vaginal, and vulvar cancers. If you served in a qualifying location during the covered windows, you do not need a medical opinion linking the cancer to service. See the qualifying locations and dates on our PACT Act guide.
Active breast cancer is rated at 100 percent during treatment under diagnostic code 7630, and residuals are rated afterward under their own criteria. VA also prioritizes cancer claims for faster processing.
What the military's own studies found
Congress ordered the Department of Defense to study breast cancer in the ranks twice, first in the 2013 defense bill and again in the 2022 bill. A few findings from the reports are worth knowing:
- Incidence among active duty women was somewhat lower than the civilian comparison overall, largely because the force is young.
- The disease concentrates sharply with age. Women over 40 made up about 8 percent of active duty service time but accounted for over half of invasive cases.
- Black service women showed roughly 30 percent higher odds of invasive breast cancer than white and Hispanic peers, especially under age 40.
- Screening matters: clinical exams before 40, annual mammograms from 40, and earlier mammograms or MRI for elevated risk.
Why this matters for a claim: many diagnoses come after separation, when the paper trail is what remains. Service treatment records, mammogram and pathology reports, and the exposure records covered in our exposure records guide all do work here.
MST claims follow different evidence rules
For PTSD claims based on in service personal assault, including military sexual trauma, VA accepts evidence from outside your service records. That includes records from law enforcement and rape crisis centers, counseling and medical records, statements from family, clergy, or fellow service members, and markers in your record such as a request for transfer, a drop in performance, or changes in behavior. You can also ask for an examiner of a specific gender for an MST related exam.
You do not need to have reported the assault at the time for VA to consider the claim.
Putting it together
- Find your conditions in the reproductive system library and read the rating criteria before any exam.
- Check the presumptive angle. If you have a covered cancer and qualifying service, the PACT Act may carry the nexus for you.
- Ask about SMC-K any time an organ or its use was lost, including FSAD and hysterectomy claims. The K rate is paid on top, not instead.
- Bring the records: treatment notes, operative and pathology reports, and exposure documentation where it applies.
- A VA accredited representative can help you sequence all of it. The directory on this site verifies accreditation against VA's list.
Worth remembering
None of this is medical or legal advice, and a rating decision always depends on your own records. What the schedule, the PACT Act, and the MST rules add up to is simple enough: the claims system has specific doors built for women veterans, and knowing which door to use is most of the work.