Proposed Rule2025-19229
Eliminating the Requirement for Laparoscopy To Establish Service Connection for Endometriosis
Primary source
Metadata and text below are from the Federal Register, a public-domain U.S. government work. Always verify the official published version before relying on it for any legal matter.
Published
October 1, 2025
Issuing agencies
Veterans Affairs Department
Abstract
The Department of Veterans Affairs (VA) proposes to remove the note under diagnostic code (DC) 7629 requiring an endometriosis diagnosis that is confirmed by laparoscopy. This update would ensure the VA Schedule for Rating Disabilities (VASRD) continues to align with current medical practice and would expedite the process for establishing service connection.
Full Text
<html>
<head>
<title>Federal Register, Volume 90 Issue 188 (Wednesday, October 1, 2025)</title>
</head>
<body><pre>
[Federal Register Volume 90, Number 188 (Wednesday, October 1, 2025)]
[Proposed Rules]
[Pages 47266-47268]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2025-19229]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF VETERANS AFFAIRS
38 CFR Part 4
[Docket No. VA-2025-VBA-0139]
RIN 2900-AS39
Eliminating the Requirement for Laparoscopy To Establish Service
Connection for Endometriosis
AGENCY: Department of Veterans Affairs.
ACTION: Proposed rule.
-----------------------------------------------------------------------
SUMMARY: The Department of Veterans Affairs (VA) proposes to remove the
note under diagnostic code (DC) 7629 requiring an endometriosis
diagnosis that is confirmed by laparoscopy. This update would ensure
the VA Schedule for Rating Disabilities (VASRD) continues to align with
current medical practice and would expedite the process for
establishing service connection.
DATES: Comments must be received on or before December 1, 2025.
ADDRESSES: You may submit comments through <a href="http://www.regulations.gov">www.regulations.gov</a> under
RIN 2900-AS39. That website includes a plain-language summary of this
rulemaking. Instructions for accessing agency documents, submitting
comments, and viewing the rulemaking docket are available on
<a href="http://www.regulations.gov">www.regulations.gov</a> under ``FAQ.''
FOR FURTHER INFORMATION CONTACT: Virginia Greenwood and Maria Welch,
Regulations Analysts, Compensation Service, Veterans Benefits
Administration, (202) 461-9700.
SUPPLEMENTARY INFORMATION:
I. Background
As part of the ongoing revision of the VASRD, VA proposes to remove
the note under title 38 Code of Federal Regulations (CFR) 4.116, DC
7629, Endometriosis. This change would help VA align DC 7629 with
current medical science and clinical practice and expedite the process
for establishing service connection. VA last updated the Gynecological
Conditions and Disorders of the Breast body system in 2018. See 83 FR
15068 (April 9, 2018). However, VA did not address DC 7629 at that
time. VA added DC 7629 to the VASRD to evaluate endometriosis in 1995
with a note that stated, ``Diagnosis of endometriosis must be
substantiated by laparoscopy.'' 60 FR 19851, 19856 (April 21, 1995). VA
established this note because medical professionals consider
laparoscopy, which is an invasive surgical procedure that allows a
surgeon to visually inspect the pelvis, as ``the gold standard'' for
the confirmatory diagnosis of
[[Page 47267]]
endometriosis. See Bafort, C. et al., ``Laparoscopic surgery for
endometriosis,'' Cochrane Database of Systematic Reviews (2020),
<a href="https://doi.org/10.1002/14651858.CD011031">https://doi.org/10.1002/14651858.CD011031</a>. To date, laparoscopically
confirmed endometriosis is still the medical ``gold standard.'' Because
of the note to DC 7629, VA cannot grant service connection for
endometriosis in the absence of confirmation by laparoscopy.
In recent years, there has been an increased interest in
establishing non-invasive means to clinically diagnose endometriosis,
such as patient interviews, physical examinations, and imaging
techniques. See Agarwal, S. et al., ``Clinical diagnosis of
endometriosis: a call to action,'' American Journal of Obstetrics and
Gynecology (2019), <a href="https://doi.org/10.1016/j.ajog.2018.12.039">https://doi.org/10.1016/j.ajog.2018.12.039</a>.
Nevertheless, researchers suggest that ``none of [these tools] have
been proven to be [a] definitive clinical tool for diagnosis of
endometriosis.'' Parasar, P. et al., ``Endometriosis: Epidemiology,
Diagnosis, and Clinical Management,'' Current Obstetrics and Gynecology
Reports (2017), <a href="https://doi.org/10.1007/s13669-017-0187-1">https://doi.org/10.1007/s13669-017-0187-1</a>. Since
medical providers are unlikely to use laparoscopy as a first line
diagnostic tool based on the variability of symptoms among patients, a
diagnosis of endometriosis can be delayed by 8 to 12 years. Kiesel, L.
& Sourouni, M., ``Diagnosis of endometriosis in the 21st century,''
Climacteric (2019), <a href="https://doi.org/10.1080/13697137.2019.1578743">https://doi.org/10.1080/13697137.2019.1578743</a>.
II. Need for Change
Due to the issues mentioned, VA contends that service connection
for endometriosis should no longer be dependent upon obtaining a
diagnosis via laparoscopy. Even though laparoscopy is the current
standard to definitively diagnose endometriosis, medical providers can
make a preliminary diagnosis using non-invasive methods. After
obtaining the patient's clinical history, clinicians can physically
examine the patient and perform pelvic and transvaginal ultrasounds,
magnetic resonance imaging, and computed tomography scans to
characterize pelvic masses. Parasar, P. et al., ``Endometriosis:
Epidemiology, Diagnosis, and Clinical Management,'' Current Obstetrics
and Gynecology Reports (2017), <a href="https://doi.org/10.1007/s13669-017-0187-1">https://doi.org/10.1007/s13669-017-0187-1</a>. Therefore, VA considers a preliminary diagnosis of endometriosis
using these other methods as sufficiently reliable to warrant service
connection for the condition and evaluation at the 10% and 30% levels
in the current rating criteria.
This change would allow VA to align DC 7629 with other rated
conditions where medical providers experience challenges with providing
an immediate confirmed diagnosis. For example, there is currently no
standard definitive test available to diagnose multiple sclerosis (DC
8018), Parkinson's disease (DC 8004 for Paralysis agitans), or chronic
fatigue syndrome (DC 6354), which means a medical professional must
generally rely on the patient's symptoms and medical history, and then
eliminate other diseases that present similar symptoms. Because of
these known challenges, VA did not include criteria within the VASRD
requiring a specific test for confirming a diagnosis for these
conditions. Moreover, even for purposes of confirming diagnoses in
disability compensation claims, Veterans Health Administration and
contract examiners cannot order surgical or other invasive procedures,
such as laparoscopy. See VA's Adjudication Procedures Manual, Part X,
Subpart i, Chapter 6, Section F, Topic 2, Paragraph i. As previously
stated, medical providers are not likely to use laparoscopy as a first
line diagnostic tool; therefore, VA does not want to impose barriers to
obtaining disability compensation that do not align with established
medical practices.
VA further considers this change appropriate for endometriosis
since it has established procedures under 38 CFR 3.105 for addressing
instances of misdiagnosis and changes in diagnosis if a preliminary
diagnosis of endometriosis later changes to a different condition upon
laparoscopy results or further medical evaluation.
III. Regulatory Amendments
VA bases the evaluations for endometriosis under DC 7629 on
successive rating criteria derived from continuous treatment and
whether symptoms are controlled by treatment. Currently, VA awards a
10% evaluation for pelvic pain or heavy or irregular bleeding requiring
continuous treatment for control and a 30% evaluation for pelvic pain
or heavy or irregular bleeding not controlled by treatment. VA assigns
a 50% evaluation if there are (1) lesions involving the bowel or
bladder confirmed by laparoscopy, (2) pelvic pain or heavy or irregular
bleeding not controlled by treatment, and (3) bowel or bladder
symptoms. To effectuate the change described in this rulemaking, VA
proposes to remove the note for DC 7629, which states that the
diagnosis of endometriosis must be substantiated by laparoscopy. This
removal will have a two-fold effect: it will (1) allow VA to establish
service connection for endometriosis by diagnosis without a laparoscopy
(assuming the other elements of service connection are present) and (2)
allow VA to assign evaluations up to 30% disabling without a
laparoscopy. Please note that the criteria for the 50% evaluation will
remain the same and will continue to require laparoscopy to confirm
that there are lesions involving the bowel or bladder.
This amendment will ensure VA uses similar evidentiary standards
across body systems when evaluating conditions having similar
diagnostic challenges. By removing the note requiring laparoscopic
confirmation for service connection, VA can provide benefits to
veterans suffering from endometriosis faster without requiring an
invasive procedure for entitlement.
Executive Orders 12866, 13563, and 14192
VA examined the impact of this rulemaking as required by Executive
Orders 12866 (September 30, 1993) and 13563 (January 18, 2011), which
direct agencies to assess all costs and benefits of available
regulatory alternatives and, if regulation is necessary, to select
regulatory approaches that maximize net benefits. The Office of
Information and Regulatory Affairs has determined that this rulemaking
is not a significant regulatory action under Executive Order 12866, as
supplemented by Executive Order 13563. This proposed rule is not
expected to be an Executive Order 14192 regulatory action because this
rule is not significant under Executive Order 12866. The regulatory
impact analysis associated with this rulemaking can be found as a
supporting document at <a href="http://www.regulations.gov">www.regulations.gov</a>.
Regulatory Flexibility Act
The Secretary hereby certifies that this proposed rule would not
have a significant economic impact on a substantial number of small
entities as they are defined in the Regulatory Flexibility Act (5
U.S.C. 601-612). This certification is based on the fact that small
entities or businesses are not impacted by VASRD revisions. Therefore,
pursuant to 5 U.S.C. 605(b), the initial and final regulatory
flexibility analysis requirements of 5 U.S.C. 603 and 604 do not apply.
Unfunded Mandates
This proposed rule would not result in the expenditure by State,
local, and Tribal governments, in the aggregate, or by the private
sector, of $100 million or
[[Page 47268]]
more (adjusted annually for inflation) in any one year.
Paperwork Reduction Act
This proposed rule contains no provisions constituting a collection
of information under the Paperwork Reduction Act of 1995 (44 U.S.C.
3501-3521).
List of Subjects in 38 CFR Part 4
Disability benefits, Pensions, Veterans.
Signing Authority
Douglas A. Collins, Secretary of Veterans Affairs, approved this
document on September 25, 2025, and authorized the undersigned to sign
and submit the document to the Office of the Federal Register for
publication electronically as an official document of the Department of
Veterans Affairs.
Taylor N. Mattson,
Alternate Federal Register Liaison Officer, Department of Veterans
Affairs.
For the reasons set out in the preamble, VA proposes to amend 38
CFR part 4 as set forth below:
PART 4--SCHEDULE FOR RATING DISABILITIES
Subpart B--Disability Ratings
0
1. The authority citation for part 4 continues to read as follows:
Authority: 38 U.S.C. 1155, unless otherwise noted.
0
2. Amend Sec. 4.116 by revising the entry for diagnostic code 7629 to
read as follows:
Sec. 4.116 Schedule of ratings--gynecological conditions and
disorders of the breast.
------------------------------------------------------------------------
Rating
------------------------------------------------------------------------
* * * * * * *
7629 Endometriosis:
Lesions involving bowel or bladder confirmed by 50
laparoscopy, pelvic pain or heavy or irregular
bleeding not controlled by treatment, and bowel or
bladder symptoms......................................
Pelvic pain or heavy or irregular bleeding not 30
controlled by treatment...............................
Pelvic pain or heavy or irregular bleeding requiring 10
continuous treatment for control......................
* * * * * * *
------------------------------------------------------------------------
0
3. Amend appendix A to part 4 by revising the entry for diagnostic code
7629 to read as follows:
Appendix A to Part 4--Table of Amendments and Effective Dates Since
1946
----------------------------------------------------------------------------------------------------------------
Sec. Diagnostic code No.
----------------------------------------------------------------------------------------------------------------
* * * * * * *
7629 Added May 22, 1995; note [effective date of
final rule].
* * * * * * *
----------------------------------------------------------------------------------------------------------------
[FR Doc. 2025-19229 Filed 9-30-25; 8:45 am]
BILLING CODE 8320-01-P
</pre></body>
</html>Indexed from Federal Register on October 1, 2025.
This is legal information, not legal advice. Laws vary by jurisdiction and change frequently. Always verify current law with official sources and consult a licensed attorney in your jurisdiction for advice on your specific situation.