Endometriosis

VA rates endometriosis under Diagnostic Code 7629 at 10, 30, or 50 percent. The schedule focuses on pelvic pain or heavy or irregular bleeding, whether treatment controls those symptoms, and, at the highest tier, a specific combination of laparoscopically confirmed bowel or bladder lesions and bowel or bladder symptoms.

As of August 14, 2026, the current 38 CFR § 4.116 still states that an endometriosis diagnosis must be substantiated by laparoscopy. A proposed rule published in 2025 would change parts of that framework, but a proposal is not the current rating rule.

TL;DR

• DC 7629 provides 10, 30, and 50-percent ratings.
• Ten percent applies when pelvic pain or heavy or irregular bleeding requires continuous treatment for control.
• Thirty percent applies when that pain or bleeding is not controlled by treatment.
• Fifty percent requires bowel or bladder lesions confirmed by laparoscopy, uncontrolled pelvic pain or heavy or irregular bleeding, and bowel or bladder symptoms.
• The current schedule still says the diagnosis must be substantiated by laparoscopy.
• Modern medical evaluation may use history, examination, ultrasound, MRI, and treatment response, but the compensation schedule's laparoscopy text is a separate legal issue.
• In-service symptoms can support direct service connection even when the diagnosis came later.
• An exposure theory requires individualized medical evidence; endometriosis is not a general PACT Act presumptive condition.

The Current DC 7629 Rating

50 percent

Lesions involving bowel or bladder confirmed by laparoscopy, pelvic pain or heavy or irregular bleeding not controlled by treatment, and bowel or bladder symptoms.

All parts of the criterion matter. Bowel symptoms alone, bladder symptoms alone, or uncontrolled pelvic pain without the required laparoscopic lesion evidence does not match the text of the 50-percent tier.

30 percent

Pelvic pain or heavy or irregular bleeding not controlled by treatment.

The treatment history should show what was prescribed, adherence and tolerability where relevant, the duration of treatment, and the symptoms that remained. A statement that medication “did not work” is stronger when supported by dated gynecology records.

10 percent

Pelvic pain or heavy or irregular bleeding requiring continuous treatment for control.

This tier focuses on the need for continuing treatment. Records should identify the medication, hormonal treatment, procedure, or other prescribed care and show that control depends on it.

The Laparoscopy Requirement and Proposed Change

The current note following DC 7629 states that the diagnosis must be substantiated by laparoscopy. The 50-percent criterion separately requires laparoscopic confirmation of bowel or bladder lesions.

On October 1, 2025, VA published a proposed rule (90 FR 47266) that would remove the note requiring laparoscopy to substantiate the diagnosis. Under the proposal, the 50-percent criterion would still require laparoscopic confirmation of bowel or bladder lesions. That proposal is useful notice of possible future change, but it does not replace current eCFR text. Check the current eCFR text for any final rule.

The legal requirement should not be confused with a claim that clinicians always need surgery before treating suspected endometriosis. The federal Office on Women's Health explains that evaluation may include history, pelvic examination, ultrasound, MRI, medication response, and laparoscopy. Clinical care and VA's current compensation text answer different questions.

Direct Service Connection

Direct service connection under § 3.303 may apply when endometriosis began during service or current disease is medically linked to in-service symptoms. A formal diagnosis may come years after the first pelvic pain or bleeding. The nexus opinion should explain why the earlier pattern is consistent with the later confirmed disease while addressing other plausible causes.

Useful evidence can include:

• service gynecology and primary-care records;
• menstrual, pain, bowel, and bladder symptom histories;
• emergency visits or limited-duty records;
• ultrasound, MRI, operative, laparoscopy, and pathology reports;
• treatment trials and response;
• fertility evaluation where relevant; and
• lay statements describing observable pain episodes and functional effects.

Toxic-Exposure Theories

Endometriosis is not listed as a general PACT Act presumptive condition. A veteran may still pursue direct service connection based on a toxic exposure risk activity under the ordinary nexus framework. The evidence must identify the actual exposure and include competent medical analysis connecting it to this veteran's disease.

Scientific literature describing an association does not by itself establish an individual nexus. The opinion should address dose or circumstances where known, latency, competing risks, the veteran's symptom timeline, and the strength and limits of the literature.

Secondary Conditions and Distinct Residuals

Endometriosis can coexist with infertility, bowel or bladder disorders, painful scars, and other gynecological conditions. Coexistence does not automatically establish secondary service connection or a separate rating. Each additional claim needs a diagnosis, a medical causal or aggravation link, and distinct functional impairment.

The 50-percent DC 7629 tier already incorporates bowel or bladder symptoms in the specified combination. Section 4.14 prevents compensating the same symptoms twice. A separate rating may be possible only when a distinct disability and nonoverlapping manifestations are established.

What the C&P Record Should Establish

The record should answer:

• Is the diagnosis substantiated in the manner required by the current schedule?
• What pelvic pain, heavy bleeding, or irregular bleeding is documented?
• What continuous treatments have been prescribed, and do they control symptoms?
• If 50 percent is at issue, are bowel or bladder lesions confirmed by laparoscopy?
• Are bowel or bladder symptoms present along with uncontrolled pain or bleeding?
• What symptoms began during service, and what medical opinion connects them to current disease?
• Are any claimed bowel, bladder, scar, fertility, or other residuals distinct rather than duplicative?

Common Failure Modes

• Publishing the proposed 2025 rule as though it is already effective.
• Saying imaging alone satisfies the current schedule's diagnostic note.
• Treating any bowel or bladder symptom as enough for 50 percent.
• Failing to document whether prescribed treatment actually controls pain or bleeding.
• Assuming a delayed diagnosis defeats direct service connection despite documented in-service symptoms.
• Presenting endometriosis as PACT Act presumptive.
• Seeking separate ratings for the same bowel, bladder, pain, or bleeding manifestations.

Bottom Line

The current endometriosis rating turns on symptom control and, at 50 percent, a demanding combination of laparoscopic lesion evidence and bowel or bladder symptoms. A strong claim preserves the operative and diagnostic record, documents treatment response, and uses a medical opinion to connect in-service symptoms to the current disease. The proposed rule should be monitored, but it should not be applied before it becomes final and effective.

Legal and medical sources: 38 CFR § 4.116, § 3.303, § 3.310, § 4.14, 2025 proposed rule on the laparoscopy note, and Office on Women's Health endometriosis guidance, checked August 14, 2026.