Benign Uterine Neoplasm (Fibroid) C&P Exam Prep

Hemoglobin (HGB) and Hematocrit (HCT)

What it measures: Blood values that indicate the presence and severity of anemia, which can result from chronic heavy menstrual bleeding caused by uterine fibroids.

What to expect: A blood draw may be ordered or recent lab results reviewed. The examiner will document HGB and HCT values on the DBQ. Normal HGB for women is approximately 12.0-16.0 g/dL; below 12.0 g/dL indicates anemia.

Pain considerations: Anemia-related fatigue can compound pain-related functional limitations. Be sure to describe how fatigue from blood loss affects your ability to work, exercise, or complete daily tasks.

Absorbent Material Usage Assessment

What it measures: The DBQ specifically quantifies how frequently absorbent materials (pads, tampons, adult incontinence products) must be changed due to menorrhagia or urinary leakage caused by fibroid pressure. This measurement directly maps to rating criteria.

What to expect: The examiner will ask how many times per day or week you change absorbent materials. The DBQ has specific checkboxes: does not require absorbent material; changed less than 2 times per day; changed 2-4 times per day; changed more than 4 times per day.

Pain considerations: Heavy bleeding episodes are often accompanied by severe cramping and pelvic pain. Describe how pain during these episodes prevents you from working, exercising, or leaving home.

Urinary Symptom Frequency Assessment

What it measures: How frequently urinary symptoms (urgency, frequency, incomplete emptying) occur due to fibroid compression of the bladder. The DBQ captures incontinence frequency: less than once a week, 1-3 times per week, 4 or more times per week, or daily/more often.

What to expect: The examiner will ask about urinary leakage, urgency, and frequency. Be prepared to describe how often episodes occur and what triggers them (sneezing, lifting, prolonged standing, etc.).

Pain considerations: Bladder pressure from large fibroids can cause a constant sensation of pelvic fullness and discomfort. Describe this pressure as a separate symptom from episodic pain.

0%

Symptoms do not require continuous treatment OR symptoms are well-controlled with continuous treatment. Under 38 CFR 4.116, DC 7631, a 0% rating applies when the neoplasm is present but causes no significant symptomatic impairment or symptoms are fully managed without functional limitation.

From 38 CFR: Symptoms do not require continuous treatment for the following: mild pain, irregular menstruation, dysmenorrhea associated with ovarian dysfunction, secondary amenorrhea associated with ovarian dysfunction, frequent or continuous menstrual disturbances, pelvic pressure, or other signs and/or symptoms.

10%

Symptoms require continuous treatment. Under 38 CFR 4.116, DC 7631, a 10% rating applies when the benign uterine neoplasm causes symptoms that require continuous treatment to control, such as ongoing pelvic pain, menstrual irregularities, or pelvic pressure requiring regular medication or medical management.

From 38 CFR: Symptoms require continuous treatment for the following: mild to moderate pain, irregular menstruation, dysmenorrhea associated with ovarian dysfunction, secondary amenorrhea associated with ovarian dysfunction, frequent or continuous menstrual disturbances, pelvic pressure, or other signs and/or symptoms.

30%

Symptoms are NOT controlled by continuous treatment. Under 38 CFR 4.116, DC 7631, a 30% rating applies when symptoms persist despite ongoing medical management, indicating that treatment is insufficient to adequately control the condition and functional impairment continues.

From 38 CFR: Symptoms are not controlled by continuous treatment for the following: moderate to severe pain, heavy or irregular bleeding, pelvic pressure, frequent or continuous menstrual disturbances, or other signs and/or symptoms.

100%

Active malignant neoplasm or during active treatment with antineoplastic therapy (chemotherapy, radiation). Note: DC 7631 applies to benign neoplasms, but if a fibroid transforms or a separate malignant neoplasm is identified, a 100% rating applies during active treatment. Also applies during the active treatment period following surgical intervention for the neoplasm, per 38 CFR 4.116 general rating principles and Note following DC ratings for neoplasms.

From 38 CFR: A 100% evaluation shall be assigned from the date of onset of primary malignancy, or date of hospital admission for treatment, and shall continue for six months following the completion of therapy. After six months, the appropriate disability rating shall be determined by mandatory VA examination.

Pelvic Pain

How to describe it: Describe the location (lower abdomen, pelvis, lower back), character (cramping, pressure, aching, stabbing), intensity on a 0-10 scale, duration of each episode, and frequency per week or month. Explain what activities trigger or worsen pain (standing, walking, intercourse, bowel movements) and what, if anything, provides relief. Distinguish between baseline daily pain and acute flare-ups.

Example: On my worst days, which happen about 8 to 10 days per month, I have a constant 7 out of 10 cramping pressure in my lower pelvis that prevents me from sitting at my desk for more than 30 minutes at a time. I have missed work approximately 2 days per month because the pain is unresponsive to ibuprofen and I cannot concentrate or function normally. I need to lie down with a heating pad for several hours.

Examiner listens for: Specific pain severity levels (mild, moderate, severe), frequency of pain episodes, functional limitation caused by pain, whether pain is controlled or uncontrolled by treatment, and impact on employment and daily activities.

Avoid: Do not say 'it's manageable' or 'I just deal with it' - these phrases suggest your symptoms are controlled. Instead, accurately describe how much effort, medication, and lifestyle modification it takes to manage the pain, and note that it still limits your functioning even with treatment.

Menstrual Disturbances and Heavy Bleeding

How to describe it: Quantify bleeding using specific metrics: how many pads or tampons per day on heavy days, how many days per cycle are heavy, how often you pass clots and what size, cycle length and regularity, and number of cycles per year that are abnormal. Describe the impact on your daily life - missed work, inability to leave home, accidents or leakage through clothing.

Example: During my heaviest days, which last 4 to 5 days each cycle, I soak through a super-plus tampon and a maxi pad every 1 to 2 hours. I have had accidents at work where blood soaked through my clothing. I carry a change of clothes and extra supplies everywhere I go. During these days I cannot be away from a restroom for more than 90 minutes and I have left work early or called in sick 3 to 4 times in the past 6 months because of this.

Examiner listens for: Frequency of absorbent material changes per day (less than 2, 2-4, or more than 4 times daily), presence of clots, cycle irregularity, impact on work attendance, social withdrawal, and whether bleeding is controlled or uncontrolled by current treatment.

Avoid: Do not simply say 'my periods are heavy.' Give the examiner quantifiable information. Avoid minimizing by saying 'it's normal for me' - what you experience may be significantly above medical norms and directly relevant to your disability rating level.

Pelvic Pressure and Bulk Symptoms

How to describe it: Describe the sensation of pelvic fullness, heaviness, or pressure as distinct from pain. Note whether it is constant or intermittent, what makes it worse (prolonged standing, end of day, physical exertion), and how it limits your ability to walk, stand, sit, or exercise. If fibroids are large, describe any visible abdominal distension.

Example: I feel a constant heaviness and fullness in my lower pelvis, like something is pressing down inside me. By the end of a workday after standing for several hours, the pressure becomes a 6 out of 10 and forces me to sit or lie down. I have stopped exercising because physical activity worsens the pressure significantly. This has been constant for the past year and my current hormonal treatment has not reduced this sensation.

Examiner listens for: Constant versus intermittent pressure, aggravating factors, impact on mobility and physical activity, and whether pelvic pressure is an uncontrolled symptom despite treatment.

Avoid: Do not overlook pelvic pressure as a minor symptom. It is a specifically listed criterion under DC 7631 and directly maps to DBQ checkboxes. Ensure you mention it explicitly if you experience it.

Urinary Symptoms from Fibroid Compression

How to describe it: Describe urinary frequency (number of times per day and night), urgency episodes, any leakage, sensation of incomplete emptying, or hesitancy. Note how often these symptoms occur per week and whether you use absorbent materials specifically for urinary leakage. Explain how urinary symptoms affect your daily routine, travel, work, and social activities.

Example: My large fibroid presses on my bladder and I urinate 12 to 15 times per day and 3 to 4 times at night. I have urgency leakage approximately 4 to 5 days per week where I cannot make it to the restroom in time. I wear an incontinence pad daily. I have declined job opportunities that require travel or fieldwork because I need constant access to a restroom.

Examiner listens for: Frequency and severity of urinary symptoms, use of absorbent materials for incontinence, impact on employment and social activities, and whether symptoms are attributed to fibroid compression versus another condition.

Avoid: Do not attribute urinary symptoms only to other causes without mentioning the fibroid connection. If your gynecologist has noted that fibroid size contributes to bladder pressure, make sure to state this explicitly during the exam.

Functional Impact on Work and Daily Life

How to describe it: Describe specific ways your fibroid symptoms limit your ability to work, including missed days, reduced hours, inability to perform physical job tasks, need for frequent restroom breaks, and difficulty concentrating due to pain or fatigue. Also describe how symptoms affect household tasks, childcare, social activities, exercise, sleep, and relationships.

Example: In the past 12 months I have missed approximately 18 days of work due to fibroid-related pain, heavy bleeding, and fatigue from anemia. On days I do work, I need to take 4 to 6 ibuprofen and change absorbent materials every 1 to 2 hours. I have been passed over for a promotion because my supervisor noted my attendance issues. At home, I am unable to cook, clean, or care for my children on my worst days. I sleep poorly 10 to 12 nights per month due to pelvic pain and nighttime bleeding.

Examiner listens for: Concrete examples of functional limitation, impact on employment (missed days, reduced productivity, job modifications), and how the condition affects activities of daily living.

Avoid: Do not give vague answers like 'it affects my life sometimes.' Provide specific numbers - missed work days, frequency of symptoms, hours of limitation per day - so the examiner can accurately document functional impairment.

Treatment History and Treatment Adequacy

How to describe it: List all treatments you have received in chronological order: medications (NSAIDs, hormonal therapy, iron supplements), procedures (uterine fibroid embolization, endometrial ablation, myomectomy, hysterectomy), and any other therapeutic interventions. For each, describe whether it helped, how much it helped, and whether symptoms persist despite treatment.

Example: I have been on combined oral contraceptives for 2 years to manage bleeding and pain. Despite this, I still have 4 to 5 days of heavy bleeding per cycle requiring pad changes more than 4 times per day. My pain is somewhat reduced from an 8 to a 6 out of 10 on heavy days, but it remains severe enough to prevent me from working. My gynecologist has recommended a hysterectomy because conservative treatments have failed to adequately control my symptoms.

Examiner listens for: Whether current treatment is controlling symptoms (critical to determining 10% versus 30% rating), duration of treatment, types of interventions attempted, and documentation of treatment failure.

Avoid: Do not say treatment is 'working fine' if you still have significant symptoms. Treatment may reduce severity without achieving full control. Accurately describe the residual symptoms that persist even with your current regimen.