Skip to main content
VA Rating Assistant

DC 7629 · 38 CFR 4.116

Endometriosis C&P Exam Prep

To evaluate the nature, severity, and functional impact of your endometriosis for VA disability rating purposes under Diagnostic Code 7629, 38 CFR 4.116. The examiner will document your current symptoms, treatment requirements, and the degree to which continuous treatment controls your symptoms.

Format:
Interview + Physical
Typical duration:
30-45 minutes
DBQ form:
Gynecological_Conditions (Gynecological_Conditions)
Examiner:
Gynecologist, Gynecologic Oncologist, or appropriate clinician

What the examiner evaluates

  • Whether your endometriosis symptoms require continuous treatment
  • Whether symptoms are controlled or not controlled by continuous treatment
  • Presence and severity of pelvic pain (mild, moderate, or severe)
  • Presence of bowel symptoms attributable to endometriosis
  • Presence of bladder symptoms attributable to endometriosis
  • Heavy or irregular bleeding patterns
  • Whether laparoscopy has confirmed lesions involving bowel or bladder
  • Presence of anemia caused by endometriosis
  • Menstrual disturbances including dysmenorrhea, amenorrhea, or irregular menstruation
  • Whether surgical interventions (partial or complete ovary removal, hysterectomy) have been performed
  • Impact of endometriosis on daily functioning, work, and activities
  • Associated or secondary gynecological conditions (ovarian cysts, fallopian tube involvement, uterine involvement)
  • Current medications and treatment regimen

The exam will include both an interview about your symptoms and medical history and a physical/pelvic examination. You have the right to have a support person present. You also have the right to request that the exam be recorded in most states. Bring all relevant medical records, imaging results, and a list of current medications. The examiner will complete the Gynecological Conditions DBQ and may order or reference lab work (CBC for anemia assessment).

Measurements and tests

Pain Severity Assessment

What it measures: The level of pelvic pain associated with endometriosis, categorized as mild, moderate, or severe. This directly maps to rating criteria under DC 7629.

What to expect: The examiner will ask you to describe your pain on a scale and in descriptive terms. Be specific about location, character (cramping, stabbing, aching, burning), radiation patterns, duration, and what activities trigger or worsen pain. The examiner will check boxes for mild, moderate, or severe pain on the DBQ.

Critical thresholds

  • Mild pain Supports lower rating tiers; symptoms may not require continuous treatment
  • Moderate pain Supports mid-tier rating; describe frequency and functional limitations carefully
  • Severe pain Supports higher rating tiers; clearly document when symptoms are not controlled despite continuous treatment

Tips

  • Use a 0-10 numeric scale AND descriptive language when answering pain questions
  • Describe pain on your WORST days, not your average days - per M21-1 guidance, the examiner should capture the full range
  • Describe how pain affects your ability to work, perform household tasks, attend school, or maintain relationships
  • Note if pain is cyclical (worse around menstruation) AND non-cyclical (present throughout the month)
  • Mention if pain wakes you from sleep or requires you to miss work or social activities

Pain considerations: Endometriosis pain is a primary rating factor under DC 7629. Clearly distinguish between menstrual pain (dysmenorrhea), chronic pelvic pain outside of menstruation, dyspareunia (painful intercourse), dyschezia (painful bowel movements), and dysuria (painful urination). Each type of pain may support different DBQ checkboxes and a higher overall rating.

Complete Blood Count (CBC) / Hemoglobin and Hematocrit

What it measures: Whether endometriosis-related heavy bleeding has caused anemia. The DBQ has specific fields for HGB (hemoglobin) and HCT (hematocrit) values and a checkbox for anemia caused by endometriosis.

What to expect: The examiner may order a CBC or reference recent lab results. Hemoglobin below 12 g/dL and hematocrit below 36% in women generally indicates anemia. Bring your most recent lab results if available.

Critical thresholds

  • Hemoglobin < 12 g/dL or Hematocrit < 36% Supports the anemia caused by endometriosis checkbox, which can support higher rating levels
  • Normal CBC values Anemia checkbox may not be checked; focus on other symptom categories for rating support

Tips

  • Bring any recent CBC lab results from your treating physician or VA provider
  • If you have been treated for anemia (iron supplements, IV iron, transfusions), document this history
  • Describe symptoms of anemia: fatigue, dizziness, shortness of breath, pallor, inability to perform physical activities
  • Note if heavy bleeding requires you to use absorbent material changed more than 4 times per day

Pain considerations: Fatigue from anemia can significantly compound the functional impairment from pelvic pain. Articulate how anemia-related fatigue combines with pain to limit your daily activities and work capacity.

Absorbent Material Usage Assessment

What it measures: The frequency of absorbent material changes required due to heavy bleeding, which is a specific rating factor in the DBQ. Options include: does not require; changed less than 2 times per day; changed 2-4 times per day; changed more than 4 times per day.

What to expect: The examiner will ask about the heaviness of your menstrual bleeding and whether you use pads, tampons, or other absorbent materials. They will ask how often you must change these materials during heavy bleeding days.

Critical thresholds

  • Changed less than 2 times per day Supports lower rating level for bleeding severity
  • Changed 2-4 times per day Supports mid-level rating for bleeding severity
  • Changed more than 4 times per day Supports higher rating level; document this clearly with specific examples

Tips

  • Track your heaviest bleeding days in the weeks before your exam - count actual pad/tampon changes
  • Include overnight changes in your count if bleeding is heavy enough to wake you
  • Describe if you have had to leave work, school, or social activities due to bleeding severity
  • Note if you use double protection (pad plus tampon) during heavy days
  • If bleeding has decreased due to treatment (hormonal therapy, IUD), clarify this is treatment-controlled and describe what symptoms were like before treatment or during treatment gaps

Pain considerations: Heavy bleeding is often accompanied by severe cramping and fatigue. When describing bleeding severity, also connect it to associated pain and functional impairment to build a complete clinical picture.

Laparoscopic Findings Assessment

What it measures: Whether endometriotic lesions have been confirmed by laparoscopy, particularly those involving the bowel or bladder. These are specific checkboxes on the DBQ that can support higher rating levels.

What to expect: The examiner will review your surgical and diagnostic history for laparoscopic procedures. They will ask about any confirmed lesions on bowel, bladder, or other organs. Bring operative reports and pathology reports from any laparoscopic procedures.

Critical thresholds

  • Laparoscopy-confirmed lesions involving bowel Supports bowel symptoms checkbox and higher rating tier
  • Laparoscopy-confirmed lesions involving bladder Supports bladder symptoms checkbox and higher rating tier

Tips

  • Bring all operative reports, pathology reports, and laparoscopy documentation
  • If you have not had laparoscopy, note other imaging (MRI, ultrasound) that has documented endometriosis
  • Ask your treating gynecologist to note any bowel or bladder involvement in a nexus letter prior to your exam
  • Note symptoms consistent with bowel involvement: rectal pain, painful bowel movements, rectal bleeding, constipation worsening with menstruation
  • Note symptoms consistent with bladder involvement: urinary urgency, frequency, painful urination, blood in urine around menstruation

Pain considerations: Bowel and bladder symptoms from endometriosis can be debilitating and are often underreported. Describe how these symptoms affect your daily activities, dietary choices, and ability to leave home or work.

Rating criteria by percentage

10%

Symptoms that do not require continuous treatment. Endometriosis is diagnosed and present, but symptoms are manageable without ongoing medical intervention.

Key symptoms

  • Mild pelvic pain
  • Mild dysmenorrhea not requiring prescription treatment
  • Occasional menstrual irregularity
  • No requirement for continuous hormonal or surgical treatment

From 38 CFR: Under DC 7629, a 10% rating applies when endometriosis symptoms do not require continuous treatment. This is the lowest compensable level. Symptoms are present but self-managed or managed with over-the-counter medications only.

30%

Symptoms requiring continuous treatment and controlled by that treatment. Endometriosis requires ongoing medical management (hormonal therapy, pain management, etc.) but symptoms are adequately controlled with treatment.

Key symptoms

  • Pelvic pain requiring prescription medication
  • Dysmenorrhea requiring ongoing treatment
  • Irregular or heavy menstrual bleeding
  • Requirement for continuous hormonal therapy (birth control pills, GnRH agonists, progestins)
  • Symptoms managed but not eliminated by continuous treatment

From 38 CFR: Under DC 7629, a 30% rating applies when symptoms require continuous treatment and are controlled by that treatment. Document all ongoing prescriptions, injections, IUDs, and other treatments. Note how your symptoms would worsen without continuous treatment.

50%

Symptoms not controlled by continuous treatment. Despite ongoing medical management, endometriosis symptoms persist and significantly impair functioning. This is the highest schedular rating under DC 7629 alone.

Key symptoms

  • Severe pelvic pain not adequately controlled by prescription medication
  • Bowel symptoms from endometriosis (confirmed or clinically documented)
  • Bladder symptoms from endometriosis
  • Anemia caused by endometriosis
  • Heavy bleeding requiring frequent absorbent material changes (more than 4 times per day)
  • Symptoms causing significant functional impairment despite continuous treatment
  • Frequent or continuous menstrual disturbances not resolved with treatment
  • Severe dyspareunia affecting quality of life

From 38 CFR: Under DC 7629, a 50% rating applies when symptoms are not controlled by continuous treatment. This requires documenting that despite receiving ongoing hormonal therapy, pain management, and/or surgical interventions, symptoms continue to significantly limit functioning. Clearly document treatment failures, medication side effects, hospitalizations, and continued disability.

Describing your symptoms accurately

Pelvic Pain

How to describe it: Describe the exact location of pain (lower abdomen, pelvis, lower back, radiating to legs or rectum), the character of pain (cramping, stabbing, burning, pressure, aching), frequency (daily, cyclical, constant), severity on a 0-10 scale, duration of each episode, and what triggers or worsens it (standing, walking, intercourse, bowel movements, urination, specific times in your cycle).

Example: On my worst days, I have a 9 out of 10 stabbing, burning pain in my lower pelvis and lower back that starts 3-4 days before my period and continues through the first 3 days of menstruation. The pain radiates down my right leg. I cannot get out of bed, I miss work 2-3 days per month, and over-the-counter pain medications and even prescription NSAIDs do not provide adequate relief. The pain wakes me from sleep and I have had to go to the emergency room twice in the past year for pain management.

Examiner listens for: Specific descriptions that support mild, moderate, or severe pain categories; functional limitations caused by pain; whether pain is cyclical only or also non-cyclical; whether pain is controlled or uncontrolled by current treatment; impact on work, daily activities, and relationships.

Avoid: Saying 'I manage it okay' or 'I push through it.' These phrases suggest controlled symptoms. Instead, accurately describe the full impact even when you have learned to cope, and always describe your worst days, not just your average days.

Menstrual Disturbances and Bleeding

How to describe it: Describe cycle regularity, length of bleeding, heaviness (how many pads or tampons per day, on your heaviest days), passage of clots, any spotting between periods, and impact on your ability to function during your period. Note if you use double protection, have had accidents, or have had to limit activities due to bleeding.

Example: During my heaviest days, I soak through a super-plus tampon and a maxi pad within one hour. I change absorbent material more than 6 times per day. I pass large clots. I have had accidents on clothing and bedding. I cannot leave the house for the first two days of my period due to bleeding severity. I have been treated for iron-deficiency anemia twice in the past three years due to blood loss.

Examiner listens for: Frequency of absorbent material changes per day, whether anemia has occurred, evidence of heavy menstrual bleeding (menorrhagia) or irregular bleeding, impact on daily functioning and work attendance.

Avoid: Minimizing bleeding as 'just a heavy period.' Provide specific, quantifiable details about pad or tampon usage. Vague descriptions prevent the examiner from checking the correct severity boxes on the DBQ.

Bowel Symptoms

How to describe it: Describe any pain with bowel movements (dyschezia), rectal pressure or pain, constipation worsening around menstruation, diarrhea, rectal bleeding, bloating, or nausea associated with your cycle or ongoing. Note any confirmed bowel involvement from laparoscopy or imaging.

Example: I have severe rectal pain and pressure every time I have a bowel movement, especially in the week before and during my period. Bowel movements sometimes bring me to tears from the pain. I have noticed rectal bleeding around my menstrual cycle. My gastroenterologist and gynecologist both believe this is due to endometriotic lesions involving my bowel, which was confirmed on MRI and during my diagnostic laparoscopy in [year].

Examiner listens for: Whether bowel symptoms are attributable to endometriosis (not another cause), whether laparoscopy has confirmed bowel involvement, frequency and severity of bowel symptoms, and impact on nutrition and daily functioning.

Avoid: Attributing bowel symptoms solely to IBS or another condition without connecting them to endometriosis. If your treating physician has linked bowel symptoms to endometriosis, state this clearly and bring supporting documentation.

Bladder Symptoms

How to describe it: Describe urinary urgency, urinary frequency, painful urination (dysuria), blood in urine around menstruation (hematuria), or bladder pressure. Note any confirmed bladder involvement from laparoscopy or cystoscopy.

Example: I experience urinary urgency and painful urination throughout my cycle, but it is significantly worse around my period. I urinate 15-20 times per day due to urgency and pelvic pressure. I have had blood in my urine around menstruation, which my urologist confirmed is related to endometriotic involvement of my bladder, documented during laparoscopy in [year].

Examiner listens for: Whether bladder symptoms are attributable to endometriosis versus other urologic conditions, whether laparoscopic confirmation exists, frequency and severity of symptoms, and impact on daily functioning.

Avoid: Failing to connect bladder symptoms to endometriosis. Bring documentation from your urologist or gynecologist linking bladder symptoms to endometriosis. Without this connection, the examiner may not check the relevant DBQ boxes.

Treatment Requirements and Effectiveness

How to describe it: List every treatment you have received or are currently receiving: hormonal medications (names and doses), pain medications (prescription and OTC), surgical procedures (laparoscopy, laparotomy, excision surgery, ablation), hormone injections (Lupron, Orilissa), intrauterine devices, and any complementary treatments. Critically, describe whether these treatments adequately control your symptoms or whether you continue to have significant symptoms despite treatment.

Example: I am currently taking Orilissa 200mg twice daily, prescription-strength naproxen, and tramadol for breakthrough pain. Despite this continuous treatment regimen, I still experience severe pelvic pain on 15-20 days per month, miss approximately 2 days of work per month, and had to reduce my work hours from full-time to part-time. My symptoms are not adequately controlled by continuous treatment.

Examiner listens for: Whether symptoms require continuous treatment (distinguishing 10% from 30/50% ratings), whether continuous treatment controls symptoms (distinguishing 30% from 50% rating), specific treatment modalities, treatment failures, and side effects of treatments that also cause disability.

Avoid: Saying treatment 'helps' without clarifying that symptoms persist despite treatment. If your treatment reduces but does not eliminate symptoms, clearly state that symptoms are NOT fully controlled by continuous treatment, and describe the residual symptoms that remain.

Functional Impact and Daily Living

How to describe it: Describe how endometriosis affects your ability to work, attend school, perform household chores, exercise, maintain personal relationships (including intimate relationships), socialize, sleep, and participate in activities you previously enjoyed. Note any work absences, accommodations requested, or job changes made due to endometriosis.

Example: Due to endometriosis, I have missed an average of 3 days of work per month for the past two years. I have requested workplace accommodations for a flexible schedule and access to a restroom. I can no longer exercise regularly due to pelvic pain and fatigue. I have had to stop participating in [specific activities]. Dyspareunia has severely impacted my intimate relationships. I spend approximately 8-10 days per month in significant pain that limits all activities.

Examiner listens for: Concrete, specific functional limitations; work absences or accommodations; social and relationship impacts; any IADLs or ADLs affected; whether the condition causes housebound or bed-ridden periods.

Avoid: Only describing medical symptoms without connecting them to daily functional limitations. The examiner completes a section on how gynecological conditions impact occupational and daily functioning - this information directly supports your overall disability rating and any TDIU consideration.

Common mistakes to avoid

Describing only average symptom days instead of worst-day symptoms

Why: VA rating is based on the severity of the condition across its full range, including worst-day presentations. Describing only average days may result in the examiner documenting a lower severity level than your condition warrants.

Do this instead: Per M21-1 guidance, when asked about your symptoms, explicitly describe your worst-day experience. You can say: 'On average, my pain is a 5-6, but on my worst days, which occur approximately X times per month, my pain is a 9-10 and I cannot function.' Provide both the average AND the worst-day description.

Impact: Can incorrectly place veterans at 30% instead of 50%

Saying 'I manage it' or 'I push through the pain'

Why: These statements suggest your symptoms are controlled and manageable, which supports a lower rating tier. The examiner may document that treatment is effective even when your symptoms continue to significantly impair you.

Do this instead: Accurately describe the impact of your symptoms even if you have adapted to them. Say: 'Even though I continue to go to work, I do so despite severe pain that affects my productivity and has required workplace accommodations. My symptoms are not adequately controlled by my current treatment.' Persistence through pain is not the same as controlled symptoms.

Impact: Can incorrectly place veterans at 30% instead of 50%

Failing to document treatment history comprehensively

Why: The distinction between the 10%, 30%, and 50% rating levels under DC 7629 hinges on whether symptoms require continuous treatment and whether they are controlled by that treatment. Without a complete treatment record, the examiner cannot accurately assess this critical rating factor.

Do this instead: Before your exam, compile a complete list of all treatments: every medication (name, dose, duration), all surgical procedures (dates, locations, findings), all injections, IUDs, and any other interventions. Bring this list to the exam and be prepared to discuss which treatments helped, which failed, and what residual symptoms persist despite current treatment.

Impact: Can result in a 10% rating when a 30% or 50% is warranted

Not connecting bowel and bladder symptoms to endometriosis

Why: Bowel and bladder symptoms are specific DBQ checkboxes that support the highest (50%) rating level under DC 7629. If these symptoms are not explicitly connected to endometriosis by the veteran and confirmed by medical records, the examiner may not check these critical boxes.

Do this instead: Bring operative reports, MRI reports, or physician statements linking bowel and bladder symptoms to endometriosis. Explicitly state during the exam: 'My [bowel/bladder] symptoms have been attributed to endometriosis by my treating gynecologist, as documented in [operative report/MRI/physician note dated X].' Request a nexus letter from your treating provider before the exam if possible.

Impact: Can prevent veterans from reaching the 50% rating level

Minimizing or omitting dyspareunia (painful intercourse) symptoms

Why: Dyspareunia is a common and significantly disabling symptom of endometriosis that affects quality of life and relationships, but many veterans feel uncomfortable discussing it with an examiner. Omitting this symptom means it will not be documented and will not contribute to the overall assessment of functional impairment.

Do this instead: Prepare ahead of time to discuss dyspareunia in clinical, matter-of-fact terms. You can say: 'I also experience significant pain during intercourse due to endometriosis, which has substantially impacted my relationship and quality of life.' This symptom can be documented under 'other signs and symptoms' on the DBQ and supports an overall picture of severe functional impairment.

Impact: Contributes to overall functional impairment assessment; relevant at 50% level

Failing to bring medical records and supporting documentation to the exam

Why: The examiner is expected to review evidence of record, but C&P examiners often have limited time and may not have access to all of your treatment records, particularly from private providers. Without supporting documentation, the examiner must rely solely on your reported history and their physical examination.

Do this instead: Compile and bring (or ensure VA has copies of): all diagnostic laparoscopy operative reports and pathology results, OB/GYN treatment records, hospital records for any ER visits or admissions related to endometriosis, pharmacy records showing continuous treatment, lab results (CBC for anemia), MRI or ultrasound reports, and any independent medical opinions or nexus letters.

Impact: Affects all rating levels; most critical for 50% rating support

Not requesting the exam be recorded when permitted

Why: If there is a discrepancy between what you reported during the exam and what the examiner documents in the DBQ, having a recording protects your ability to appeal an inadequate or inaccurate examination.

Do this instead: In most states, you have the right to record your C&P examination. Notify the examiner at the start of the exam that you intend to record it. Bring a phone or recording device. Review the DBQ findings after your exam and compare them to what you reported. If the findings are inaccurate or incomplete, you can file for a new and material evidence review or CUE claim citing the recording.

Impact: Protects all rating levels from inadequate examination findings

Treating the exam as a clinical appointment rather than a disability evaluation

Why: C&P exams are not for treatment - the examiner's role is to document your disability for rating purposes. Veterans sometimes minimize symptoms hoping to appear 'healthy' or avoid seeming like they are complaining. This results in under-documentation of actual disability.

Do this instead: Understand that the purpose of this exam is to accurately document the severity and impact of your condition. Provide complete, honest, detailed answers. You are not complaining - you are accurately communicating the nature of your disability so the VA can provide appropriate compensation. Describe your condition as it actually is, particularly on your worst days.

Impact: Affects all rating levels

Prep checklist

  • critical

    Gather all diagnostic laparoscopy and operative reports

    Collect operative notes, pathology reports, and surgical findings from all laparoscopic or laparotomic procedures. These documents confirm the diagnosis, stage/extent of disease, and any bowel or bladder involvement - critical for DBQ checkboxes supporting the 50% rating.

    before exam

  • critical

    Compile a comprehensive treatment history list

    Create a chronological list of every treatment: all medications (name, dose, start/stop dates, whether they helped), all procedures (dates, facilities, findings), all surgeries, and all specialist referrals. The distinction between 10%, 30%, and 50% rating levels under DC 7629 depends on whether continuous treatment is required and whether it controls symptoms.

    before exam

  • critical

    Obtain recent Complete Blood Count (CBC) results

    If you have had heavy bleeding, obtain a recent CBC showing hemoglobin and hematocrit values. Anemia caused by endometriosis is a specific DBQ checkbox that supports the 50% rating. If you do not have recent labs, ask your primary care or gynecologist to order them before your exam.

    before exam

  • critical

    Request a nexus letter or treatment summary from your treating gynecologist

    Ask your treating gynecologist to write a letter documenting your diagnosis, treatment history, current symptoms, whether symptoms are controlled by treatment, and any bowel or bladder involvement. A well-written nexus letter from your treating provider significantly strengthens your claim.

    before exam

  • recommended

    Track and document your symptoms for 2-4 weeks before the exam

    Keep a daily symptom diary noting: pain levels (0-10), menstrual cycle details, number of absorbent material changes per day, days missed from work or activities, bowel and bladder symptoms, and medication taken. Bring this diary to your exam as supporting evidence and to help you accurately report symptom frequency and severity.

    before exam

  • recommended

    Gather all imaging reports (MRI, ultrasound, CT)

    Collect all pelvic MRI, transvaginal ultrasound, CT scan, or other imaging reports that document endometriomas, adhesions, or other endometriosis-related findings. These support the diagnosis and may document organ involvement.

    before exam

  • recommended

    Compile records of work absences or workplace accommodations

    Gather any HR records, sick leave documentation, FMLA paperwork, workplace accommodation requests, or supervisor statements documenting work missed or accommodations needed due to endometriosis. This supports the functional impairment section of the DBQ.

    before exam

  • recommended

    Prepare written notes summarizing your worst-day symptoms

    Write a clear, concise summary of your worst-day symptoms in each category: pelvic pain, bleeding, bowel symptoms, bladder symptoms, fatigue, and functional limitations. Practice describing these symptoms aloud so you can communicate them clearly under the stress of the exam environment.

    before exam

  • recommended

    Research whether your state permits exam recording

    Determine if your state permits one-party consent audio recording. If permitted, plan to record your exam using your phone or another device. Notify the examiner at the beginning of the exam. This protects you if the DBQ findings do not accurately reflect what you reported.

    before exam

  • recommended

    Confirm VA has all private treatment records uploaded

    Ensure all private provider records have been submitted to VA (via VA Form 21-4142 authorization if needed) before your exam date. The C&P examiner should review these, but verify by checking your VA.gov records portal.

    before exam

  • critical

    Bring all compiled documentation in an organized folder

    Organize your documents in labeled sections: operative reports, treatment history, imaging reports, lab results, nexus letter, and symptom diary. Having organized documentation demonstrates thoroughness and makes it easy for the examiner to reference specific findings.

    day of

  • critical

    Do not take extra pain medication before the exam to 'get through it'

    Taking extra medication before the exam to manage pain or anxiety may make your symptoms appear more controlled than they typically are. Take only your regular, prescribed doses at your normal times. The examiner needs to see your condition as it typically presents.

    day of

  • recommended

    Bring a support person if permitted

    You are permitted to bring a support person (spouse, family member, VSO representative, or advocate) to your C&P exam. A support person can help you remember to mention important symptoms, take notes, and can serve as a witness if the exam findings are disputed.

    day of

  • recommended

    Arrive early and note how you feel at that specific time

    Arrive 15-20 minutes early. Note your current pain level and any symptoms present. If you are having a particularly good or particularly bad day, tell the examiner this at the start of the exam: 'Today is [better/worse] than my typical day. On a typical bad day, my symptoms are...'

    day of

  • recommended

    Plan for physical examination

    The exam will likely include a pelvic examination. Wear comfortable clothing that is easy to change. Know that you may experience discomfort during the pelvic exam - tell the examiner if you feel pain during the examination, as this is clinically relevant information for documenting dyspareunia and pelvic tenderness.

    day of

  • recommended

    Notify the examiner if recording the exam

    At the start of the exam, clearly state: 'I would like to let you know that I will be audio recording this examination.' Place your recording device visibly in the room. This is your right in most jurisdictions and protects the accuracy of the record.

    during exam

  • critical

    Report pain during physical examination

    If you experience pain during the pelvic examination, tell the examiner immediately: 'That is causing me significant pain - I would rate that a [X] out of 10.' Pelvic tenderness on examination is clinical evidence that supports your reported symptoms and should be documented in the DBQ.

    during exam

  • critical

    Reference your worst-day symptoms explicitly

    When describing symptoms, explicitly reference your worst days: 'On my worst days, which happen approximately [X] times per month...' This ensures the examiner documents the full range of your symptoms, not just your current presentation or average day.

    during exam

  • critical

    Describe all symptom categories even if not asked

    If the examiner does not ask about bowel symptoms, bladder symptoms, dyspareunia, anemia symptoms, or work impact, volunteer this information: 'I also want to make sure you are aware of my [specific symptoms] related to endometriosis.' These categories correspond to specific DBQ checkboxes that affect your rating level.

    during exam

  • critical

    Clearly state whether your symptoms are controlled by treatment

    Explicitly state: 'Despite my continuous treatment with [medications/procedures], my symptoms are [not controlled/partially controlled/significantly limited but not eliminated].' The distinction between controlled and uncontrolled symptoms under continuous treatment is the difference between a 30% and 50% rating under DC 7629.

    during exam

  • recommended

    Ask the examiner to confirm they have reviewed your documentation

    Politely confirm: 'Did you have an opportunity to review my operative reports and nexus letter from Dr. [name]?' This ensures critical supporting documents are not overlooked. If the examiner has not reviewed them, offer your copies.

    during exam

  • critical

    Write detailed notes about the exam immediately afterward

    Within 30 minutes of leaving the exam, write down everything you remember: what questions the examiner asked, what you answered, what the physical examination involved, and any statements the examiner made about your condition or the DBQ. These notes will be valuable if you need to appeal an inadequate exam.

    after exam

  • critical

    Request a copy of the completed DBQ

    You have the right to obtain a copy of the completed DBQ through a VA records request (VA Form 21-4138 or FOIA request). Review it carefully to ensure all reported symptoms are accurately documented. Compare to what you reported during the exam.

    after exam

  • recommended

    File a notice of inadequate examination if DBQ findings are inaccurate

    If the DBQ does not accurately reflect your reported symptoms - for example, if severe pain is documented as mild, or if bowel/bladder symptoms you reported are not checked - you can request a new examination by submitting a letter to VA explaining the specific deficiencies with your exam recording or notes as evidence.

    after exam

  • recommended

    Consider applying for secondary service-connected conditions

    Endometriosis can cause or aggravate other ratable conditions including: anemia (rated separately under the hematopoietic system), mental health conditions (depression, anxiety, PTSD related to chronic pain), bowel conditions (rated under the digestive system), bladder conditions (rated under the genitourinary system), and infertility. Consult with a VSO or claims agent about potential secondary claims.

    after exam

Your rights during a C&P exam

  • You have the right to have a support person (spouse, family member, VSO representative, or advocate) present during your C&P examination.
  • In most states, you have the right to audio record your C&P examination under one-party consent laws. Notify the examiner before recording begins.
  • You have the right to request a copy of the completed DBQ through a VA records request after your exam.
  • You have the right to request a new C&P examination if the original examination is found to be inadequate, incomplete, or does not accurately reflect your reported symptoms.
  • You have the right to submit a written statement (VA Form 21-4138) describing your symptoms and functional limitations for inclusion in your claim file before and after the examination.
  • You have the right to submit buddy statements from family members, friends, or coworkers who have observed the impact of your endometriosis on your daily functioning.
  • You have the right to submit independent medical opinions or nexus letters from private treating physicians, which the VA must consider as evidence.
  • You have the right to a decision review through Higher-Level Review, Supplemental Claim, or Board of Veterans' Appeals if you disagree with the rating decision.
  • You have the right to request a copy of all evidence in your claim file (C-file) through a FOIA request or by contacting your VA regional office.
  • You have the right to be treated with dignity and respect during your examination. If you feel the examiner was dismissive, rushed, or failed to adequately document your symptoms, you may report this to your VA regional office and request a new examination.
  • You have the right to postpone your exam and reschedule if you are experiencing an acute medical issue that would prevent you from accurately communicating your symptoms, provided you contact the scheduling office in advance.
  • You have the right to representation from a Veterans Service Organization (VSO), claims agent, or attorney at no cost or at regulated fees throughout the claims process.

Related conditions

Get a personalized prep packet

This guide covers what to expect for any veteran with this condition. If you have already uploaded your medical records, sign in to generate a packet that maps your specific symptoms to the DBQ fields your examiner will fill out.

Get personalized prep

This C&P exam preparation guide is for educational purposes only and does not constitute legal, medical, or claims advice. Always consult with a qualified Veterans Service Organization (VSO) representative or VA-accredited attorney for guidance specific to your claim. Never exaggerate, minimize, or fabricate symptoms during a C&P examination.