Gynecological Conditions and Disorders of the Breast§ 4.116Updated
Rating criteria

VA Diagnostic Code 7626Breast, surgery of:

Rated from 0% to 80% under § 4.116. Here is what the VA requires at each level.

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What each rating requires

The VA assigns the highest level your evidence actually supports. Read up the stack until your records stop matching.

  1. 80%

    Following radical mastectomy: Both

  2. 60%

    Following modified radical mastectomy: Both

  3. 50%

    Following radical mastectomy: One

  4. 50%

    Following simple mastectomy or wide local excision with significant alteration of size or form: Both

  5. 40%

    Following modified radical mastectomy: One

  6. 30%

    Following simple mastectomy or wide local excision with significant alteration of size or form: One

  7. 0%

    Following wide local excision without significant alteration of size or form: Both or one

From the schedule

Notes on this code

These notes are part of the regulation. They change how the levels above are applied.

  • Note: For VA purposes:
  • (1) Radical mastectomy means removal of the entire breast, underlying pectoral muscles, and regional lymph nodes up to the coracoclavicular ligament.
  • (2) Modified radical mastectomy means removal of the entire breast and axillary lymph nodes (in continuity with the breast). Pectoral muscles are left intact.
  • (3) Simple (or total) mastectomy means removal of all of the breast tissue, nipple, and a small portion of the overlying skin, but lymph nodes and muscles are left intact.
  • (4) Wide local excision (including partial mastectomy, lumpectomy, tylectomy, segmentectomy, and quadrantectomy) means removal of a portion of the breast tissue.

Breast Surgery (VA Diagnostic Code 7626)

Understanding how the VA rates disability following breast surgery.

Gynecological Conditions and Disorders of the Breast — evaluated under 38 CFR § 4.116

What This Rating Covers

VA Diagnostic Code 7626 addresses disability following surgery of the breast. The rating you receive depends on the type of surgery performed and whether one or both breasts were affected.

For VA purposes, the following surgical terms have specific meanings:

  • Radical mastectomy — removal of the entire breast, underlying pectoral muscles, and regional lymph nodes up to the coracoclavicular ligament.
  • Modified radical mastectomy — removal of the entire breast and axillary lymph nodes (in continuity with the breast). The pectoral muscles are left intact.
  • Simple (or total) mastectomy — removal of all of the breast tissue, nipple, and a small portion of the overlying skin, but lymph nodes and muscles are left intact.
  • Wide local excision — removal of a portion of the breast tissue. This category includes partial mastectomy, lumpectomy, tylectomy, segmentectomy, and quadrantectomy.

Available Rating Levels

RatingCriteria
80%Following radical mastectomy: Both
60%Following modified radical mastectomy: Both
50%Following radical mastectomy: One
50%Following simple mastectomy or wide local excision with significant alteration of size or form: Both
40%Following modified radical mastectomy: One
30%Following simple mastectomy or wide local excision with significant alteration of size or form: One
0%Following wide local excision without significant alteration of size or form: Both or one

What the VA Looks For

When rating breast surgery under Diagnostic Code 7626, the VA focuses on two main factors:

  1. The type of surgery performed — radical mastectomy, modified radical mastectomy, simple (total) mastectomy, or wide local excision.
  2. How many breasts were affected — one or both.

For simple mastectomy or wide local excision, the VA also considers whether there was a significant alteration of size or form. A wide local excision without significant alteration of size or form is assigned a 0% rating, whether one or both breasts are involved.

The more extensive the surgery and the more breasts affected, the higher the assigned rating level, as reflected in the schedule above.

These criteria are a rendering of § 4.116, diagnostic code 7626. The official version is the one that governs your rating.

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What next

How to claim this

Knowing the criteria is the first half. Getting your file to show them is the second.

  1. Find your level in the stack

    Read each rung against what your medical records already say. The level your records document today is the one the VA can support today.

  2. Name the gap

    Look at the rung above yours and write down exactly what it asks for that your file does not show yet — a diagnosis, a measurement, a prescribed brace, a doctor’s opinion linking it to service.

  3. Claim it by code

    File under diagnostic code 7626 and attach the evidence for the level you are asking for. Other Gynecological Conditions and Disorders of the Breast codes may cover your secondary conditions.

Find out which rating your evidence supports.

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