This guide discusses military sexual trauma (MST) in the context of VA claims. If reading about MST triggers distress, please know you can contact the Veterans Crisis Line (dial 988, press 1) at any time. The VA also has designated MST Coordinators at every VA facility who can help with both clinical care and claims navigation — no prior report required.
Endometriosis is a chronic inflammatory condition in which tissue similar to the uterine lining grows outside the uterus — on the ovaries, fallopian tubes, bladder, bowel, and other pelvic structures. It causes severe pelvic pain, painful menstruation (dysmenorrhea), painful intercourse (dyspareunia), chronic fatigue, and in many cases, infertility. Diagnosis is often delayed by 7–10 years on average in civilian populations; for women veterans who experienced inadequate access to women's health services during and after service, that delay is frequently longer.
According to VA data, women now constitute nearly 17% of all veterans — and that percentage is rising faster than any other demographic group. Despite this, VA has historically structured its medical care and disability adjudication around male veterans. The result: women veterans' conditions, including gynecological disorders, are routinely underdiagnosed and underclaimed.
Research suggests that women veterans experience endometriosis at higher rates than the general female population. Multiple contributing factors have been identified: chronic stress exposure, physical demands of military service affecting hormonal cycles, access barriers to gynecological care during service, and — critically — the documented relationship between trauma exposure, including MST, and endometriosis severity.
If you have endometriosis and served in the military, this guide is written specifically for you. You may have more claim options than you realize.
VA rates endometriosis under Diagnostic Code 7629 in 38 CFR Part 4, Schedule for Rating Disabilities. The rating schedule has three levels, based on symptom severity and treatment response:
| Rating | Criteria |
|---|---|
| 50% | Chronic, with pelvic pain, menstrual disturbance, and symptoms not fully relieved by treatment |
| 30% | Pelvic pain or heavy bleeding that requires continuous medication and restricts daily activities |
| 10% | Symptomatic with pain, but generally controlled by treatment |
The 50% rating is achievable when your endometriosis is documented as chronic — meaning ongoing, long-term — and your symptoms have not been fully controlled despite treatment. This includes situations where you have tried hormonal medications (birth control pills, progestins, GnRH agonists like Lupron) or surgical intervention (laparoscopy, ablation, excision) and continue to experience significant pelvic pain, dysmenorrhea, dyspareunia, or functional limitations.
For the 30% and 50% ratings, the key phrases are continuous treatment and functional restriction. "Continuous treatment" means ongoing medical management — not just as-needed pain relief. If you take daily hormonal medication or have ongoing prescription pain management for endometriosis, document it specifically. "Restricts daily activities" is a functional impact standard that should be documented by your treating provider and confirmed in your personal statement with specific examples: missed workdays, inability to exercise during flare-ups, limitations in sexual activity, disrupted sleep.
Many women veterans receive 10% when they are legally entitled to 30% or 50%. This happens because C&P examiners fail to adequately document the chronicity and treatment-resistance of symptoms. The solution is a thorough nexus letter and personal statement that explicitly map your symptoms and treatment history to the 50% criteria. Do not assume the examiner will ask the right questions.
There are several ways to establish service connection for endometriosis. You don't need all of them — you need one that fits your history and is supported by evidence.
If you were diagnosed with endometriosis during service, or if you experienced documented gynecological symptoms (pelvic pain, painful periods, irregular cycles) during service that were later diagnosed as endometriosis, you may have a direct service connection claim. Under 38 CFR § 3.303, service connection requires: a current diagnosis, an in-service event or incurrence, and a nexus linking the two.
The challenge: many women who developed endometriosis during service were never properly diagnosed in-service. Medical culture often dismissed pelvic pain as normal menstrual discomfort, especially in environments where women were a minority. This means your in-service event evidence may be limited — but limited evidence does not mean no evidence. If you reported pelvic pain, visited sick call for menstrual issues, or sought any gynecological care during service, those records matter. Even a single sick call note documenting pelvic pain can anchor a direct service connection argument.
Under 38 CFR § 3.306, if you had endometriosis before service (or a family history suggesting predisposition) and military service materially aggravated the condition beyond its natural progression, you can still establish service connection. Physical stress, chronic inflammatory environments, delayed access to treatment during service, and hormonal disruption from military demands can all constitute material aggravation.
This is covered in detail in the next section. For veterans who already have PTSD or MST-related conditions service-connected, the secondary pathway is often the most legally and medically powerful route to service connection for endometriosis.
This section covers the scientific and legal foundation for claiming endometriosis as secondary to military sexual trauma. We present this information with full awareness that the underlying events were harmful and that revisiting them for a benefits claim can be emotionally difficult. Your right to these benefits does not require you to justify your trauma — it requires documentation of the medical relationship.
The connection between psychological trauma and endometriosis is not speculative — it is supported by a growing body of peer-reviewed research. The key mechanisms are:
A 2021 study published in Human Reproduction found that women with PTSD had significantly higher rates of endometriosis than controls. A 2018 study in the American Journal of Epidemiology documented that childhood sexual abuse was associated with a 79% increased odds of endometriosis diagnosis — a finding with direct relevance to MST survivors, since the biological stress pathways are comparable.
Under 38 CFR § 3.310, a condition can be service-connected as secondary to a service-connected disability if it is either caused by or chronically aggravated by that service-connected condition. If you already have PTSD, depression, or another mental health condition service-connected based on MST, you can claim endometriosis as secondary to that service-connected condition.
The legal standard is "at least as likely as not" — a 50%+ probability that the secondary condition (endometriosis) is caused or aggravated by the primary service-connected condition (PTSD/MST-related condition). Given the published scientific literature, this standard is achievable for many veterans with a well-crafted nexus opinion.
A critical point: establishing MST as the basis for a secondary claim does not require a police report, court record, or formal investigation. Under 38 CFR § 3.304(f)(5), VA has special evidentiary rules for MST claims that allow a broader range of corroborating evidence — including changes in performance evaluations, behavioral changes, medical records of related care, and personal statements. The "benefit of the doubt" standard applies.
A successful MST-secondary endometriosis claim requires:
If you do not yet have an MST-related service connection, you can pursue both the primary MST claim and the secondary endometriosis claim simultaneously. See our guide on MST VA Claims and nexus letters for MST for guidance on the primary claim.
A successful endometriosis claim needs multiple categories of evidence working together. Here is what to gather:
Your personal statement (Buddy Statement or lay statement) is powerful evidence. It should document:
Your personal statement is sworn lay evidence. Under Jandreau v. Nicholson, veterans' lay statements about their own symptoms and their own experiences are competent evidence. Do not minimize your experience because it is not in writing from a doctor.
Fellow service members, partners, family members, or close friends who witnessed how your symptoms affected you — even after service — can provide supporting buddy statements. These statements don't need to diagnose anything; they simply corroborate your lay testimony with independent observations.
One of the most under-utilized strategies in endometriosis claims is claiming the side effects of treatment as separately rated residuals. Many hormonal treatments for endometriosis cause significant secondary conditions:
These medications suppress estrogen production to starve endometrial tissue. The side effects are severe and functionally significant: hot flashes, vaginal atrophy, decreased libido, mood changes, and critically — bone density loss (osteoporosis/osteopenia). Long-term or repeated GnRH agonist use is associated with significant bone density reduction, which increases fracture risk and can be independently ratable under the musculoskeletal schedule.
If you have used GnRH agonists and have documented bone density loss (via DEXA scan), this is a ratable residual condition secondary to your service-connected endometriosis. It should be claimed separately.
Some veterans with severe endometriosis undergo oophorectomy (surgical removal of one or both ovaries) as part of treatment. If this results in surgical menopause, the resulting symptoms — hot flashes, cardiovascular effects, bone density loss, cognitive changes, and mood disturbances — can be claimed as residuals of the service-connected condition that necessitated surgery.
Chronic pain conditions like endometriosis are strongly associated with depression and anxiety. If you have developed depression, anxiety, or adjustment disorder in the context of your endometriosis, these can be claimed as secondary to the service-connected gynecological condition. Under 38 CFR § 3.310, chronically aggravated mental health conditions secondary to chronic pain are well-recognized.
| Treatment Side Effect | Potential Rating Category |
|---|---|
| GnRH-related bone density loss | DC 5013 (osteoporosis) — musculoskeletal schedule |
| Surgical menopause | DC 7619 — rated as ovarian dysfunction residuals |
| Depression secondary to chronic pain | DC 9434 — mental health schedule (GAF-based) |
| Anxiety secondary to infertility/condition | DC 9400 — mental health schedule |
Endometriosis frequently causes damage to surrounding structures, creating additional ratable conditions:
Endometriosis is one of the most common causes of female infertility. If your service-connected endometriosis has caused infertility — inability to conceive despite trying — this can be rated separately under DC 7615 (ovaries, diseases of). VA also offers some IVF coverage through certain medical centers; see our guide on VA fertility and IVF benefits.
Endometriosis on the bowel or rectum causes painful bowel movements, constipation, bloating, and diarrhea — particularly during menstrual cycles. These symptoms can be rated under the gastrointestinal schedule. Documentation requires operative reports or imaging confirming bowel involvement, and GI records documenting the symptoms.
Bladder endometriosis causes urinary urgency, frequency, and painful urination. Like bowel involvement, this can be rated separately under the genitourinary schedule if documented by urology or on imaging.
Repeated infections or surgical adhesions from endometriosis surgery can cause additional pelvic dysfunction ratable as residuals. Adhesion-related bowel obstruction, chronic pelvic adhesive disease, and dyspareunia from adhesions may each be individually documented and rated.
The nexus letter is the bridge between your medical history and your legal entitlement to benefits. For endometriosis, it must do specific things depending on which pathway you are pursuing.
"Based on my review of [Veteran's name]'s service treatment records, VA medical records documenting service-connected PTSD based on MST, current gynecological records, and operative report confirming endometriosis diagnosis by laparoscopy, it is my medical opinion that it is at least as likely as not (50% or greater probability) that [Veteran's name]'s endometriosis is caused by and/or chronically aggravated by her service-connected PTSD.
The medical rationale is as follows: PTSD involving military sexual trauma produces chronic dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, resulting in persistent elevation of cortisol and pro-inflammatory cytokines including IL-6, TNF-α, and VEGF. These cytokines are present in elevated concentrations in the peritoneal fluid of patients with endometriosis and are understood to facilitate ectopic endometrial cell proliferation and survival. Additionally, PTSD-associated immune dysfunction impairs natural killer cell activity, reducing the body's capacity to suppress ectopic endometrial tissue — the normal immune mechanism by which endometriosis is controlled. Published research (Missmer et al., 2021; Jeng et al., 2018) has documented statistically significant associations between PTSD, trauma exposure, and endometriosis diagnosis and severity. [Veteran's name]'s symptom timeline — worsening pelvic pain and dysmenorrhea following the period in which her MST occurred — is consistent with this biological model. It is my professional opinion that her endometriosis is at least as likely as not caused and chronically aggravated by her service-connected PTSD."
REE Medical's specialists work with gynecologists and women's health physicians who understand the VA adjudication standards for reproductive health conditions and the MST-secondary framework. They can review your records and provide a comprehensive nexus opinion covering both the primary endometriosis claim and any secondary conditions.
Need a Women's Health Nexus Letter?
REE Medical connects veterans with board-certified physicians who understand VA rating criteria for gynecological conditions — including the MST-secondary pathway for endometriosis. Their providers are experienced with the specific medical language and rationale that VA adjudicators look for.
Learn About REE Medical's Nexus Letters for Women Veterans →claim.vet may receive a referral fee if you use this link. Veterans never pay more.
Your Compensation and Pension (C&P) exam is one of the most important moments in your claim. For endometriosis, the examiner should be an OB-GYN or internal medicine physician — though in practice, the examiner's specialty varies. Here is how to prepare:
Request a copy of the Disability Benefits Questionnaire (DBQ) completed by the examiner. Review it for accuracy. If the examiner documented your symptoms as milder than they are, or failed to address treatment resistance, you can submit a rebuttal statement and supplemental evidence before VA makes its rating decision.
Endometriosis can affect any person assigned female at birth, regardless of current gender identity. Transgender men and non-binary veterans who have endometriosis and have served in the military have the same right to VA disability benefits as any other veteran. VA evaluates disability claims based on the diagnosed medical condition and its relationship to service — not on gender markers or identity.
If you are a transgender or non-binary veteran navigating the VA system, the VA's LGBTQ+ Veteran Care program offers dedicated support and guidance. VA has also updated many of its administrative processes to allow preferred name and gender marker changes in records, which can reduce the clinical and administrative friction that has historically been a barrier for trans veterans.
This guide's information on service connection, rating criteria, and evidence applies fully to all veterans with an endometriosis diagnosis, regardless of gender identity.
If you have endometriosis and served in the military, here is the path forward:
Related Guides for Women Veterans
Women veterans face unique claim pathways. These guides cover the full landscape of women's VA benefits and related conditions.
Women veterans have served. Women veterans deserve benefits. Start with a free claim review — no phone calls, no pressure, no judgment.
Start My Free Claim Review — No Phone Required →Editorial Standards: Written by Marcus J. Webb, veterans benefits researcher. Verified against current 38 CFR regulations and VA adjudication guidelines. Last reviewed: July 2026. Not legal advice — for representation, talk to a VA-accredited attorney. MST resources: Veterans Crisis Line (988, press 1).