Body system: Gynecological ConditionsRegulation: 38 CFR § 4.116DBQ: DBQ GYN Breast
Diagnostic Code 7626 covers surgery of the breast. The rating depends on the type of surgery and on whether one or both breasts were operated on. Radical mastectomy is 80% for both breasts or 50% for one. Modified radical mastectomy is 60% for both or 40% for one. Simple mastectomy, or wide local excision that significantly changes the size or form of the breast, is 50% for both or 30% for one. Wide local excision without a significant change in size or form is 0%. The rating schedule flags the compensable ratings under this code for review for special monthly compensation under 38 CFR § 3.350.
Rating levels
- 80% — This rating applies when you have had both breasts completely removed through radical mastectomy (surgical removal of the entire breast, underlying chest muscle, and nearby lymph nodes). The surgery must have been performed on both sides to qualify for this level.
- 50% — You qualify for this rating if you've had a radical mastectomy (complete removal of one breast along with surrounding tissue and lymph nodes) on one side. This applies specifically to the more extensive type of breast removal surgery, not just a simple mastectomy where only the breast tissue is removed.
- 60% — You qualify for this rating if both breasts were removed by modified radical mastectomy: the whole breast and the lymph nodes under the arm are removed, but the chest (pectoral) muscles are left in place. That is what separates it from a radical mastectomy, which also removes the chest muscles.
- 40% — You qualify for this rating if one breast was removed by modified radical mastectomy: the whole breast and the lymph nodes under the arm are removed, but the chest (pectoral) muscles are left in place. That is what separates it from a radical mastectomy, which also removes the chest muscles.
- 50% — You qualify for this rating if both breasts have had either a simple mastectomy (removal of the whole breast without the lymph nodes or chest muscles) or a wide local excision (removal of a tumor with a wide margin of breast tissue) that significantly changed the size or shape of the breast. "Both" means both breasts, not both procedures.
- 30% — You qualify for this rating if you've had one breast completely removed (simple mastectomy) or had a large portion of breast tissue removed (wide local excision) that significantly changed the size or shape of that breast. The surgery must have resulted in a noticeable alteration to how the breast looks compared to before the procedure.
- 0% — You qualify for this rating if you had a wide local excision (surgical removal of breast tissue and some surrounding healthy tissue) that did not significantly change the size or shape of your breast. This applies whether the surgery was on one breast or both breasts, as long as there was no major alteration to how your breast looks or its overall form.