VA Female Sexual Arousal Disorder Claims: DC 7632 and SMC-K

What the VA Counts as FSAD

FSAD is rated under 38 CFR 4.116, the Schedule of Ratings for Gynecological Conditions and Disorders of the Breast, diagnostic code 7632, titled simply "Female sexual arousal disorder (FSAD)." That schedule took effect May 13, 2018, replacing an older, thinner set of gynecological codes.

The 0% Rating and SMC-K: Where This Gets Genuinely Unsettled

Under DC 7632, the schedular rating is a fixed 0 percent. As with erectile dysfunction (DC 7522), the code carries a footnote: "Review for entitlement to special monthly compensation under 3.350 of this chapter." That is the same referral language used for ED, and it is where any additional compensation would come from.

Here is the part worth understanding clearly: 38 CFR 3.350(a)(1)(i), the regulation that defines "loss of use of a creative organ" for SMC-K, writes out a specific functional-loss test only for testicles, measured by size reduction or a biopsy showing absence of spermatozoa. It defines actual loss (absence) for "ovaries or other creative organ," but it does not write out a parallel functional-loss test for ovaries, and it does not write out one for the penis either. In practice, ED reaches SMC-K through long-standing rater practice and guidance beyond the bare regulatory text. FSAD does not yet have that same well-worn path in the text, so it is genuinely evaluated case by case rather than under a codified formula.

DC 7632 Rating

The gynecological schedule lists a single rating line for FSAD. There is no percentage ladder for severity, the schedular value is fixed.

If a gynecological exam documents actual physical damage or injury to the reproductive organs (as opposed to a functional arousal disorder), that damage may instead be ratable under a different, organ-specific gynecological code. DC 7632 is specifically for the arousal disorder itself.

How FSAD Gets Service Connected

Direct service connection

Direct service connection requires a current diagnosis, an in-service event, injury, or disease, and a medical nexus linking the two. This is the less common path for FSAD, since the condition typically develops from an underlying cause rather than a single discrete event.

Secondary service connection (the main route)

Secondary service connection is the more common path. Under 38 CFR 3.310, a secondary claim requires a current FSAD diagnosis and a medical nexus opinion tying it to a service-connected condition, or to a medication taken for one, by causation or aggravation.

PTSD, particularly stemming from military sexual trauma (MST), is the pathway most consistently discussed across sources on this condition. In the Board's published record, the volume is small but the pattern is visible: FSAD claimed as secondary to PTSD appears in a small number of published issues, granted at roughly half of decided issues (published BVA decisions). Treat that as a directional signal from a thin sample, not a population estimate. See the PTSD claims guide and MST claims guide.

Beyond PTSD, depression and anxiety, chronic pelvic pain, hormonal imbalance (including thyroid disorders and PCOS), and diabetes are recognized causal pathways in the clinical literature and are argued as secondary theories. See secondary conditions and secondary vs aggravation.

Common Causes and Secondary Conditions

The clinical literature on FSIAD (the DSM-5 name for this condition) identifies several categories of contributing cause, useful for understanding what a nexus opinion might point to:

• Medical conditions: diabetes, thyroid disease, cardiovascular disorders, liver disease, and neurological conditions.
• Medications: SSRIs and other antidepressants, tricyclic antidepressants, antipsychotics, and antihypertensives (beta-blockers, calcium channel blockers) are all documented causes of reduced arousal function.
• Psychological and trauma-related factors: depression, PTSD, trauma (including MST), relationship difficulty, and chronic stress.
• Neurobiological factors: declining testosterone (notably postmenopausal), and dysregulation of dopamine and serotonin pathways.
• Other contributing factors: age, menopausal status, obesity, and smoking.

Pyramiding and Rating Separately

The VA's pyramiding rules prevent paying twice for the same disability. For FSAD, this rarely becomes an issue because the schedular rating is 0 percent and contributes nothing to the combined evaluation. Any additional compensation, SMC, is layered on top of the combined rating rather than folded into it.

The underlying condition that caused the FSAD (PTSD, depression, a medical condition, or a medication reaction) is rated under its own diagnostic code. The FSAD itself is rated 0 percent under DC 7632, and SMC is considered separately. These are distinct lines, not double-counting.

Evidence That Helps

• A gynecological or sexual-health specialist's evaluation: documentation from a gynecologist, urologist, or sexual-health specialist who has examined or treated the condition.
• A nexus opinion addressing both causation and aggravation: a private or treating clinician's opinion stating whether the service-connected condition or medication caused, or made worse, the arousal difficulty.
• Medication history: a list of medications tried, including any prescribed for a service-connected condition with a documented effect on arousal function, and their effectiveness or side effects.
• A personal statement: describing onset, how the condition affects daily life, relationships, and well-being.
• Buddy or lay statements: from a spouse or partner describing observed effects, if the veteran is comfortable including one.
• Records connecting the condition to MST or PTSD, where applicable: treatment records showing the trauma-related condition's timeline relative to the arousal difficulty.

Common Mistakes

Diagnostic Evaluation and the DBQ

No lab test changes the schedular percentage for FSAD, which is fixed at 0 percent. Evaluation serves a different purpose: confirming the diagnosis, establishing etiology and nexus, and supporting an SMC review.

• The C&P examination using the Gynecological Conditions DBQ: the VA Disability Benefits Questionnaire covering female reproductive and sexual health conditions. See the DBQ guide.
• Gynecological history and exam: documenting onset, progression, and any physiological findings.
• Review of the primary condition workup: when claimed as secondary, this includes records for the underlying condition (PTSD treatment history, thyroid labs, diabetes labs, a medication list) that supports the causal link.
• Response to treatment attempts: counseling, medication (such as flibanserin or bremelanotide, the two FDA-approved options for this condition), and any documented effect on symptoms.

Frequently Asked Questions