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C&P Exam Prep: Benign Breast Neoplasm
DBQ Overview
Interview + Physical- Form Name
- Breast_Conditions
- Form Code
- Breast_Conditions
- Page Count
- 5
- Examiner Type
- Oncologist, Breast Surgeon, or appropriate clinician
- Estimated Duration
- 30-45 minutes
- Exam Format
- Interview + Physical
What to Expect During Your Exam
Exam Overview
To document the nature, extent, and functional impact of a diagnosed benign breast neoplasm and any chronic residuals including scars, lymphedema, disfigurement, and impairment of function for VA disability rating purposes under DC 7628.
What the examiner evaluates:
- Presence and confirmation of benign breast neoplasm diagnosis with ICD code
- History of surgical treatment including biopsy, wide local excision, simple mastectomy, modified radical mastectomy, or radical mastectomy
- Whether surgery caused significant alteration of breast size or form
- History of radiation therapy including side treated
- History of antineoplastic chemotherapy or other therapeutic procedures
- Presence of scars or disfigurement resulting from treatment
- Presence of lymphedema in the breast or arm
- Functional impairment of the arm, shoulder, or wrist related to treatment
- Loss of grip strength, sensation, or range of motion from treatment residuals
- Whether veteran is currently in watchful waiting status or treatment completed
- Impact of condition and residuals on daily activities and occupational function
- Whether condition is currently active or in remission
- Any other findings or conditions related to the breast disorder
Exam will include a physical examination of the breast(s) and potentially the arm and shoulder if lymphedema or functional impairment is claimed. Examiner will review your claims file, service treatment records, and any private medical records submitted. Bring all relevant medical records, operative reports, pathology reports, and imaging results. In most states you have the right to record the examination - inform the examiner at the start.
Typical duration: 30-45 minutes
Breast and Chest Wall Physical Examination
Presence of palpable masses, scar tissue, disfigurement, asymmetry, and alteration of breast size or form resulting from treatment
What to expect:
The examiner will visually inspect and palpate the affected breast(s), noting surgical scars, contour changes, size differences between breasts, skin changes, and any residual masses. Both breasts may be compared.
Key thresholds:
- Significant alteration of size or form present — Triggers higher rating consideration for surgical procedures and may support separate scar or disfigurement ratings
- No significant alteration of size or form — Lower rating level for surgical residuals; rating driven by functional residuals under appropriate DC
Tips:
- Point out all visible scars and describe any pain, tenderness, or tethering at scar sites
- If reconstruction was performed, describe any asymmetry or functional limitations from the reconstruction
- Note any skin changes from radiation such as fibrosis, discoloration, or tenderness
Pain considerations: Describe any chronic breast pain, tenderness at scar sites, or chest wall discomfort on your worst days, not just your average days.
Lymphedema Assessment (Arm and Breast)
Presence, severity, and functional impact of lymphedema resulting from axillary or sentinel lymph node excision or radiation therapy
What to expect:
The examiner may measure arm circumference at multiple points to assess swelling, evaluate range of motion of the shoulder and arm, and assess grip strength. You may be asked about heaviness, tightness, or swelling in your arm or hand.
Key thresholds:
- Lymphedema with functional limitation of arm/shoulder motion — Rated separately under musculoskeletal DCs (e.g., DC 5201 for shoulder limitation of motion) as chronic residuals
- Lymphedema with loss of grip strength — Rated separately under DC 5155 or applicable hand/wrist DC as a chronic residual
- Lymphedema present but without significant functional limitation — May support rating under DC 7120 or applicable soft tissue DC
Tips:
- Describe how lymphedema affects your ability to lift, carry, or perform overhead activities
- Note whether swelling worsens with activity, heat, or at end of day (worst day reporting)
- Mention any compression garments you use and how often
- Describe any numbness or tingling in the arm, hand, or fingers
Pain considerations: On your worst days, describe the heaviness, aching, tightness, and any difficulty using your arm due to swelling or discomfort.
Shoulder and Arm Range of Motion
Limitation of motion in the shoulder, arm, or wrist resulting from surgical treatment, lymphedema, or muscle harvesting for reconstruction
What to expect:
If you have functional complaints, the examiner may assess active and passive range of motion of the shoulder, elbow, and wrist. Measurements may be taken with a goniometer. You may be asked to perform movements such as reaching overhead, behind your back, or to the side.
Key thresholds:
- Forward flexion of shoulder 0-90 degrees — Rated at 40% under DC 5201
- Forward flexion of shoulder 91-130 degrees — Rated at 20% under DC 5201
- Forward flexion of shoulder 131-170 degrees — Rated at 10% under DC 5201
Tips:
- Perform range of motion testing to your actual comfortable limit, not pushing through severe pain
- Report any pain, weakness, or fatigue that occurs with movement
- Describe whether motion is worse after activity or at end of day (DeLuca factors)
- Mention if you have difficulty with activities like dressing, reaching shelves, or lifting
Pain considerations: Inform the examiner if pain limits your motion before the anatomical end range is reached, and describe the worst day severity of this limitation.
Scar Examination
Presence, size, location, and characteristics of surgical scars including whether they are painful, unstable, or cause functional limitation
What to expect:
The examiner will visually inspect and potentially palpate all surgical scars from biopsy, excision, or mastectomy procedures. They will note scar size, whether scars are adherent to underlying tissue, whether they are tender, and whether they cause any functional limitation.
Key thresholds:
- Scar causing significant disfigurement of breast — Supports rating under appropriate scar DC as a chronic residual of DC 7628 - note M21-1 prohibits use of DC 7800 (head/face/neck disfigurement) for breast neoplasm disfigurement
- Scar that is painful or unstable — May be ratable separately under DC 7804 (painful or unstable scars)
Tips:
- Point out every scar from every surgical procedure you have had
- Describe whether any scars are tender to touch, itchy, burn, or limit your movement
- Mention if scars tighten or pull when you move your arm or shoulder
- Note any keloid formation or hypertrophic scarring
Pain considerations: Describe how scar tenderness or tethering affects your daily activities and whether it is worse with certain movements or weather changes.
Rating Criteria Breakdown
| Rating % | Criteria | Key Symptoms |
|---|---|---|
| 100% | A 100% rating under DC 7628 is not directly assigned. However, if the benign neoplasm transforms or is reclassified as malignant, rating shifts to DC 7630 at 100% during active malignancy. Chronic residuals from mastectomy procedures (modified radical or radical) rated under applicable residual DCs may cumulatively support a high combined rating. Note: Per M21-1, separate 100% evaluations are assigned for active breast cancer, not benign neoplasms. |
CFR: DC 7630 Malignant neoplasms of the breast: 100% during active malignancy. Chronic residuals after cessation of treatment rated under applicable DCs per M21-1, Part V, Subpart ii, 3.D.5.a and b. |
| 30% | Chronic residuals rated under applicable DC result in a 30% or higher rating. Example: Severe limitation of shoulder motion under DC 5201 (ankylosis), severe lymphedema with significant functional impairment, or multiple unstable scars causing functional limitation. |
CFR: Under DC 5201: arm motion limited to 45 degrees from side = 30%. Under DC 7804: five or more painful scars, three or more unstable scars, or unstable scar near a joint = 30%. Loss of grip strength or sensation rated under applicable DC for peripheral nerve impairment. |
| 20% | Chronic residuals rated under applicable DC result in a 20% rating. Example: Moderate limitation of shoulder motion under DC 5201, or multiple painful scars under DC 7804, or moderate lymphedema causing functional restriction. |
CFR: Under DC 5201: arm motion limited to 90 degrees from side = 20%. Under DC 7804: three or four painful scars or one or two unstable scars = 20%. |
| 10% | Chronic residuals rated under applicable DC result in a 10% rating. Example: Surgical scar that is painful under DC 7804, or minimal limitation of shoulder or arm motion under DC 5201 from lymphedema or reconstructive surgery. |
CFR: Under DC 5201: arm motion limited to 90 degrees at shoulder = 20%; at 131-170 degrees = 10%. Under DC 7804: one or two painful scars or scars not near a joint = 10%. |
| 0% | DC 7628 itself does not assign a specific percentage rating. A 0% (noncompensable) rating may result if the benign neoplasm has been treated without resulting in chronic residuals such as scars, lymphedema, disfigurement, or functional impairment. The condition is still service-connected but rated at 0%. |
CFR: DC 7628 requires rating chronic residuals under appropriate diagnostic code(s). If no chronic residuals exist, a noncompensable evaluation may be assigned for the benign neoplasm itself. |
100% A 100% rating under DC 7628 is not directly assigned. Howeve ...
A 100% rating under DC 7628 is not directly assigned. However, if the benign neoplasm transforms or is reclassified as malignant, rating shifts to DC 7630 at 100% during active malignancy. Chronic residuals from mastectomy procedures (modified radical or radical) rated under applicable residual DCs may cumulatively support a high combined rating. Note: Per M21-1, separate 100% evaluations are assigned for active breast cancer, not benign neoplasms.
Key Symptoms
- Active malignancy detected (triggers reclassification to DC 7630)
- Radical mastectomy with severe functional residuals
- Severe lymphedema causing complete functional loss of arm
- Combination of multiple highly rated residuals achieving 100% combined rating
CFR: DC 7630 Malignant neoplasms of the breast: 100% during active malignancy. Chronic residuals after cessation of treatment rated under applicable DCs per M21-1, Part V, Subpart ii, 3.D.5.a and b.
30% Chronic residuals rated under applicable DC result in a 30% ...
Chronic residuals rated under applicable DC result in a 30% or higher rating. Example: Severe limitation of shoulder motion under DC 5201 (ankylosis), severe lymphedema with significant functional impairment, or multiple unstable scars causing functional limitation.
Key Symptoms
- Severe or complete limitation of shoulder abduction (0-90 degrees)
- Severe lymphedema significantly impairing arm use
- Five or more painful scars or three or more unstable scars
- Significant functional impairment from muscle harvesting for reconstruction
- Loss of sensation in arm or hand from lymph node excision or radiation neuropathy
CFR: Under DC 5201: arm motion limited to 45 degrees from side = 30%. Under DC 7804: five or more painful scars, three or more unstable scars, or unstable scar near a joint = 30%. Loss of grip strength or sensation rated under applicable DC for peripheral nerve impairment.
20% Chronic residuals rated under applicable DC result in a 20% ...
Chronic residuals rated under applicable DC result in a 20% rating. Example: Moderate limitation of shoulder motion under DC 5201, or multiple painful scars under DC 7804, or moderate lymphedema causing functional restriction.
Key Symptoms
- Moderate limitation of shoulder or arm motion (e.g., forward flexion 91-130 degrees)
- Three or four painful or unstable scars
- Moderate lymphedema with activity-related swelling and discomfort
- Significant alteration of breast size or form after wide local excision
CFR: Under DC 5201: arm motion limited to 90 degrees from side = 20%. Under DC 7804: three or four painful scars or one or two unstable scars = 20%.
10% Chronic residuals rated under applicable DC result in a 10% ...
Chronic residuals rated under applicable DC result in a 10% rating. Example: Surgical scar that is painful under DC 7804, or minimal limitation of shoulder or arm motion under DC 5201 from lymphedema or reconstructive surgery.
Key Symptoms
- Painful surgical scar at biopsy or excision site
- Mild limitation of shoulder range of motion (e.g., forward flexion to 131-170 degrees)
- Minimal lymphedema without significant functional limitation
- Minor alteration of breast form following wide local excision
CFR: Under DC 5201: arm motion limited to 90 degrees at shoulder = 20%; at 131-170 degrees = 10%. Under DC 7804: one or two painful scars or scars not near a joint = 10%.
0% DC 7628 itself does not assign a specific percentage rating. ...
DC 7628 itself does not assign a specific percentage rating. A 0% (noncompensable) rating may result if the benign neoplasm has been treated without resulting in chronic residuals such as scars, lymphedema, disfigurement, or functional impairment. The condition is still service-connected but rated at 0%.
Key Symptoms
- Benign neoplasm present or history of benign neoplasm
- No significant surgical treatment or treatment completed without residuals
- No scars, lymphedema, disfigurement, or functional impairment remaining
- Watchful waiting status with no active treatment
CFR: DC 7628 requires rating chronic residuals under appropriate diagnostic code(s). If no chronic residuals exist, a noncompensable evaluation may be assigned for the benign neoplasm itself.
How to Describe Your Symptoms
Surgical Treatment History
How to describe:
Clearly state every surgical procedure you have undergone, including dates, which breast was treated, the type of procedure (biopsy, wide local excision, lumpectomy, simple mastectomy, modified radical mastectomy, radical mastectomy), and whether axillary or sentinel lymph nodes were removed. Specify whether any reconstruction was performed and what muscles were used.
Worst-day example:
“On my worst days, the surgical area from my lumpectomy pulls and aches so badly I cannot raise my right arm above shoulder height, and the scar feels like it is tearing when I try to reach across my body.”
What the examiner listens for:
Specific procedure names and dates, laterality (which breast), whether lymph nodes were removed, evidence of significant alteration of breast size or form, and any ongoing symptoms directly tied to the surgical intervention.
Understatements to avoid:
Do not say 'I had a procedure on my breast' - be specific. Do not minimize by saying 'it healed fine' if you still have pain, tightness, or movement limitations.
Scar Pain and Disfigurement
How to describe:
Describe the location of every scar, its approximate size, whether it is tender to touch, whether it causes burning or itching, whether it is raised or adherent to underlying tissue, and whether it restricts your movement or causes pain with activity.
Worst-day example:
“On my worst days, the scar from my excision is so tender I cannot wear a bra or any clothing that touches it directly, and the skin feels tight and pulls when I try to raise my arm or twist my torso.”
What the examiner listens for:
Number of scars, whether scars are painful or unstable, proximity to joints, functional limitation caused by scar tethering or adherence, and any disfigurement of breast contour, shape, or size.
Understatements to avoid:
Do not say 'it is just a scar' or 'it does not bother me much' if the scar is regularly painful or limits your activity. Do not fail to mention all scars including biopsy scars.
Lymphedema Symptoms
How to describe:
Describe the location of swelling (breast, arm, hand, or fingers), when it started, what makes it worse, how it affects your ability to use your arm, whether you use a compression garment, and how the swelling impacts your work and daily activities.
Worst-day example:
“On my worst days, my entire right arm from the armpit to my wrist swells so severely that I cannot close my hand into a fist, grip a steering wheel, or lift anything heavier than a cup of water without the arm feeling heavy and burning.”
What the examiner listens for:
Onset of lymphedema after lymph node excision or radiation therapy, severity and frequency of swelling episodes, functional limitations in the arm and hand, use of compression garments, and impact on employment and activities of daily living.
Understatements to avoid:
Do not minimize swelling as 'just a little puffiness.' Do not forget to mention that symptoms worsen with heat, activity, or at end of day. Do not fail to report numbness or tingling associated with lymphedema.
Arm and Shoulder Functional Impairment
How to describe:
Describe specific activities you cannot perform or perform with difficulty due to shoulder, arm, or wrist limitations from your breast treatment. Include difficulty with overhead reaching, lifting, dressing, driving, typing, or occupational tasks. Use the DeLuca factors: describe pain with motion, weakness, fatigue with repetitive use, and flare-ups.
Worst-day example:
“On my worst days, I cannot lift my left arm above chest height due to pain and weakness from the radiation fibrosis and lymph node removal. After any attempt at repetitive overhead activity, my arm aches deeply for hours and my grip becomes so weak I drop objects.”
What the examiner listens for:
DeLuca factors - pain on motion, weakness, fatigue with use, incoordination, and flare-up frequency and severity. Specific functional tasks that are limited and whether limitations relate to the treated breast side.
Understatements to avoid:
Do not perform range of motion beyond your comfortable limit just to seem cooperative. Do not forget to report that your symptoms are worse after activity or in certain weather. Do not fail to mention flare-ups of pain or swelling.
Radiation Therapy Residuals
How to describe:
If you received radiation therapy, describe any chronic skin changes (fibrosis, discoloration, sensitivity, burns), chest wall pain, fatigue, or secondary effects on the shoulder and arm. State which breast was treated and when treatment occurred.
Worst-day example:
“On my worst days, the skin over the radiated area of my right breast is so sensitive and thickened from fibrosis that even light clothing contact causes burning pain, and the tightness in my chest wall limits how deeply I can breathe and how far I can reach.”
What the examiner listens for:
Chronic radiation dermatitis, fibrosis, chest wall pain, brachial plexopathy, fatigue, and any secondary lymphedema or vascular damage attributed to radiation fields.
Understatements to avoid:
Do not say 'radiation was a long time ago so I am fine now' if you have ongoing skin changes, tightness, pain, or arm symptoms. Radiation residuals can persist for years and are ratable chronic residuals.
Impact on Daily Activities and Employment
How to describe:
Provide specific examples of how your benign breast neoplasm and its treatment residuals affect your ability to work, perform household tasks, care for yourself, engage in recreation, or maintain relationships. Be concrete - not 'it affects my life' but 'I cannot stock shelves, lift my children, or work a full day without stopping due to arm swelling and pain.'
Worst-day example:
“On my worst days, I cannot report to work because the combination of scar pain, arm swelling, and shoulder stiffness makes it impossible to sit at a desk and type for more than 20 minutes, and I require help washing my hair and dressing because I cannot raise my arm above my shoulder.”
What the examiner listens for:
Specific occupational and functional limitations tied to the breast condition and its treatment residuals, frequency of bad days versus good days, and whether functional limitations are appropriately linked to the service-connected condition.
Understatements to avoid:
Do not say 'I manage' or 'I get by' if you have substantially modified your life or work to accommodate your symptoms. Do not fail to mention days you cannot work, need help, or have had to cancel activities.
Common Mistakes to Avoid
Describing only the benign neoplasm itself and not its treatment residuals
DC 7628 provides no standalone rating - your rating comes entirely from the chronic residuals of the condition and its treatment such as scars, lymphedema, and functional impairment. If you only discuss the lump itself, the examiner may document minimal findings.
Instead: Focus your description on every treatment you received (surgery, radiation, chemotherapy) and every lasting symptom or physical change that resulted from that treatment.
Impact: All levels - without documented residuals, a 0% noncompensable rating is likely
Failing to mention all surgical procedures and their dates
The DBQ specifically asks about procedure type (biopsy, wide local excision, mastectomy type), laterality, and whether significant alteration of size or form resulted. Omitting procedures means the examiner cannot accurately complete these fields.
Instead: Bring operative reports and pathology reports to the exam. List every procedure, the date, which breast, and what was removed or altered.
Impact: 10-30%+ - type and extent of surgery drives significant alteration findings
Not reporting lymphedema symptoms or minimizing their severity
Lymphedema from axillary or sentinel lymph node excision is a significant ratable residual under DC 7628. Veterans often normalize swelling or consider it 'not a real problem' but it directly impacts arm function and rating.
Instead: Report all swelling in the arm, breast, or hand. Describe how it limits arm use, when it worsens, and what treatment you use (compression garments, manual drainage). Report on your worst days.
Impact: 20-40%+ under musculoskeletal and vascular DCs as residuals
Performing range of motion testing beyond your actual comfortable limit
If you push through pain to demonstrate full range of motion, the DBQ will reflect higher motion than you actually have on a daily or worst-day basis, resulting in a lower musculoskeletal rating for residuals.
Instead: Stop at the point where you feel pain or significant resistance. Clearly state 'this is where I feel pain' or 'I cannot go further without significant pain.' The examiner should note pain on motion per DeLuca.
Impact: 10-40% under shoulder/arm motion DCs
Assuming a breast condition cannot be disabling or that scars do not count
Many veterans underreport breast and scar residuals, believing the VA will not rate them significantly. Painful scars, breast disfigurement, and functional limitations from treatment are all ratable under specific diagnostic codes as chronic residuals.
Instead: Report every scar, its characteristics, and any functional limitation. Understand that each painful or unstable scar can contribute to your rating under DC 7804 and that disfigurement may support additional ratings.
Impact: 10-30%+ under scar and disfigurement DCs
Not mentioning radiation therapy or chemotherapy treatment received
Radiation therapy and antineoplastic chemotherapy for a benign neoplasm can produce chronic residuals including skin fibrosis, chest wall changes, lymphedema, and brachial plexopathy. If not mentioned, these treatment-related residuals may not be evaluated.
Instead: Disclose all radiation therapy (side, dates, total dose if known) and any chemotherapy received. Describe all persistent symptoms you attribute to these treatments.
Impact: 10-40%+ depending on residuals documented
Reporting only average or good-day symptoms
Per M21-1 guidance, VA examinations should capture the full range of severity including worst-day presentations. Reporting only how you feel on a good day results in a DBQ that understates your actual functional impairment.
Instead: For every symptom, explicitly describe both your typical day and your worst day. Use phrases like 'on my worst days' or 'at its worst' to ensure the examiner captures the full spectrum of your disability.
Impact: All levels - worst day reporting can shift ratings by one or more levels
Prep Checklist
Before Your Exam
Day Of
During the Exam
After the Exam
Your Rights During a C&P Exam
- You have the right to a thorough and accurate C&P examination that evaluates all claimed residuals of your benign breast neoplasm under DC 7628, including scars, lymphedema, disfigurement, and functional impairment.
- You have the right to audio or video record your C&P examination in most states - inform the examiner at the start of the appointment.
- You have the right to request a copy of the completed DBQ after your examination through a records request to the VA Regional Office or via VA.gov.
- You have the right to challenge an inadequate or inaccurate C&P examination by requesting a new examination or submitting a private Independent Medical Opinion (IMO) to rebut its findings.
- You have the right to submit lay statements (from yourself or others) describing the functional impact of your condition to supplement the C&P examination findings.
- You have the right to have the VA apply the benefit of the doubt in your favor when evidence is in approximate balance under 38 U.S.C. 5107(b).
- Under DC 7628, your condition must be rated based on its chronic residuals under appropriate diagnostic codes - you are entitled to a rating for every ratable residual condition including scars (DC 7804), lymphedema (DC 7120), and musculoskeletal limitations (e.g., DC 5201).
- Per M21-1, disfigurement from breast neoplasms must NOT be evaluated under DC 7800 (which applies only to the head, face, or neck) - you have the right to have breast disfigurement rated under the appropriate alternative diagnostic code.
- You have the right to claim secondary service connection for conditions that develop as a result of your service-connected benign breast neoplasm and its treatment, such as lymphedema, radiation-induced conditions, or neuropathy.
- You have the right to request a higher-level review or file a Notice of Disagreement (NOD) if you believe the VA's rating decision did not accurately reflect the severity of your condition and its residuals.
Related Conditions
- Lymphedema Lymphedema of the arm or breast is a common chronic residual of axillary or sentinel lymph node excision performed as part of benign breast neoplasm treatment. It is ratable separately as a residual of DC 7628 under DC 7120 or applicable vascular diagnostic codes.
- Painful Surgical Scars Surgical scars from biopsy, wide local excision, or mastectomy procedures are ratable chronic residuals of DC 7628. Painful or unstable scars are rated under DC 7804 with ratings from 10% to 30% based on number and characteristics of scars.
- Limitation of Motion of the Arm (Shoulder) Limitation of shoulder or arm motion resulting from lymphedema, radiation fibrosis, scar tethering, or muscle harvesting for reconstruction is a ratable residual of DC 7628 rated under DC 5201 based on degrees of motion limitation.
- Malignant Breast Neoplasm If a benign breast neoplasm transforms to or is reclassified as malignant, the rating shifts from DC 7628 to DC 7630 at 100% during active malignancy. Veterans should report any change in pathology or new malignant diagnosis immediately to the VA.
- Peripheral Neuropathy (Breast/Arm Region) Peripheral neuropathy of the arm, intercostobrachial nerve, or brachial plexus can result from axillary lymph node dissection or radiation therapy as part of breast neoplasm treatment. Numbness, tingling, or weakness in the arm or hand may be ratable as a secondary residual.
- Radiation-Induced Skin Conditions Chronic radiation dermatitis, fibrosis, or skin changes resulting from radiation therapy for a benign breast neoplasm are ratable chronic residuals of DC 7628 under applicable dermatological diagnostic codes.
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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.