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Evidence checklist

Female Infertility

DC 763238 CFR § 4.116Gynecological/Breast

Evidence strength

Mark what you already have below and your evidence strength appears here.

Target
Saved locally
01

Specialist opinion

Highest value0 of 2 collected
Reproductive endocrinology or gynecology evaluationCritical

Records from a fertility specialist or gynecologist documenting the diagnosis of infertility, the cause (tubal, hormonal, uterine, unexplained), and treatment options discussed.

Private provider · independent opinion
Nexus opinion linking infertility to service or service-connected conditionCritical

A medical opinion connecting your infertility to military service or a service-connected condition like PID, endometriosis, toxic exposure, or surgical complications.

Private provider · independent opinion
02

Treatment records

0 of 2 collected
Records from underlying service-connected condition causing infertility

Treatment records for the service-connected condition that caused infertility, such as endometriosis records, PID treatment, or toxic exposure documentation.

VA or private records · written request
Fertility treatment records (IVF, IUI, medications)

Records of any fertility treatments attempted, including medications, IUI, IVF cycles, and outcomes.

VA or private records · written request
03

Diagnostic tests and lab results

0 of 1 collected
Fertility workup results (hormone levels, HSG, ultrasound)Critical

Results from fertility testing including hormone panels (FSH, LH, AMH), hysterosalpingography (HSG) showing tubal patency, and ovarian reserve testing.

Imaging or lab facility · records request
04

Lay statements

0 of 2 collected
Buddy statement from spouse, family, or fellow service member

A written statement from someone who can describe observable symptoms and how your condition affects daily life.

You or a witness · VA Form 21-4138 or 21-10210How to get this →
Personal statement describing symptoms and functional impact

Your own written account of how this condition affects your daily activities, work, and relationships. Describe your worst days.

You or a witness · VA Form 21-4138 or 21-10210How to get this →
05

Benefits questionnaire

0 of 1 collected
DBQ — Gynecological Conditions

Disability Benefits Questionnaire completed by your doctor documenting the cause of infertility, treatments tried, and current status.

Provider-completed · VA DBQ formHow to get this →
06

Service records

0 of 1 collected
Service treatment records (STRs)Critical

Military medical records showing in-service treatment, complaints, or injuries related to this condition.

NPRC / milConnect · SF-180
Condition guideRating criteria and what VA looks forC&P exam prepWhat the examiner will askBuddy statement builderGuided VA Form 21-10210

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