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Evidence checklist

Mastectomy Residuals

DC 762638 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 1 collected
Nexus opinion linking mastectomy to service-connected cancer or conditionCritical

A medical opinion connecting your mastectomy to a service-connected breast cancer or other service-related condition.

Private provider · independent opinion
02

Treatment records

0 of 4 collected
Surgical report from mastectomy procedureCritical

The operative report showing the type of mastectomy (simple, modified radical, or radical), whether one or both breasts, and what tissue was removed.

VA or private records · written request
Documentation of residual conditions (lymphedema, scars, pain)Critical

Records documenting lasting effects like lymphedema, nerve damage, phantom pain, chest wall tightness, shoulder range of motion loss, or significant scarring.

VA or private records · written request
Reconstruction or prosthetic records (if applicable)

Records from breast reconstruction surgery or prosthetic fitting, including any complications.

VA or private records · written request
Mental health records documenting emotional impact

Records from a counselor or psychiatrist showing the emotional impact of mastectomy, such as depression, anxiety, or body image concerns.

VA or private records · written request
03

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 →
04

Benefits questionnaire

0 of 1 collected
DBQ — Breast Conditions

Disability Benefits Questionnaire completed by your doctor documenting your current residual symptoms and functional limitations.

Provider-completed · VA DBQ formHow to get this →
05

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

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