Endocrine System - (Caution, not complete)

The Endocrine System

Topics:

Diabetes

Thyroid Conditions

Parathyroid Conditions

Pituitary Conditions

Adrenal Conditions

Multiple-Gland Conditions

Cancer and Tumors of the Endocrine System

Other Endocrine Conditions

DBQs for Endocrine Conditions

Principles that Apply

--The VA changed the codes and ratings for Endocrine Conditions on December 10, 2017. See the Historic VASRDs page for all codes and ratings from before this date. Not all codes were changed, so if the code cannot be found on the Historic VASRDs page, the ratings did not change.--

Reminder: The VA will give a Military Disability Rating for each service-connected condition a service member has, but the DoD will only rate service-connected conditions that make a service member Unfit for Duty.

The endocrine system is a network of glands that create hormones to help regulate the body. These hormones control the growth of new cells and metabolism. Some organs, like the kidney, also help in producing hormones. The endocrine system is made up of the hypothalamus, thymus, pituitary gland, thyroid gland, parathyroid glands, adrenal glands, pineal gland, reproductive glands (ovaries or testes), and the pancreas. All these parts work together to keep the body in balance.

military disability of the endocrine system

Diabetes

Code 7913: Diabetes mellitus is the condition that most of us think of as just diabetes. It occurs either when the pancreas does not produce enough insulin (Type 1), or when the cells do not respond properly to insulin (Type 2). Type 3 diabetes can occur during pregnancy, but this condition resolves after the birth and is not ratable.

Diabetes can affect many different organs including the heart, eyes, and kidneys. It can cause strokes, loss of blood flow to the arms and legs, and nerve dysfunction. It usually takes 10 to 20 years for these secondary conditions to develop.

Note: When rating diabetes mellitus, keep in mind that the secondary conditions of diabetes can be rated separately as long as they are not part of the requirement for a 100% rating. So, if the diabetes is severe enough to warrant a 100% rating under this code, any other conditions that are caused by the diabetes cannot be separately rated. If the diabetes only warrants a 60% rating or lower, however, those other conditions can be rated separately.

Diabetes is rated 100% if all of the following circumstances are present: 1) It requires an insulin injection more than once a day, a restricted diet, and a low physical activity level; 2) It causes three or more hospitalizations each year or requires weekly visits to a care provider; 3) It causes continuous weight loss and weakness.

A 60% rating is given if the condition requires or causes all of the following: 1) at least one or more insulin injections each day; 2) a restricted diet; 3) a low physical activity level; 4) one or two hospitalizations each year or two visits a month to a care provider; 5) minor side effects that would not make a person unemployable without the diabetes.

If the condition requires at least one or more insulin injections each day, a restricted diet, and a low physical activity level, then it is rated 40%.

If the condition requires at least one or more insulin injections each day and a restricted diet, or requires medication taken by mouth and a restricted diet, it is rated 20%.

If it can be managed by a restricted diet alone, it is rated 10%.

Code 7909: Diabetes insipidus is completely different from diabetes mellitus. It is either caused by the body not producing enough antidiuretic hormone or by the kidneys not recognizing and responding properly to that hormone. Without this hormone, much higher levels of water in the body are filtered out through the urine. It causes polyuria.

This condition is rated 30% for the first 3 months after diagnosis. At that point, if there is still polyuria that requires constant hormone medication, it is rated 10%. All other remaining symptoms are rated separately.

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Thyroid Conditions

The thyroid gland makes proteins, controls how the body uses energy and how sensitive the body is to other hormones. It regulates so much of the body’s functioning that it is a vital gland and can cause many major problems if it doesn’t function properly. Most thyroid conditions can be successfully treated with surgery or other medical options, including medications that give the body the hormones that the thyroid gland is no longer able to produce.

Code 7900: Hyperthyroidism, including Graves' disease, occurs when the thyroid produces too many hormones. This causes all the functions in the body to speed up, which can cause symptoms like tremors, hair loss, nervousness and anxiety, rapid heart rate, eye swelling, vomiting, and muscle weakness.

It is rated 30% for the first 6 months after being diagnosed. After 6 months, the condition is then re-evaluated and rated on any remaining symptoms or complications from the medication. Each distinctbody part that is affected can be rated separately. For example, any heart symptoms are rated under code 7008, hyperthyroid heart disease, and any eye conditions are rated under the most appropriate eye code (i.e. diplopia, code 6090), etc. Any symptoms caused by Graves’ disease are rated separately, even without the presence of hyperthyroidism.

Code 7901: Toxic thyroid enlargement is any condition that causes the thyroid gland to become enlarged (tumors, nodules, swelling, etc.) and produce too many hormones (hyperthyroidism). It is rated as hyperthyroidism under code 7900. If the enlargement of the thyroid causes disfigurement of the neck, then an additional rating can be given under code 7800.

Code 7902: Nontoxic thyroid enlargement is any condition that causes the thyroid to become enlarged (tumors, nodules, swelling, etc.), but does not cause it to produce too many hormones. If it causes problems from pushing on the organs or bodily systems around it, then it can be rated based on the problems it causes. For example, if it pushes on the esophagus and makes it hard to swallow, then it can be rated as a stricture of the esophagus, code 7203. If it also causes disfigurement of the neck, then it can be given an additional rating under code 7800.

Code 7903: Hypothyroidism is the opposite of hyperthyroidism in that the thyroid does not produce enough thyroid hormone. This can cause symptoms like constipation, weight gain, tiredness, depression, and muscle cramps, but if left undiagnosed and untreated can cause myxedema, a life-threatening condition with symptoms including muscle weakness, slowing of thought (stupor), dementia, heart problems (most commonly hypotension, bradycardia, and pericardial effusion), and cold intolerance.

A 100% rating is given the entire time myxedema is present and for the first 6 months after the physician determines that the condition is stabilized.

All other cases of hypothyroidism are rated 30% for the first 6 months after diagnosis.

After the 6-month waiting periods, all cases of hypothyroidism are rated on any remaining symptoms. Eye problems, like blurred vision or diplopia, can be rated additionally to other ratings given under this code.

Code 7906: Thyroiditis occurs when the thyroid gland becomes irritated and swells. It can cause no symptoms at all, or result in either hyperthyroidism or hypothyroidism. If it doesn't cause any symptoms, then it is rated 0% under this code. If it causes hyperthyroidism or hypothyroidism, it is rated under their respective codes.

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Parathyroid Conditions

The parathyroid glands control the amount and uses of calcium and phosphate in the body.

Code 7904: Hyperparathyroidism occurs when the parathyroid gland produces too many hormones. There are two kinds of hyperparathyroidism: primary and secondary. Primary is a result of the glands themselves malfunctioning. This kind has very few symptoms but can include symptoms like depression, fatigue, bone pain, and muscle soreness. Secondary is a result of low Vitamin D levels. Symptoms include bone conditions like osteomalacia.

If there is hypercalcemia (too much calcium in the blood), it is rated 60%. To qualify as hypercalcemia, one or more of the following must be present:

- the total calcium level must be greater than 12 mg/dL (3-3.5 mmol/L)

- the ionized calcium level greater than 5.6 mg/dL (2-2.5 mmol/L)

- the creatinine clearance less than 60 mL/min

- the bone mineral density T-score less than 2.5 SD (below the mean)

This 60% rating will continue for 6 months after treatment begins or until surgery is performed, if indicated. If surgery is performed, a 100% rating will be given and will continue for the first 6 months following the surgery. After the 6-month period following either surgery or other treatment, any remaining symptoms (like kidney stones, vision problems, heart problems, etc.) will be rated separately under the appropriate codes unless they are covered by the 10% rating below.

A 10% rating is given if symptoms including nausea, anorexia, fatigue, or constipation are present despite surgery, or if constant medication is required to control the symptoms and surgery cannot be performed.

A 0% rating is given if there are no symptoms.

Code 7905: Hypoparathyroidism occurs when the parathyroid glands produce too few hormones. This causes low levels of calcium in the blood and can cause symptoms like cramping, muscle aches, muscle twitches, headaches, and fatigue. This condition can occur as a side effect from thyroid surgery.

This condition is rated 100% for the first 3 months after diagnosis. It is then rated on any remaining symptoms, like kidney stones, cataracts, congestive heart failure, or any decrease in renal function.

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Pituitary Conditions

The pituitary gland produces growth hormones. These help with initial growth and development in childhood and help with cell reproduction in adulthood.

Code 7908: Acromegaly is a condition where the pituitary gland produces too much growth hormone. This can cause severe disfigurement and gigantism.

If there is pressure in the skull, which causes problems with things like vision, diseases in the joints, glucose intolerance (hyperglycemia), and either high blood pressure or swelling of the heart, it is rated 100%. If there are diseases in the joints, glucose intolerance, and high blood pressure, it is rated 60%. If there is significant over-growth in the limbs or long bones, it is rated 30%.

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Adrenal Conditions

The adrenal glands produce hormones, like adrenaline, in response to stress. They also provide the kidneys a necessary hormone for filtering the blood, and they produce steroid hormones which help with the immune system, the metabolism, and sex-specific parts and functions.

Code 7911: Addison’s disease is a condition where the adrenal glands do not produce enough steroid hormones.

If this disease is caused by a tuberculosis infection, please see the Tuberculosis page.

For this code, a “crisis” occurs if arteries and veins in the limbs collapse and blood can no longer circulate throughout the limbs. This is accompanied by extremely low blood pressure and severe shock. Other symptoms can include nausea, vomiting, anorexia, dehydration, severe weakness, pain in the stomach, legs, and back, fever, and seriously limited brain functioning which could lead to coma and death.

Likewise, an “episode” is not as severe as a crisis. The arteries and veins do not collapse, but symptoms may include anorexia, nausea, vomiting, diarrhea, dehydration, weakness, low blood pressure, low blood sugar, and a slowing of mental functioning.

The ratings: If there were 4 or more crises during the past year, it is rated 60%. If there were 3 crises or 5 or more episodes during the past year, it is rated 40%. If there were 1 or 2 crises during the past year, 2 to 4 episodes during the past year, weakness and fatigability, or if corticosteroids are required to control the condition, it is rated 20%.

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Multiple-Gland Conditions

Code 7912: Polyglandular syndrome (including multiple endocrine neoplasia and autoimmune polyglandular syndrome) covers any condition that affects multiple glands of the endocrine system at the same time. This condition is rated on the main symptoms it causes. So, if it causes diabetes mellitus, it is rated under code 7913. Similarly, if it causes hyperthyroidism, hypothyroidism, hypoparathyroidism, Addison’s disease, or any other condition, it is rated under that condition’s code.

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Cancer and Tumors of the Endocrine System

Cancer and tumors are made up of the growth of abnormal cells. These cells can be benign—they do not destroy the good cells around them (tumors)—or they can be malignant—they destroy the cells around them (cancers). A “cancerous tumor” is just cancer under our definition.

Code 7901: Toxic thyroid enlargement occurs when a tumor forms and causes the thyroid to produce too many hormones. It is rated as hyperthyroidism under code 7900. If the enlargement of the thyroid causes disfigurement of the neck, then an additional rating can be given under code 7800.

Code 7902: Nontoxic thyroid enlargement occurs when a tumor forms but it does not cause the thyroid to produce too many hormones. If it causes problems from pushing on the organs or bodily systems around it, then it can be rated based on the problems it causes. For example, if it pushes on the esophagus and makes it hard to swallow, then it can be rated as a stricture of the esophagus, code 7203. If it also causes disfigurement of the neck, then it can be given an additional rating under code 7800.

Code 7907: Cushing’s syndrome occurs when there is too much cortisol in the body. Symptoms include rapid weight gain, excessive sweating, bruising easily, weakness, high blood pressure, and more. This condition is most often caused by either a tumor in the pituitary gland (“Cushing’s disease”) or by the prolonged use of steroids to treat other conditions.

If it is an active disease that is getting progressively worse and it causes osteoporosis, high blood pressure, and muscle wasting that makes it impossible to rise from a squatting position or a deep chair, climb stairs, or raise your arms, it is rated 100%.

If it is no longer getting worse, but there is still muscle wasting that makes it impossible to rise from a squatting position or a deep chair, climb stairs, or raise your arms, it is rated 60%.

If it causes obesity, a significantly round face caused by weight gain (“moon face”), stretch marks, fragile veins or arteries, and glucose intolerance (a pre-diabetic condition), it is rated 30%.

These ratings are all given for the first 6 months following diagnosis, afterwhich time any left over symptoms or complications are each rated separately.

Code 7916: Hyperpituitarism occurs when the pituitary gland produces too many hormones because of a tumor or a cancer. If it is caused by a cancer, it is rated under code 7914. If it is caused by a tumor, it is rated under code 7915. The final code will look like this: 7916-7914. The first four-digit code defines the condition as hyperpituitarism, and the second four-digit code tells how it is rated. If 7914 or 7915 guides the rating to another code, then that four-digit code will be added to the end of 7916.

Code 7917: Hyperaldosteronism occurs when the adrenal glands produce too many aldosterone hormones because of a tumor or a cancer. If it is caused by a cancer, it is rated under code 7914. If it is caused by a tumor, it is rated under code 7915. The final code will look like this: 7917-7914. The first four-digit code defines the condition as hyperpituitarism, and the second four-digit code tells how it is rated. If 7914 or 7915 guides the rating to another code, then that four-digit code will be added to the end of 7917.

Code 7918: Pheochromocytoma occurs when the adrenal glands produce too many noradrenaline and adrenaline hormones because of a tumor or a cancer. If it is caused by a cancer, it is rated under code 7914. If it is caused by a tumor, it is rated under code 7915. The final code will look like this: 7918-7914. The first four-digit code defines the condition as hyperpituitarism, and the second four-digit code tells how it is rated. If 7914 or 7915 guides the rating to another code, then that four-digit code will be added to the end of 7918.

Code 7919: C-cell hyperplasia of the thyroid is a condition where the C-cells that produce calcitonin in the thyroid grow abnormally into a cancer. If it is treated with chemotherapy, it is rated under code 7914. If surgery is performed and chemo is not required, then it is rated under code 7903.

Code 7914: Any active cancer of the endocrine system that is not listed above is rated under this code. While it is active, it is rated 100%. This 100% rating will continue for the first 6 months after the last treatment or procedure. It is then reevaluated. If it is no longer active, then any left over symptoms or complications are rated separately on the function they affect. So if the symptoms affect the adrenal gland, then it is rated on the impact they have on that gland.

Code 7915: Any tumor of the endocrine system that is not listed above is rated under this code. There are no set ratings for this code. Any symptoms that the tumor causes are rated separately on the function they affect. So if the symptoms affect the adrenal gland, then it is rated on the impact they have on that gland. The final code for any of these tumors will look like this: 7915-7100. The first four-digit code defines the condition as a tumor of the endocrine system, and the second four-digit code tells how it is rated.

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Other Endocrine Conditions

All other genitourinary system conditions will be rated analogously (see the Analogous and Equivalent Codes page) with the above ratings. The bottom line rule is to rate any condition under the code that BEST describes it, even if it is not exact.

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DBQs for Endocrine Conditions

Here are the Disability Benefits Questionnaires (DBQs) used for endocrine conditions: Diabetes DBQ, Thyroid and Parathyroid DBQ, and Endocrine Conditions (other) DBQ.

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Principles that Apply

Pyramiding: A single condition can only be rated once! However, if another condition exists that is additional to the endocrine condition (not simply caused by it), then it can also be rated.

Probative Value: If two exams record the condition differently, the exam with the most thorough data and performed by the most qualified person in that specialty will be the exam the rating is based on.

A Tie Goes to the Veteran: If there are two equally strong exams with conflicting information, or if the condition can be equally rated under two different codes, then the one that gives the highest rating will be assigned. Every conflict should be resolved in favor of the higher rating.

Accurate Measurements: It is essential that the necessary information to rate your condition is recorded by the physician in your exam. With the information on this page, you should know what needs to be measured and recorded. Make sure this happens correctly to ensure that you receive a proper rating.

Hospital or Convalescent Ratings: Some conditions require periods of hospitalization or constant medical care (at-home nurse, etc.). Any condition that requires this is rated 100% during this intensive treatment. Once it ends, then the 100% rating will continue for a certain period. This period is 3 months unless another length (6 months, 1 year, etc.) is directly specified in the condition ratings. Some patients may need more time to recover than others, so the physician or Rating Authorities can lengthen this time period if they see fit.

Please see the VASRD Principles page for further guidance.

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