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

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) insulin; 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 insulin, a restricted diet, and a low physical activity level, then it is rated 40%.

If the condition requires insulin 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.

If the condition causes polyuria with almost continuous thirst and three or more episodes during the past year of dehydration requiring a replacement of liquids through IV, then it is rated 100%. If the condition causes polyuria with almost continuous thirst and one or two episodes of dehydration requiring a replacement of liquids through IV during the past year, then it is rated 60%. If the condition causes polyuria with almost continuous thirst and one or more episodes of dehydration during the past year that did not require IV treatments, it is rated 40%. If the condition causes polyuria with almost continuous thirst but no episodes of dehydration, it is rated 20%.

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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 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. Most severely symptomatic patients would be treated to stop the excessive production of thyroid hormones, therefore any permanent rating over 10% is very unusual.

If the only significant symptom of this condition is heart disease, then it can be rated under code 7008 if that would produce a higher rating than one under this code. Likewise, if the only significant symptom is problems with the eyes, then rate it under the eye condition closest to the symptom.

If the thyroid is swollen, the heart rate is faster than 100 beats per minute, there are eye problems, weakness, weight loss and other symptoms of the cardiovascular system, nervous system, or gastrointestinal system then it is rated 100%.

If you have unstable emotions, a fast heart rate, you get tired and weak easily, and have an increased pulse or blood pressure, it is rated 60%. If you have a fast heart rate, tremors (most often in the hands), and an increased pulse or blood pressure, it is rated 30%. If you have an occasionally fast heart rate and tremors, or if constant medication is required to control the condition then it is rated 10%.

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. Once again, this condition is very easy to treat with medications (Synthroid, Cytomel, levothyroxine), which generally satisfactorily control all the symptoms. A permanent rating over 10% is again unusual.

If you cannot stand the cold, have muscle weakness, mental issues (depression, dementia, etc.), a slow heart rate (less than 60 beats per minute), drowsiness, and other problems with the heart, it is rated 100%. If there is muscle weakness, mental issues and weight gain, it is rated 60%. If you are easily tired, constipated, and your mind is slow and sluggish, then it is rated 30%. If you are easily tired or if you require constant medication, then it is rated 10%.

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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 are kidney stones, weakness, loss of calcium in the bones, and gastrointestinal symptoms: vomiting, constipation, weight loss, nausea, anorexia, or a peptic ulcer, it is rated 100%. If there are gastrointestinal symptoms and weakness, it’s rated 60%. If constant medication is required to control the condition, it is rated 10%.

If surgery was performed to fix this condition, then the condition can be rated under this code or under any code for a remaining symptom or complication, whichever gives the highest rating. Only one rating can be given.

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.

If there are severe muscle twitches, spasms, cramping throughout the body or wheezing in the throat, and either cataracts in the eyes or pressure inside the skull from brain swelling, it is rated 100%. If there is paresthesia in any of the limbs or around the mouth with cataracts in the eyes or pressure inside the skull, or if there are severe muscle twitches, spasms, cramping or wheezing, it is rated 60%. If constant medication is required to control the condition, it is rated 10%.

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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 and an enlarged sella turcica, 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: Pluriglandular syndrome is 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 is tuberculosis that affects numerous glands, then it is rated based on the tuberculosis rating systems. Likewise, if it mainly causes high blood pressure problems, rate it under code 7101. The final code for this condition will look like this: 7912-7101. The first four-digit code defines the condition as pluriglandular, and the second four-digit code tells how it is rated.

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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: A toxic adenoma of the thyroid gland is a tumor in the thyroid that causes it to produce 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. Most severely symptomatic patients would be treated to stop the excessive production of thyroid hormone, therefore any permanent rating over 10% is very unusual.

If the only significant symptom of this condition is heart disease, then it can be rated under code 7008 if that would produce a higher rating than one under this code. Likewise, if the only significant symptom is problems with the eyes, then rate under the eye condition closest to the symptom.

The ratings: If the thyroid is swollen, the heart rate is faster than 100 beats per minute, there are eye problems, weakness, weight loss and other symptoms of the cardiovascular system, nervous system, or gastrointestinal system, then it is rated 100%.

If you have unstable emotions, a fast heart rate, you get tired and weak easily, and have an increased pulse or blood pressure, it is rated 60%. If you have a fast heart rate, tremors (most often in the hands), and an increased pulse or blood pressure, it is rated 30%. If you have an occasionally fast heart rate and tremors, or if constant medication is required to control the condition then it is rated 10%.

Code 7902: A nontoxic adenoma of the thyroid gland is a tumor that does not cause the thyroid to over-produce hormones. If there is disfigurement of the head or neck, it is rated 20%. Without disfigurement, it is rated 0%. If the tumor causes problems from pushing on the organs or bodily systems around it, then it can be rated based on the problems it causes if their ratings would give a higher rating than 20%. This condition can only be rated once, however. A rating under this code and a rating under a code for a symptom the tumor causes is not allowed.

Code 7907: Cushing’s syndrome occurs when there is too much cortisol in the body. Symptoms include rapid weight gain, excessive sweating, easy bruising, 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 muscle weakness, osteoporosis, high blood pressure, and the swelling or enlargement of the pituitary or adrenal gland, it is rated 100%. If it is not getting worse and there is muscle weakness and the enlargement of the pituitary or adrenal gland, 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%.

If the condition is under control or is gone, then 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 the cancer is active, it is rated 100%. This 100% rating continues for the first 6 months after the last treatment of 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 condition caused high blood pressure, then it would be rated separately.

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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