Endocrine system conditions including diabetes mellitus, thyroid disorders, and hormonal imbalances.
How Hormones & Diabetes conditions are rated
The endocrine schedule at 38 CFR §4.119 covers the thyroid, parathyroid, adrenal and pituitary glands, diabetes mellitus and diabetes insipidus, and tumors of the endocrine system. Much of it is built around time. Many codes assign a set evaluation for a fixed period after diagnosis, surgery, or a crisis, and then direct the rater to evaluate whatever residuals remain under the body system they affect.
Thyroid conditions show that pattern clearly. Hyperthyroidism, including Graves' disease (DC 7900), is rated 30% "for six months after initial diagnosis"; after that, residuals or complications of treatment are rated "within the appropriate body system." Hypothyroidism without myxedema (DC 7903) follows the same six-month 30% rule, while hypothyroidism manifesting as myxedema is rated 100% and continues for six months after an examining physician determines crisis stabilization. Thyroiditis with normal thyroid function (DC 7906) is 0%, and when it manifests as hyperthyroidism or hypothyroidism it is evaluated under those codes. Notes direct separate evaluation of hyperthyroid heart disease (DC 7008), of eye involvement under the eye schedule, and of neck disfigurement from thyroid enlargement under DC 7800.
Diabetes mellitus (DC 7913) is rated on the management it requires, and each level lists every element it needs. 10% is "manageable by restricted diet only." 20% requires insulin and restricted diet, or an oral hypoglycemic agent and restricted diet. 40% requires insulin, restricted diet, and "regulation of activities," which the 100% criteria describe as "avoidance of strenuous occupational and recreational activities." 60% adds episodes of ketoacidosis or hypoglycemic reactions requiring one or two hospitalizations a year or twice-a-month visits to a diabetic care provider, plus complications that would not be compensable if separately evaluated. 100% requires more than one daily insulin injection, restricted diet, and regulation of activities, with episodes requiring at least three hospitalizations a year or weekly visits, plus either progressive loss of weight and strength or complications that would be compensable if separately evaluated.
Note (1) to DC 7913 handles complications: "Evaluate compensable complications of diabetes separately unless they are part of the criteria used to support a 100-percent evaluation. Noncompensable complications are considered part of the diabetic process" under DC 7913. In practice, conditions such as peripheral neuropathy, eye disease, or kidney involvement can each carry their own rating under their own codes once they reach a compensable level. Kidney involvement, for example, has its own genitourinary code (DC 7541), rated as renal dysfunction. Note (2) adds that once diabetes "has been conclusively diagnosed," a glucose tolerance test is not to be requested "solely for rating purposes."
The other codes mix timed ratings with criteria. Hyperparathyroidism (DC 7904) is rated 100% for six months from discharge after surgery and 60% for hypercalcemia shown by listed findings such as calcium levels, creatinine clearance, bone density, or a previous fragility fracture, with 10% for symptoms that persist despite surgery or that need continuous medication in someone who is not a surgical candidate. Addison's disease (DC 7911) is rated mainly by counting crises and the less severe "episodes" in the past year, with the 20% level also covering weakness and fatigability or corticosteroid therapy required for control; its notes define both terms. Malignant endocrine neoplasms (DC 7914) are rated 100%, with a mandatory VA examination six months after treatment ends and any change subject to §3.105(e).
Because so many evaluations here are temporary by design, the residuals step can decide the long-term rating, and records that describe each residual clearly can matter as much as the endocrine diagnosis itself.