C-Cell Hyperplasia of the Thyroid — VA Rating (DC 7919)
Diagnostic Code 7919 · 38 CFR §4.119
What Is It?
C-cell hyperplasia is an overgrowth of the parafollicular cells of the thyroid, the cells that make calcitonin. It matters because it sits on the path to medullary thyroid carcinoma, and it is found most often in people who carry a mutation in the RET gene, the same mutation behind the multiple endocrine neoplasia type 2 syndromes. Veterans usually encounter it in one of two ways: a raised calcitonin level or a family history leads to genetic testing, or the finding turns up in the pathology after a thyroid was removed for another reason. Under 38 CFR §4.119, DC 7919 carries no percentage tiers of its own, and it is the one code in this group with an explicitly two-branch instruction. If antineoplastic therapy is required, it is evaluated as a malignant neoplasm under DC 7914, which provides 100 percent continuing beyond the cessation of surgical, X-ray, antineoplastic chemotherapy, or other therapeutic procedure, with the rating determined by a mandatory VA examination six months after discontinuance and residuals rated after that. If a prophylactic thyroidectomy is performed based upon genetic testing and antineoplastic therapy is not required, it is evaluated as hypothyroidism under DC 7903. Which branch you are in is a documentary question, and the documents that answer it are the pathology report and the genetic test.
Rating Criteria
| Rating | Criteria |
|---|---|
| See pathways | DC 7919 (C-cell hyperplasia of the thyroid) assigns no percentage of its own under 38 CFR §4.119. It carries an explicitly two-branch instruction. If antineoplastic therapy is required, evaluate as a malignant neoplasm under DC 7914 — 100 percent, continuing beyond the cessation of any surgical, X-ray, antineoplastic chemotherapy or other therapeutic procedure, with the rating determined by mandatory VA examination six months after treatment is discontinued and residuals rated thereafter. If a prophylactic thyroidectomy is performed (based upon genetic testing) and antineoplastic therapy is not required, evaluate as hypothyroidism under DC 7903. Note that this second branch routes to DC 7903, not to the benign neoplasm code — the surgery leaves you hypothyroid and that is what is evaluated. Injured parathyroid function is separately evaluated under DC 7905, vocal cord injury under the codes covering the larynx, and the neck scar under DC 7800. |
Evidence Needed
Two documents decide the route, so lead with them: the RET proto-oncogene genetic testing report, and the surgical pathology stating whether the specimen showed C-cell hyperplasia alone or medullary carcinoma. Add serial calcitonin levels and carcinoembryonic antigen results, the neck ultrasound, and documentation of the family history that prompted the testing. If any antineoplastic therapy was given, the oncology records with the start and stop dates are essential, because the six month clock under DC 7914 runs from discontinuance. For the hypothyroid branch, gather the levothyroxine prescription history with every dose change and the TSH and free T4 results that go with it, plus post-operative calcium and PTH levels and any voice or vocal cord evaluation.
C&P Exam Tips
Tell the examiner at the start which branch applies, and hand over the two documents that prove it, the pathology report and the genetic testing result. If your thyroid was removed preventively and you never needed antineoplastic therapy, say that plainly, because the evaluation is then built on hypothyroidism under DC 7903 and the examiner needs your symptom history and dosing record rather than a cancer workup. Describe the hypothyroid experience honestly: fatigue through the afternoon, cold intolerance, weight change, constipation, slowed thinking, muscle aches, and what the weeks after a dose adjustment feel like. Mention tingling in the hands or around the mouth, cramping, and any voice change since surgery, and ask that the neck scar be examined and measured.
How to File
File VA Form 21-526EZ listing C-cell hyperplasia under DC 7919. Include pathology and calcitonin level results. If antineoplastic therapy was required, the claim should reference DC 7914 for the cancer rating. If prophylactic thyroidectomy was performed, file separately for hypothyroidism under DC 7903 and any surgical complications. If related to radiation exposure, include exposure documentation.
Common Mistakes
The first mistake is leaving the genetic testing report out of the claim file. It is the document that establishes why the thyroid was removed, and without it the surgery reads as elective. The second is assuming a preventive operation cannot be compensated. The regulation contemplates that exact situation and routes it to hypothyroidism under DC 7903, which is a rated condition with real criteria. The third is describing replacement hormone as a solved problem when the daily symptoms continue, since the evaluation depends on the symptoms and the record of dose changes rather than on the existence of a prescription. The fourth is forgetting what the surgery cost besides the gland, particularly injured parathyroid function, a changed voice, and the neck scar.
Frequently Asked Questions
Why does DC 7919 have no percentage of its own?
Because it splits into two routes instead. If antineoplastic therapy is required, the condition is evaluated as a malignant neoplasm under DC 7914. If a prophylactic thyroidectomy is performed based upon genetic testing and antineoplastic therapy is not required, it is evaluated as hypothyroidism under DC 7903. Those two codes carry the percentages. The practical task in the claim is proving which branch you are in, which is a matter of producing the pathology and the treatment record rather than arguing about severity.
My thyroid was removed preventively. How is that rated?
It is evaluated under the hypothyroidism criteria in DC 7903, the same as anyone whose thyroid stopped working, because that is the state a total thyroidectomy leaves you in. The evidence that supports it is your symptom history and the record of replacement dosing over time, including the stretches after each adjustment when your levels were off. Keep the levothyroxine history, the matching TSH and free T4 results, and a plain account of fatigue, cold intolerance, weight change, and mental slowing.
What changes if I need antineoplastic therapy?
The evaluation moves to DC 7914 at 100 percent, and it continues beyond the cessation of the surgical, X-ray, antineoplastic chemotherapy, or other therapeutic procedure. Six months after treatment is discontinued, the rating is determined by a mandatory VA examination, and from that point the evaluation is based on residuals. Note the date therapy ended, and use the months that follow to get residuals documented in treatment records, because that examination measures what is present rather than what the disease used to be.
Can I claim the other effects of the neck surgery?
Yes, and they are easy to lose. Thyroid surgery in that part of the neck can injure the parathyroid glands, leaving low calcium evaluated under DC 7905, and can injure the nerve that runs to a vocal cord, leaving hoarseness or a paralyzed cord evaluated under the codes covering the larynx. The incision leaves a scar that may be separately evaluable under DC 7800. Each is a distinct disability, claimed by name, and separate evaluations are combined under 38 CFR §4.25 rather than added together.
I carry the mutation but have not had surgery. What should I do now?
Carrying a RET mutation with a raised calcitonin level and no surgery yet is worth documenting now. Establish care with an endocrinologist, keep the serial calcitonin results and the surveillance ultrasounds, and make sure the genetic report is in your medical record. If the thyroid comes out later, the route under DC 7919 depends on the treatment that follows, and having the monitoring history already in place makes the eventual claim a matter of adding the pathology rather than reconstructing years of care.