Hyperaldosteronism — VA Disability Rating (DC 7917)
Diagnostic Code 7917 · 38 CFR §4.119
What Is It?
Hyperaldosteronism is the overproduction of aldosterone, the hormone that tells the kidneys to hold on to sodium and shed potassium. The usual sources are a small benign adrenal adenoma or an overgrowth of both adrenal glands. The result is high blood pressure that does not respond well to ordinary medication, often paired with a low potassium level, and with it muscle cramps and weakness, frequent urination including at night, headaches, and fatigue. Veterans usually arrive at the diagnosis through the blood pressure rather than the gland, after years of treatment-resistant readings or a potassium level that kept coming back low, and many carry documented hypertension in their service records long before anyone tests for a cause. Under 38 CFR §4.119, DC 7917 carries no percentage tiers of its own. The instruction is to evaluate as a malignant or benign neoplasm, as appropriate, which sends benign cases to DC 7915 and from there to residuals of endocrine dysfunction, and malignant cases to DC 7914. In practice the evaluation is built from what the excess hormone did to the rest of the body: the hypertension, any kidney impairment, changes to the heart, and the effects of low potassium, each rated under its own code and combined under 38 CFR §4.25.
Rating Criteria
| Rating | Criteria |
|---|---|
| See pathways | DC 7917 (hyperaldosteronism, benign or malignant) assigns no percentage of its own under 38 CFR §4.119. The instruction is to evaluate as malignant or benign neoplasm, as appropriate. Malignant adrenal tumors are evaluated under DC 7914 at 100 percent with the six-month mandatory examination provision; benign adenomas and bilateral adrenal hyperplasia are evaluated under DC 7915, which routes again to residuals of endocrine dysfunction. Those residuals are where the evaluation actually comes from: hypertension under the cardiovascular codes, kidney impairment under the renal dysfunction criteria of 38 CFR §4.115a, hypertensive heart disease under the cardiovascular codes, and the effects of low potassium. Separate evaluations are combined under 38 CFR §4.25, and each has to be claimed and examined. |
Evidence Needed
The diagnostic pair is a plasma aldosterone concentration with a plasma renin activity and the ratio between them, followed by whatever confirmatory test was used, such as saline infusion, oral salt loading, or a captopril challenge. Adrenal imaging by CT with an adrenal protocol, and an adrenal vein sampling report if one was done, establish the source. Then document the damage. A blood pressure log with dated readings matters more than any single clinic value, because hypertension evaluations turn on numbers. Include the full list of blood pressure medications with doses, potassium levels over time with any supplementation, creatinine and eGFR with a urine albumin for kidney involvement, an echocardiogram if one was ordered, and the operative report and pathology if an adrenal gland was removed.
C&P Exam Tips
Bring a blood pressure log. Take readings at the same times each day for several weeks before the examination, write down the date, the time, the reading, and the medication you were on, and hand the log to the examiner. A single reading taken in a hallway will not represent the condition. State plainly that your readings are on medication, and list every blood pressure medication you take, including the doses you have escalated to. Describe the potassium symptoms as function rather than as lab values: cramping that wakes you, weakness climbing stairs, how many times you get up at night to urinate. Ask whether a hypertension questionnaire and, if your creatinine is abnormal, a kidney questionnaire are being completed.
How to File
File VA Form 21-526EZ listing hyperaldosteronism under DC 7917. Include hormone testing, adrenal imaging, blood pressure records, and potassium levels. Because DC 7917 is rated as a neoplasm with the actual rating based on consequences, file separate claims for hypertensive heart disease, kidney damage, and cardiac arrhythmias under their own diagnostic codes. Provide evidence connecting the condition to service.
Common Mistakes
The largest mistake is claiming the adrenal condition and never claiming the hypertension. The gland carries no evaluation of its own, and the blood pressure is where most of the value sits. The second is walking into the examination without readings, since hypertension criteria are numeric and a claim with no log gets decided on whatever the examiner measures that morning. The third is assuming that surgery closed the matter, when blood pressure frequently stays elevated after an adrenalectomy and the medication continues for life. The fourth is ignoring the downstream organs. Kidney function and heart changes are evaluated separately, and they are the part of this disease that quietly worsens while the claim stays focused on the gland.
Frequently Asked Questions
Why is no percentage listed under DC 7917?
Because DC 7917 is a routing instruction rather than a set of criteria. It says to evaluate as a malignant or benign neoplasm, as appropriate, which sends a benign adenoma or adrenal overgrowth to DC 7915 and a malignant tumor to DC 7914. DC 7915 then says to rate as residuals of endocrine dysfunction. What the excess aldosterone did to your blood pressure, kidneys, heart, and potassium is what carries the evaluation, so those are the things that have to be claimed and examined.
Where does the high blood pressure get rated?
Hypertension is evaluated under its own diagnostic code in the cardiovascular system, based on diastolic and systolic readings and on whether continuous medication is required for control. It is a separate evaluation from the adrenal condition, and separate evaluations are combined under 38 CFR §4.25 rather than added. Claim it by name and support it with a dated home log rather than relying on a single examination reading, because a well controlled reading on the day of the exam is still the reading that goes into the report.
The adrenal gland was removed. Is anything left to claim?
Usually. Removing an aldosterone producing adenoma often improves blood pressure without normalizing it, particularly when the hypertension ran for years before diagnosis, since vascular changes do not reverse. Many veterans stay on medication afterward. File on the residual hypertension, on kidney function if creatinine or albumin is abnormal, on any heart findings, and on the surgical scar. Bring the operative report, the pathology, and the blood pressure readings taken after surgery to show what remained.
What about kidney and heart problems that came from it?
They are rated in their own systems. Kidney impairment is evaluated on the genitourinary criteria that use creatinine, eGFR, and albumin, and hypertensive heart disease with changes to the left ventricle is evaluated in the cardiovascular system. Both are treated as separate disabilities and combined under 38 CFR §4.25. If they developed from service-connected hypertension, they can be claimed as secondary conditions with a physician's statement drawing the link. Get the echocardiogram report and the labs into the file rather than describing them.
My hypertension was diagnosed in service but the cause was found years later. Does that work?
That sequence usually helps rather than hurts. Hypertension documented in service establishes the condition in service, and a later diagnosis of hyperaldosteronism explains what was driving it the whole time. Point the rater to the in-service readings by date, then supply the endocrine workup that identified the cause. A supporting opinion stating that the aldosterone excess predated the diagnosis and accounts for the earlier readings connects the two records into one disease rather than two unrelated episodes.