Nontoxic Thyroid Enlargement — VA Disability Rating (DC 7902)
Diagnostic Code 7902 · 38 CFR §4.119
What Is It?
Nontoxic thyroid enlargement is a goiter with normal hormone levels. The gland grows, sometimes as a smooth diffuse swelling and sometimes as a lumpy multinodular mass, but the labs stay in range, so the problem is mechanical rather than hormonal. What the enlargement does is take up space in a crowded part of the neck. Growing downward behind the breastbone, a substernal goiter can press on the trachea and cause shortness of breath or a choking sensation when you lie flat, press on the larynx or the nerve that runs to the vocal cords and change your voice, or press on the esophagus and make solid food and pills hard to get down. Veterans often find it on an imaging study ordered for something else, or after somebody notices the swelling. Under 38 CFR §4.119, DC 7902 carries no percentage tiers of its own. The instruction is to evaluate the symptoms due to pressure on adjacent organs, meaning the trachea, larynx, and esophagus, appropriately within the relevant body systems, and to evaluate disfigurement of the neck separately under DC 7800. That routing is the whole point of the code. Nothing is paid for the size of the gland. The evaluation comes from breathing, voice, and swallowing findings rated where those live, then combined under 38 CFR §4.25.
Rating Criteria
| Rating | Criteria |
|---|---|
| See pathways | DC 7902 (thyroid enlargement, nontoxic) assigns no percentage of its own under 38 CFR §4.119. The instruction is to evaluate symptoms due to pressure on adjacent organs — such as the trachea, larynx, or esophagus — appropriately within the relevant body systems, and to evaluate disfigurement of the neck due to thyroid disease separately under DC 7800. In practice that means airway narrowing and the breathing limits it causes are evaluated in the respiratory system, voice change and vocal cord dysfunction under the codes covering the larynx, and difficulty swallowing under the digestive codes covering the esophagus. Post-thyroidectomy hypothyroidism is evaluated under DC 7903, injured parathyroid function under DC 7905, and surgical scars under DC 7801-7805. Separate evaluations are combined under 38 CFR §4.25. |
Evidence Needed
The imaging has to describe the gland, not just name it. Ask for the ultrasound report with dimensions, and for the neck and chest CT if substernal extension was suspected, because that is where tracheal narrowing and deviation get measured. For breathing, pulmonary function testing with a flow-volume loop is the study that shows upper airway obstruction, and a plain spirometry summary often misses it. For voice, get the laryngoscopy report describing vocal cord movement and any paralysis. For swallowing, a barium swallow or a modified barium swallow study documents the actual obstruction. Add thyroid labs showing that you are euthyroid, any fine needle aspiration pathology, and, if the gland was removed, the operative report, the pathology, and the levothyroxine records that followed.
C&P Exam Tips
Be specific about pressure symptoms, because they are the entire claim. Describe what happens when you lie flat, whether you sleep propped up, whether you cough or choke on solid food, how often food or pills stick, whether your voice tires or has changed pitch, and whether you get short of breath bending forward or lifting. Bring the imaging report with the measurements and hand it to the examiner. A thyroid examination on its own will not measure airway, voice, or swallowing, so ask whether pulmonary function testing, laryngoscopy, and a swallow study are being ordered, and say clearly that you are claiming the breathing, voice, and swallowing symptoms as part of this condition. Mention the neck itself, including any visible swelling or scar.
How to File
File VA Form 21-526EZ listing nontoxic thyroid enlargement under DC 7902. Include ultrasound results, thyroid function tests, and documentation of pressure symptoms. File separate claims for each pressure symptom under the appropriate body system code, and for neck disfigurement under DC 7800. If surgery was performed, include surgical records and file separately for hypothyroidism (DC 7903) or other surgical complications.
Common Mistakes
The first mistake is expecting a rating for the size of the gland. Size drives nothing under DC 7902. What the gland presses on is what drives the evaluation. The second is going to the examination without the tests that measure pressure, then losing on an absence of findings that nobody looked for. If your breathing, voice, or swallowing is affected, the flow-volume loop, the laryngoscopy, and the swallow study are the evidence. The third is reading a decision that shows no evaluation as a denial and letting the appeal period run out, when the right move is to file for the specific manifestations. The fourth is finishing a thyroidectomy, starting levothyroxine, and never claiming hypothyroidism or the neck scar, both of which are rated on their own.
Frequently Asked Questions
Why does DC 7902 carry no percentage?
Because a nontoxic goiter is defined by having normal hormone levels. There is no metabolic disturbance to measure, so the regulation rates what the gland does mechanically instead. DC 7902 instructs that symptoms from pressure on the trachea, larynx, and esophagus be evaluated within the body systems that own those organs, and that neck disfigurement be evaluated under DC 7800. The code is a pointer. The percentage exists, but it is assigned under the codes the pointer sends you to.
Where do the pressure symptoms actually get rated?
Airway narrowing and the breathing limits it causes are evaluated in the respiratory system, voice changes and vocal cord problems under the codes covering the larynx, and difficulty swallowing under the digestive codes covering the esophagus. Each is a separate evaluation supported by its own findings, and separate evaluations are combined under 38 CFR §4.25 rather than added. Because they live in different systems, they have to be claimed and examined individually. A thyroid examination will not generate them on its own.
The goiter was removed. Is there anything left to claim?
Usually yes. Removing part or all of the thyroid commonly leaves you on daily replacement hormone, which is hypothyroidism and is evaluated under DC 7903. Surgery in that space can injure the nerve that runs to a vocal cord, leaving hoarseness or a paralyzed cord, and it can injure the parathyroid glands, leaving low calcium that is evaluated under DC 7905. The incision leaves a neck scar. Each of those is a separate claim, and each one has to be named.
Does the neck itself get evaluated?
DC 7902 provides for separate evaluation of neck disfigurement under DC 7800, which looks at visible tissue distortion and at the characteristics of any scar. A large goiter that visibly changes the contour of the neck, or a thyroidectomy incision, can support an evaluation there. Photograph it straight on and in profile in even light, include something for scale, and measure any scar's length and width so the examiner has numbers to work with instead of an impression.
My thyroid labs are normal. Does that sink the claim?
No. Normal labs are what make the goiter nontoxic, so they are part of the diagnosis rather than evidence against it. The claim turns on pressure effects, so move the evidence toward imaging that shows tracheal narrowing or deviation, pulmonary function testing with a flow-volume loop, laryngoscopy, and a swallow study. If a decision leans on a normal TSH to deny, that reasoning misreads the code, and it is worth saying so plainly in a supplemental claim or an appeal.