Pheochromocytoma — VA Disability Rating (DC 7918)
Diagnostic Code 7918 · 38 CFR §4.119
What Is It?
A pheochromocytoma is a tumor of the adrenal medulla that secretes catecholamines, the hormones behind the fight or flight response. A closely related tumor called a paraganglioma does the same thing from nerve tissue outside the adrenal gland. Because the hormone release comes in surges, the classic picture is episodic: a pounding headache, heavy sweating, a racing heart, pallor, tremor, and a spike in blood pressure that can be severe, set off by exertion, a change in position, certain medications, or nothing at all. Between episodes a veteran can look entirely normal, which is why these are so often mistaken for panic attacks or for anxiety related to service. A meaningful share are linked to inherited mutations, so genetic testing is commonly part of the workup. Under 38 CFR §4.119, DC 7918 carries no percentage tiers of its own. The instruction is to evaluate as a malignant or benign neoplasm as appropriate, which sends malignant cases to DC 7914 and benign cases to DC 7915, and DC 7915 routes again to residuals of endocrine dysfunction. The lasting evaluation usually comes from persistent hypertension, heart damage, steroid dependence after adrenal surgery, and the anxiety that trails the episodes, combined under 38 CFR §4.25.
Rating Criteria
| Rating | Criteria |
|---|---|
| See pathways | DC 7918 (pheochromocytoma, 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, and the pathology report is what decides which. Malignant tumors are evaluated under DC 7914 at 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. Benign tumors are evaluated under DC 7915, which routes again to residuals of endocrine dysfunction. The residuals that usually carry the evaluation are persistent hypertension under the cardiovascular codes, hypertensive heart disease, adrenal insufficiency under DC 7911 where both adrenal glands were removed, and any psychiatric condition arising from recurrent crises. Separate evaluations are combined under 38 CFR §4.25. |
Evidence Needed
Biochemical proof comes from plasma free metanephrines or a twenty-four hour urine collection for metanephrines and catecholamines, ideally drawn while you were symptomatic. Localization comes from CT or MRI of the abdomen and, where used, an MIBG scan or a DOTATATE PET. The pathology report from the resection is the document that decides the route, because it states whether the tumor was benign or malignant. Include genetic testing results if the RET, VHL, SDHB, SDHD, or NF1 genes were checked. For residuals, gather emergency department records from any blood pressure crisis, a blood pressure log from after the surgery, an echocardiogram if heart muscle damage was suspected, cortisol levels and steroid replacement prescriptions if both adrenal glands were removed, and the dates any antineoplastic therapy started and stopped.
C&P Exam Tips
Bring the pathology report and say directly whether the tumor was benign or malignant, because the examiner needs that to know which code applies. If any antineoplastic therapy was used, bring the start and stop dates in writing, since the six month clock under DC 7914 runs from discontinuance and a mandatory examination follows it. Describe episodes with dates rather than in general terms: what set them off, how long they lasted, whether you went to an emergency room, and what you could not do afterward. If both adrenal glands were removed and you take steroid replacement, say so clearly and describe what happens when you are ill or miss a dose. Ask whether hypertension, heart, and mental health questionnaires are being completed.
How to File
File VA Form 21-526EZ listing pheochromocytoma under DC 7918. Include lab results, imaging, surgical reports, pathology, and blood pressure records. Because DC 7918 is rated as a neoplasm, file separately for adrenal insufficiency (DC 7911) if the gland was removed, and for cardiovascular damage, kidney damage, and anxiety as secondary conditions under their own codes.
Common Mistakes
The first mistake is treating the resection as the end of the claim. Blood pressure often stays high afterward, the heart may carry lasting changes, and a veteran who lost both adrenal glands depends on steroid replacement for life. The second is losing track of the six month clock when the tumor was malignant, since the 100 percent evaluation under DC 7914 continues beyond the end of therapy and is then reassessed by a mandatory examination. Going into that examination with no residuals in the record is how a large evaluation drops without warning. The third is letting the episodes stay filed under anxiety, which happens often and buries the medical history. The fourth is never claiming the psychiatric residual, since living through recurrent crises leaves its own mark.
Frequently Asked Questions
Why does DC 7918 have no percentage?
Because DC 7918 assigns none and instead says to evaluate as a malignant or benign neoplasm as appropriate. A malignant tumor is evaluated under DC 7914 and a benign one under DC 7915, which routes again to residuals of endocrine dysfunction. The practical meaning is that the tumor is a gateway rather than the disability. What you are compensated for is the blood pressure, the heart, the hormone dependence, and the other lasting effects, each of which has to be claimed and examined on its own.
Does it matter whether the tumor was benign or malignant?
The pathology report decides it and the difference is large. Under DC 7914 a malignant endocrine neoplasm is evaluated at 100 percent, and that evaluation continues beyond the cessation of surgical, X-ray, antineoplastic chemotherapy, or other therapeutic procedure. A benign tumor routes through DC 7915 to residuals of endocrine dysfunction from the start. Malignancy in a pheochromocytoma is defined by spread rather than by how the cells look under a microscope, so make sure any documented metastasis is in the file.
What is the six month examination under DC 7914?
Under DC 7914 the 100 percent evaluation continues beyond the end of treatment, and six months after the surgical, X-ray, antineoplastic chemotherapy, or other therapeutic procedure is discontinued, the rating is determined by a mandatory VA examination. After that the evaluation is based on residuals. Mark the date therapy ended on your own calendar. Use the months before that examination to get every residual documented in treatment records, because the examination looks for what is there rather than what used to be.
Both of my adrenal glands were removed. How is that rated?
Removing both adrenal glands leaves permanent adrenal insufficiency, which is evaluated on the criteria for Addison's disease under DC 7911 and turns on how often crises and lesser episodes occur. That is a distinct disability from the tumor and from any residual hypertension, and separate evaluations are combined under 38 CFR §4.25 rather than added. Claim each one by name, keep a dated record of every stress dose and every emergency visit, and bring the steroid prescription history to the examination.
My episodes were treated as panic attacks for years. Can that be fixed?
It is common and it is correctable. Ask the treating physician to write a short statement explaining that the episodes recorded as panic attacks match the catecholamine surges of a pheochromocytoma and that the diagnosis was delayed. Then point the rater to the specific service entries by date and pair them with the metanephrine results and the pathology. The mislabeled entries stop being a problem and start being evidence that the disease existed well before the diagnosis date.