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ENDOCRINE CONDITIONS SECTION
Current Section: Endocrine Conditions
Table of Contents

Endocrine Conditions

Endocrine Conditions

Overview of VA Endocrine Condition Ratings

Endocrine conditions involve disorders of the hormone-producing glands that regulate many of the body's functions. Military service can lead to endocrine disorders through environmental exposures, traumatic injuries, stress, or as secondary effects of other service-connected conditions. This section explains how the VA rates endocrine conditions and provides detailed guidance for the most common conditions.

General Rating Principles for Endocrine Conditions

The VA rates endocrine conditions based on several factors:

  • Required treatments: Medications, insulin, dietary restrictions, or other therapies needed
  • Frequency of medical visits: How often you need to see healthcare providers for your condition
  • Complications: Secondary conditions that develop as a result of the endocrine disorder
  • Impact on daily activities: How the condition affects your ability to work and perform daily tasks
  • Hospitalizations: Frequency and duration of hospitalizations required for the condition
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Presumptive Service Connection for Diabetes

Diabetes mellitus type 2 qualifies for presumptive service connection for veterans who:

  • Served in Vietnam between January 9, 1962, and May 7, 1975 (including brief visits ashore and service in inland waterways)
  • Served in or near the Korean DMZ between September 1, 1967, and August 31, 1971
  • Regularly and repeatedly operated, maintained, or served onboard C-123 aircraft known to have been used to spray Agent Orange during the Vietnam War
  • Served at certain Thailand military bases during specific timeframes

For these veterans, the VA presumes that diabetes mellitus type 2 is related to Agent Orange exposure during military service, eliminating the need to prove a direct connection.

Diabetes Mellitus

Diabetes mellitus is a chronic condition that affects how your body processes blood sugar (glucose). There are two main types: type 1, which is an autoimmune condition where the body doesn't produce insulin, and type 2, which is characterized by insulin resistance. Type 2 diabetes is much more common and is the type presumptively associated with Agent Orange exposure.

Establishing Service Connection for Diabetes

To establish service connection for diabetes, you need:

  1. Diagnosis of diabetes mellitus by a qualified medical professional
  2. Evidence of service in a location that qualifies for presumptive service connection (for Agent Orange exposure), OR evidence of onset during service or within one year of discharge, OR evidence of a service-connected condition that caused or aggravated your diabetes
  3. Medical nexus linking your diabetes to service or to another service-connected condition (not required for presumptive service connection)
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Secondary Service Connection

Diabetes can be secondary to other service-connected conditions, including:

  • PTSD or other mental health conditions (which can lead to obesity, a risk factor for type 2 diabetes)
  • Medication side effects (some medications, particularly certain antipsychotics, can cause or worsen diabetes)
  • Pancreatitis (damage to the pancreas can affect insulin production)

If you have one of these service-connected conditions, you may be able to establish service connection for your diabetes as secondary to that condition.

VA Rating Criteria for Diabetes Mellitus

Diabetes mellitus is rated under Diagnostic Code 7913 based on the required treatment and complications:

100%
Requiring more than one daily injection of insulin, restricted diet, and regulation of activities (avoidance of strenuous occupational and recreational activities) with episodes of ketoacidosis or hypoglycemic reactions requiring at least three hospitalizations per year or weekly visits to a diabetic care provider, plus either progressive loss of weight and strength or complications that would be compensable if separately evaluated

Evidence for 100% Rating:

  • Medical documentation showing multiple daily insulin injections
  • Medical records showing prescribed restricted diet
  • Medical documentation of required regulation of activities
  • Hospital records showing at least three hospitalizations per year for ketoacidosis or hypoglycemic reactions, OR
  • Medical records showing weekly visits to a diabetic care provider
  • Documentation of progressive weight and strength loss, OR
  • Medical evidence of complications that would be compensable if separately evaluated
  • Statement from endocrinologist about severity of diabetes
  • Evidence of significant impact on daily activities and inability to work
60%
Requiring insulin, restricted diet, and regulation of activities with episodes of ketoacidosis or hypoglycemic reactions requiring one or two hospitalizations per year or twice a month visits to a diabetic care provider, plus complications that would not be compensable if separately evaluated

Evidence for 60% Rating:

  • Medical documentation showing insulin requirement
  • Medical records showing prescribed restricted diet
  • Medical documentation of required regulation of activities
  • Hospital records showing one or two hospitalizations per year for ketoacidosis or hypoglycemic reactions, OR
  • Medical records showing twice a month visits to a diabetic care provider
  • Documentation of complications that would not be compensable if separately evaluated
  • Statement from endocrinologist about severity of diabetes
  • Evidence of significant impact on daily activities and work
40%
Requiring insulin, restricted diet, and regulation of activities

Evidence for 40% Rating:

  • Medical documentation showing insulin requirement
  • Medical records showing prescribed restricted diet
  • Medical documentation of required regulation of activities
  • Statement from endocrinologist about need to regulate activities due to diabetes
  • Evidence of impact on daily activities and work
20%
Requiring insulin and restricted diet, or; oral hypoglycemic agent and restricted diet

Evidence for 20% Rating:

  • Medical documentation showing insulin requirement OR prescription for oral hypoglycemic medication
  • Medical records showing prescribed restricted diet
  • Prescription records showing diabetes medications
  • Evidence of some impact on daily activities
10%
Manageable by restricted diet only

Evidence for 10% Rating:

  • Medical documentation showing diabetes diagnosis
  • Medical records showing prescribed restricted diet
  • Evidence that condition is managed without medication
  • Evidence of minimal impact on daily activities
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Key Terms

Regulation of activities: The VA defines this as the doctor-prescribed avoidance of strenuous occupational and recreational activities. This is a key requirement for the 40%, 60%, and 100% ratings. Simply having difficulty with activities is not enough; your doctor must specifically prescribe that you avoid strenuous activities because of your diabetes.

Ketoacidosis: A serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones.

Hypoglycemic reaction: A condition that occurs when your blood sugar is too low, which can cause symptoms ranging from mild (shakiness, sweating) to severe (confusion, seizures, loss of consciousness).

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Separate Ratings for Complications

Note 1 under DC 7913 states: "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 diagnostic code 7913."

This means that complications of diabetes that would qualify for at least a 10% rating on their own should be rated separately. Common complications that may qualify for separate ratings include:

  • Diabetic peripheral neuropathy (nerve damage in extremities)
  • Diabetic retinopathy (eye damage)
  • Diabetic nephropathy (kidney damage)
  • Cardiovascular conditions
  • Erectile dysfunction (if it qualifies for special monthly compensation)
  • Diabetic foot ulcers

These separate ratings are then combined with your diabetes rating using the VA's combined ratings table, potentially resulting in a much higher overall rating.

Building a Strong Diabetes Claim

Evidence Checklist for Diabetes Claims

Required Medical Evidence
Military Records
Supporting Statements
Additional Evidence (if applicable)
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Diabetes Claim Tip

For a 40% rating, you need medical evidence that your doctor has prescribed "regulation of activities" specifically due to your diabetes. This means your doctor has told you to avoid strenuous occupational and recreational activities. Ask your doctor to document this prescription clearly in your medical records, using the specific phrase "regulation of activities" or "avoidance of strenuous activities due to diabetes." A general statement that diabetes affects your activities is not sufficient for this rating criterion.

Complications of Diabetes

Diabetes can cause numerous complications that may qualify for separate VA disability ratings. Here are some of the most common:

Common Diabetes Complications

Diabetic Peripheral Neuropathy

Nerve damage in the extremities causing numbness, tingling, or pain.

  • Rating range: 10% to 40% per extremity
  • Diagnostic codes: 8520-8530 (depending on affected nerves)
  • Key evidence: EMG/NCS testing, neurological examination, documentation of symptoms
Diabetic Retinopathy

Damage to the blood vessels in the retina that can lead to vision problems or blindness.

  • Rating range: 10% to 100% based on visual acuity and field loss
  • Diagnostic code: 6006
  • Key evidence: Eye examination by ophthalmologist, visual field testing, documentation of treatment
Diabetic Nephropathy

Kidney damage that can lead to chronic kidney disease or kidney failure.

  • Rating range: 0% to 100% based on renal function
  • Diagnostic code: 7541
  • Key evidence: Lab tests showing kidney function, documentation of symptoms, treatment records
Cardiovascular Conditions

Heart disease, hypertension, or peripheral vascular disease related to diabetes.

  • Rating range: Varies by specific condition
  • Diagnostic codes: Various (7005, 7101, 7114, etc.)
  • Key evidence: Cardiac testing, blood pressure readings, vascular studies, medical opinion linking to diabetes
Erectile Dysfunction

Inability to achieve or maintain an erection due to diabetes.

  • Rating: 0% (but may qualify for Special Monthly Compensation for loss of use of a creative organ)
  • Diagnostic code: 7522
  • Key evidence: Medical diagnosis, documentation of treatment, medical opinion linking to diabetes
Diabetic Foot Ulcers

Open sores or wounds on the feet that can be slow to heal.

  • Rating range: Varies based on severity and treatment required
  • Diagnostic codes: Various (7801-7805 for scars, 5276-5284 for foot conditions)
  • Key evidence: Treatment records, photographs, documentation of healing time and complications

Case Study: Successful Diabetes Claim

Veteran Profile

Navy veteran who served on a ship in the coastal waters of Vietnam from 1968-1969.

Condition

Type 2 diabetes mellitus diagnosed in 2010, with complications including peripheral neuropathy and early diabetic retinopathy.

Symptoms & Presentation
  • Required insulin injections twice daily
  • Followed restricted diet prescribed by endocrinologist
  • Doctor-prescribed avoidance of strenuous activities due to risk of hypoglycemia
  • Experienced numbness and tingling in feet and hands
  • Early signs of diabetic retinopathy detected during eye examination
  • Required visits to diabetic care provider every three months
  • One hospitalization in the past year for severe hypoglycemia
Evidence Submitted
  • Service records showing ship's presence in Vietnam coastal waters (now qualifying for presumptive Agent Orange exposure under Blue Water Navy provisions)
  • Diagnosis of type 2 diabetes mellitus from endocrinologist
  • Medical records documenting insulin requirement and restricted diet
  • Letter from endocrinologist specifically stating that the veteran must avoid strenuous occupational and recreational activities due to diabetes
  • Hospital records for hypoglycemic episode
  • Appointment records showing quarterly visits to diabetic care provider
  • EMG/NCS testing confirming peripheral neuropathy
  • Ophthalmology records documenting early diabetic retinopathy
  • Blood glucose monitoring logs
  • Personal statement describing daily diabetes management and impact on activities
  • Statement from spouse about observed limitations and assistance with insulin injections
Outcome

The veteran was awarded:

  • 40% for diabetes mellitus under DC 7913 (requiring insulin, restricted diet, and regulation of activities)
  • 20% for peripheral neuropathy of right lower extremity under DC 8520 (moderate incomplete paralysis of sciatic nerve)
  • 20% for peripheral neuropathy of left lower extremity under DC 8520
  • 10% for peripheral neuropathy of right upper extremity under DC 8515 (mild incomplete paralysis of median nerve)
  • 10% for peripheral neuropathy of left upper extremity under DC 8515
  • 10% for diabetic retinopathy under DC 6006

These separate ratings were combined using VA's combined ratings table for a significant overall disability rating.

Key Takeaways
  1. The veteran qualified for presumptive service connection based on Blue Water Navy service near Vietnam
  2. The endocrinologist's specific statement about regulation of activities was crucial for the 40% diabetes rating
  3. Complications were properly rated separately, significantly increasing the overall combined rating
  4. Comprehensive medical documentation of all aspects of the condition supported the ratings
  5. The personal statement and spouse's statement helped illustrate the daily impact of the condition

Thyroid Disorders

Thyroid disorders involve abnormal function of the thyroid gland, which produces hormones that regulate metabolism, energy, and growth. The two main types of thyroid disorders are hyperthyroidism (overactive thyroid) and hypothyroidism (underactive thyroid). Military service can lead to thyroid disorders through environmental exposures, traumatic injuries, or as secondary effects of other conditions or treatments.

Establishing Service Connection for Thyroid Disorders

To establish service connection for thyroid disorders, you need:

  1. Diagnosis of a thyroid disorder by a qualified medical professional
  2. Evidence of onset during service or within one year of discharge (for presumptive service connection), OR evidence of a service-connected condition that caused or aggravated your thyroid disorder
  3. Medical nexus linking your thyroid disorder to service or to another service-connected condition
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Presumptive Service Connection for Radiation Exposure

Non-malignant thyroid nodular disease and thyroid cancer may qualify for presumptive service connection for veterans who participated in:

  • Atmospheric nuclear weapons testing
  • Occupation of Hiroshima or Nagasaki during specific periods
  • Service at gaseous diffusion plants in Paducah, KY, Portsmouth, OH, or Oak Ridge, TN
  • Service on Amchitka Island, Alaska

For these veterans, the VA presumes that certain thyroid conditions are related to radiation exposure during military service.

VA Rating Criteria for Hypothyroidism

Hypothyroidism (underactive thyroid) is rated under Diagnostic Code 7903 based on symptoms and required treatment:

100%
Cold intolerance, muscular weakness, cardiovascular involvement, mental disturbance (dementia, slowing of thought, depression), bradycardia (less than 60 beats per minute), and sleepiness

Evidence for 100% Rating:

  • Medical documentation of cold intolerance
  • Medical documentation of muscular weakness
  • Evidence of cardiovascular involvement (e.g., bradycardia, heart rate less than 60 BPM)
  • Mental health evaluation showing dementia, slowing of thought, or depression
  • Medical documentation of excessive sleepiness
  • Statement from endocrinologist about severity of hypothyroidism
  • Evidence of significant impact on daily activities and inability to work
60%
Muscular weakness, mental disturbance, and weight gain

Evidence for 60% Rating:

  • Medical documentation of muscular weakness
  • Mental health evaluation showing mental disturbance
  • Medical records documenting weight gain related to hypothyroidism
  • Statement from endocrinologist about severity of hypothyroidism
  • Evidence of significant impact on daily activities and work
30%
Fatigability, constipation, and mental sluggishness

Evidence for 30% Rating:

  • Medical documentation of fatigability
  • Medical records documenting constipation
  • Evidence of mental sluggishness
  • Statement from endocrinologist about symptoms of hypothyroidism
  • Evidence of moderate impact on daily activities
10%
Fatigability, or; continuous medication required for control

Evidence for 10% Rating:

  • Medical documentation of fatigability, OR
  • Prescription records showing continuous medication (e.g., levothyroxine) required for control
  • Statement from endocrinologist about treatment requirements
  • Evidence of mild impact on daily activities

VA Rating Criteria for Hyperthyroidism

Hyperthyroidism (overactive thyroid) is rated under Diagnostic Code 7900 based on symptoms and required treatment:

100%
Thyroid enlargement, tachycardia (more than 100 beats per minute), eye involvement, muscular weakness, loss of weight, and sympathetic nervous system, cardiovascular, or gastrointestinal symptoms

Evidence for 100% Rating:

  • Medical documentation of thyroid enlargement
  • Medical documentation of tachycardia (heart rate over 100 BPM)
  • Ophthalmology records showing eye involvement
  • Medical documentation of muscular weakness
  • Medical records documenting weight loss
  • Evidence of sympathetic nervous system symptoms
  • Documentation of cardiovascular or gastrointestinal symptoms
  • Statement from endocrinologist about severity of hyperthyroidism
  • Evidence of significant impact on daily activities and inability to work
60%
Emotional instability, tachycardia, fatigability, and increased pulse pressure of systolic blood pressure

Evidence for 60% Rating:

  • Mental health evaluation showing emotional instability
  • Medical documentation of tachycardia
  • Medical documentation of fatigability
  • Blood pressure readings showing increased pulse pressure
  • Statement from endocrinologist about severity of hyperthyroidism
  • Evidence of significant impact on daily activities and work
30%
Tachycardia, tremor, and increased pulse pressure or blood pressure

Evidence for 30% Rating:

  • Medical documentation of tachycardia
  • Medical documentation of tremor
  • Blood pressure readings showing increased pulse pressure or blood pressure
  • Statement from endocrinologist about symptoms of hyperthyroidism
  • Evidence of moderate impact on daily activities
10%
Tachycardia, which may be intermittent, and tremor, or; continuous medication required for control

Evidence for 10% Rating:

  • Medical documentation of intermittent tachycardia and tremor, OR
  • Prescription records showing continuous medication required for control
  • Statement from endocrinologist about treatment requirements
  • Evidence of mild impact on daily activities
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Note on Thyroid Cancer

Thyroid cancer is rated under Diagnostic Code 7914. The rating criteria are:

  • 100%: For 6 months beyond the cessation of any surgical, X-ray, antineoplastic chemotherapy or other therapeutic procedure
  • After 6 months, if there has been no recurrence or metastasis, the condition is rated based on residuals of hypothyroidism or hyperthyroidism

This means that thyroid cancer is automatically rated at 100% during treatment and for 6 months after treatment ends. After that, the rating is based on any remaining thyroid dysfunction.

Building a Strong Thyroid Disorder Claim

Evidence Checklist for Thyroid Disorder Claims

Required Medical Evidence
Military Records
Supporting Statements
Additional Evidence (if applicable)
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Thyroid Disorder Claim Tip

Many veterans with thyroid disorders are underrated because they don't document all their symptoms. For hypothyroidism, keep a symptom diary tracking fatigue, cold intolerance, constipation, mental sluggishness, and weight changes. For hyperthyroidism, document episodes of rapid heartbeat, tremors, anxiety, and heat intolerance. Share this diary with your healthcare provider and make sure these symptoms are recorded in your medical records. This documentation can be crucial for obtaining a higher rating that accurately reflects the impact of your condition.

See Also

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