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C&P Exam Prep: Thyroid and Parathyroid Conditions
DBQ Overview
Interview + Physical- Form Name
- Thyroid_and_Parathyroid
- Form Code
- Thyroid_and_Parathyroid
- Page Count
- 10
- Examiner Type
- Endocrinologist or Physician
- Estimated Duration
- 15-30 minutes
- Exam Format
- Interview + Physical
What to Expect During Your Exam
Exam Overview
To document the current severity of your thyroid or parathyroid condition for VA disability rating purposes under 38 CFR 4.119. The examiner will assess the nature of your diagnosis (e.g., hypothyroidism, hyperthyroidism, thyroiditis, hypo/hyperparathyroidism, or neoplasm), current symptom burden, laboratory values, treatment history, and functional impact on daily living and employment.
What the examiner evaluates:
- Current diagnosis type: hypothyroidism, hyperthyroidism (including Graves' disease), thyroiditis, hypo- or hyperparathyroidism, or thyroid/parathyroid neoplasm
- Thyroid function status: euthyroid, hypothyroid, or hyperthyroid, and whether controlled with medication
- Presence and severity of myxedema (severe hypothyroidism)
- Hypercalcemia indicators for hyperparathyroidism (bone mineral density T-score, total calcium, ionized calcium, creatinine clearance)
- Vital signs: heart rate and blood pressure
- Physical exam of thyroid gland: size, nodules, enlargement, post-surgical changes
- Scar/skin findings related to thyroid surgery or the disease process
- Eye involvement (exophthalmos, diplopia, corneal changes) particularly in Graves' disease
- Systemic symptoms: fatigue, anorexia, nausea, constipation
- Associated musculoskeletal symptoms and deep tendon reflexes (biceps, triceps, brachioradialis, knee, ankle)
- Cardiovascular, respiratory/ENT, GI, GU, reproductive, neurological, skin, and psychiatric symptom involvement
- Treatment history: radioactive iodine (RAI), surgery (type and dates), chemotherapy, radiation, other therapeutic treatments
- Residuals and complications from treatment
- Functional impact on occupational and daily activities
- Whether condition is a primary or secondary/metastatic malignancy if neoplasm is present
The exam will typically take place at a VA medical center, CBOC, or contracted exam facility (e.g., LHI, QTC, VES). The examiner will review your claims file, conduct a brief interview about your symptoms and history, and perform a focused physical examination. Bring all relevant lab results and records you have available. In most states you have the right to record this examination - notify the examiner before beginning.
Typical duration: 15-30 minutes
TSH (Thyroid-Stimulating Hormone)
Reflects pituitary signal to the thyroid; elevated TSH indicates hypothyroidism, suppressed TSH indicates hyperthyroidism
What to expect:
The examiner will review your most recent TSH lab result from your medical records or may order one. Normal range is approximately 0.4-4.0 mIU/L.
Key thresholds:
- TSH > 4.0 mIU/L — Suggests undertreated or uncontrolled hypothyroidism; supports higher severity rating
- TSH < 0.4 mIU/L — Suggests hyperthyroidism or over-replacement; relevant to hyperthyroid rating criteria
- TSH within normal range on medication — May indicate controlled disease, but symptoms can persist - document breakthrough symptoms
Tips:
- Bring printed copies of your most recent TSH, Free T4, and Free T3 lab results to the exam
- If your TSH has fluctuated over time, bring a history of multiple results showing instability
- Even if TSH is 'normal' on medication, you may still have disabling symptoms - document these clearly
Pain considerations: N/A - TSH is a laboratory test; however, if labs are drawn at the exam, report any anxiety or symptoms you experience during the process
Free T4 (Free Thyroxine)
Active thyroid hormone level; low Free T4 confirms hypothyroidism, elevated Free T4 confirms hyperthyroidism
What to expect:
Examiner will review existing labs. Normal range is approximately 0.8-1.8 ng/dL.
Key thresholds:
- Free T4 < 0.8 ng/dL — Consistent with undertreated hypothyroidism; supports higher disability rating
- Free T4 > 1.8 ng/dL — Consistent with hyperthyroid state; relevant to hyperthyroid disability evaluation
Tips:
- Have your most recent Free T4 result available; if it was abnormal at any point, bring those records
- Discuss how your Free T4 levels have changed over time and correlate with your symptom severity
Pain considerations: N/A - laboratory test
Free T3 (Free Triiodothyronine)
Active form of thyroid hormone at the cellular level; relevant in hyperthyroidism and T3 toxicosis
What to expect:
Reviewed from existing records. Normal range is approximately 2.3-4.2 pg/mL.
Key thresholds:
- Elevated Free T3 with suppressed TSH — Supports hyperthyroid diagnosis and severity
Tips:
- Relevant if you have Graves' disease or toxic goiter - bring all available T3 results
- T3-only hyperthyroidism can be missed if only TSH and T4 are checked
Pain considerations: N/A - laboratory test
Thyroid Antibodies
Detects autoimmune thyroid disease (TPO antibodies for Hashimoto's; TSI/TRAb for Graves' disease)
What to expect:
Examiner will review existing antibody results. These support the diagnosis of autoimmune thyroid disease.
Key thresholds:
- Elevated TPO antibodies — Confirms autoimmune hypothyroidism (Hashimoto's); supports nexus to service if applicable
- Elevated TSI/TRAb — Confirms Graves' disease; relevant to rating hyperthyroidism and associated eye/cardiac complications
Tips:
- If you have Hashimoto's thyroiditis, ensure antibody results are in your file
- Antibody testing supports separate ratings for associated conditions (e.g., eye involvement in Graves')
Pain considerations: N/A - laboratory test
Parathyroid Hormone (PTH) and Calcium Levels
PTH controls calcium regulation; elevated PTH with hypercalcemia indicates hyperparathyroidism; low PTH indicates hypoparathyroidism
What to expect:
Examiner will review existing PTH, total calcium, and ionized calcium results. These are critical for rating hyperparathyroidism severity.
Key thresholds:
- Total calcium > 12 mg/dL (3.0 mmol/L) — Indicates significant hypercalcemia; relevant to 60% rating threshold for hyperparathyroidism
- Ionized calcium > 5.6 mg/dL (1.4 mmol/L) — Severe hypercalcemia indicator; supports higher rating
- Creatinine clearance < 30 mL/min related to hypercalcemia — Renal complication of hyperparathyroidism; supports higher disability rating
- Bone mineral density T-score - -2.5 — Osteoporosis from chronic hypercalcemia; supports higher rating and secondary conditions
Tips:
- Bring all calcium, PTH, and DEXA scan results to the exam
- If you have kidney stones related to hyperparathyroidism, ensure these are documented and filed separately
- Low PTH after thyroid surgery may indicate iatrogenic hypoparathyroidism - report all post-surgical symptoms including muscle cramps, tingling, and tetany
Pain considerations: If hypocalcemia causes muscle cramps, tetany, or spasms, describe the frequency, severity, and any emergency treatments needed
Heart Rate and Blood Pressure
Vital signs reflecting autonomic and cardiovascular impact of thyroid dysfunction; tachycardia common in hyperthyroidism, bradycardia possible in hypothyroidism
What to expect:
The examiner will record your heart rate and blood pressure as part of the physical exam.
Key thresholds:
- Heart rate > 100 bpm at rest — Tachycardia supporting hyperthyroid or Graves' disease severity
- Heart rate < 60 bpm at rest — Bradycardia potentially consistent with undertreated hypothyroidism
Tips:
- Do not take stimulants or caffeine before the exam if you want an accurate resting heart rate
- If you have palpitations or irregular heartbeat, mention these explicitly - they may support a separate cardiovascular rating
Pain considerations: Report any chest pain, palpitations, shortness of breath, or exercise intolerance associated with your thyroid condition
Deep Tendon Reflexes (DTR)
Neurological examination assessing reflex responses at biceps, triceps, brachioradialis, knee (patellar), and ankle - hypothyroidism can cause delayed (hung) reflexes; hyperthyroidism can cause hyperreflexia
What to expect:
Examiner will test reflexes bilaterally using a reflex hammer. Results will be graded (0 = absent to 4+ = hyperactive).
Key thresholds:
- Absent or markedly diminished ankle reflexes (0-1+) — Supports neuropathy related to hypothyroidism; may warrant separate neurological DBQ
- Hyperreflexia (3-4+) — Consistent with hyperthyroid state or associated neurological involvement
Tips:
- Report any numbness, tingling, or weakness in your hands or feet - these may reflect peripheral neuropathy secondary to hypothyroidism
- If reflexes are tested and you have noticed changes in your balance or coordination, mention this
Pain considerations: If reflex testing causes discomfort due to muscle tenderness or joint pain, communicate this to the examiner
Thyroid Physical Examination (Palpation)
Assesses gland size, texture, presence of nodules, symmetry, and post-surgical changes including scar tissue
What to expect:
The examiner will palpate your neck to assess the thyroid gland. They will note whether it is normal, enlarged (goiter), nodular, tender, or absent/surgically altered.
Key thresholds:
- Palpable enlargement with nodule(s) — Supports diagnosis of toxic or non-toxic goiter; may prompt additional imaging documentation
- Surgical scar present — Documents post-thyroidectomy status; scar characteristics (size, induration, disfigurement) affect scar rating
Tips:
- Inform the examiner of any surgery dates, what was removed (partial vs. total thyroidectomy), and any complications
- If you have a visible or symptomatic neck scar, point it out - the DBQ includes scar evaluation fields
- Mention any difficulty swallowing, voice changes, or neck tightness related to the thyroid or surgery
Pain considerations: If neck palpation causes pain or tenderness, say so clearly during the exam
Rating Criteria Breakdown
| Rating % | Criteria | Key Symptoms |
|---|---|---|
| 100% | Hypothyroidism: Myxedema (cold intolerance, muscular weakness, mental disturbance, and characteristic skin changes) with or without complications; or with cardiac involvement |
CFR: 38 CFR 4.119, DC 7903: Myxedema with or without complications, or with cardiac involvement - 100% |
| 60% | Hypothyroidism: Fatigability, constipation, and mental sluggishness. For hyperparathyroidism: hypercalcemia indicated by bone mineral density T-score - -3.0, ionized calcium > 5.6 mg/dL, total calcium > 12 mg/dL, or creatinine clearance < 30 mL/min |
CFR: 38 CFR 4.119, DC 7903: Fatigability, constipation, and mental sluggishness - 60%. Hyperparathyroidism with severe hypercalcemia indicators - 60% |
| 30% | Hypothyroidism: Fatigability, constipation, or mental sluggishness (one or more symptoms present but less severe than 60% level). Hyperparathyroidism: hypercalcemia with bone mineral density T-score between -2.5 and -3.0, or symptoms controlled with medication but still present |
CFR: 38 CFR 4.119, DC 7903: Fatigability, constipation, or mental sluggishness - 30% |
| 10% | Hypothyroidism: Continuous medication required (hypothyroidism controlled on replacement therapy with minimal or no persistent symptoms). Thyroiditis with normal thyroid function: rated 0% under DC 7906 unless manifesting as hypo- or hyperthyroidism. |
CFR: 38 CFR 4.119, DC 7903: Continuous medication required - 10%. Note: Thyroiditis with euthyroid state = 0% under DC 7906, but if manifesting as hypothyroidism evaluate under DC 7903. |
100% Hypothyroidism: Myxedema (cold intolerance, muscular weaknes ...
Hypothyroidism: Myxedema (cold intolerance, muscular weakness, mental disturbance, and characteristic skin changes) with or without complications; or with cardiac involvement
Key Symptoms
- Severe cold intolerance interfering with daily function
- Significant muscular weakness affecting mobility or work capacity
- Mental disturbance including cognitive impairment, depression, or psychosis
- Classic myxedematous skin: dry, coarse, non-pitting edema
- Cardiac involvement: bradycardia, pericardial effusion, or heart failure
- Marked fatigue and lethargy unresponsive to treatment
- Severely elevated TSH despite maximum tolerated treatment
CFR: 38 CFR 4.119, DC 7903: Myxedema with or without complications, or with cardiac involvement - 100%
60% Hypothyroidism: Fatigability, constipation, and mental slugg ...
Hypothyroidism: Fatigability, constipation, and mental sluggishness. For hyperparathyroidism: hypercalcemia indicated by bone mineral density T-score - -3.0, ionized calcium > 5.6 mg/dL, total calcium > 12 mg/dL, or creatinine clearance < 30 mL/min
Key Symptoms
- Persistent fatigue significantly limiting daily activities
- Chronic constipation requiring medication
- Mental sluggishness: slow processing, memory problems, difficulty concentrating
- Hypercalcemia with severe bone density loss (T-score - -3.0) for hyperparathyroidism
- Renal impairment from chronic hypercalcemia
- Muscle weakness and joint pain from calcium dysregulation
CFR: 38 CFR 4.119, DC 7903: Fatigability, constipation, and mental sluggishness - 60%. Hyperparathyroidism with severe hypercalcemia indicators - 60%
30% Hypothyroidism: Fatigability, constipation, or mental sluggi ...
Hypothyroidism: Fatigability, constipation, or mental sluggishness (one or more symptoms present but less severe than 60% level). Hyperparathyroidism: hypercalcemia with bone mineral density T-score between -2.5 and -3.0, or symptoms controlled with medication but still present
Key Symptoms
- Fatigue present but does not completely prevent daily activities
- Occasional or managed constipation
- Mild cognitive slowing or difficulty with complex tasks
- Intermittent muscle weakness or aches
- Moderate hypercalcemia requiring ongoing medication management
- Bone density loss in the osteopenic range related to parathyroid disease
CFR: 38 CFR 4.119, DC 7903: Fatigability, constipation, or mental sluggishness - 30%
10% Hypothyroidism: Continuous medication required (hypothyroidi ...
Hypothyroidism: Continuous medication required (hypothyroidism controlled on replacement therapy with minimal or no persistent symptoms). Thyroiditis with normal thyroid function: rated 0% under DC 7906 unless manifesting as hypo- or hyperthyroidism.
Key Symptoms
- Requires daily thyroid hormone replacement (levothyroxine/liothyronine)
- Condition controlled on medication but dependent on lifelong treatment
- Minimal or subclinical symptoms at time of exam
- History of prior symptomatic periods even if currently stable
CFR: 38 CFR 4.119, DC 7903: Continuous medication required - 10%. Note: Thyroiditis with euthyroid state = 0% under DC 7906, but if manifesting as hypothyroidism evaluate under DC 7903.
How to Describe Your Symptoms
Fatigue and Energy Levels
How to describe:
Describe fatigue in concrete, functional terms. Explain how many hours per day you feel functional, how often you need to rest, and what activities you cannot complete due to exhaustion. Tie fatigue to specific work, household, or social limitations.
Worst-day example:
“On my worst days, I cannot get out of bed until mid-morning even after 10 hours of sleep. I am too fatigued to cook, shower, or leave the house. Any small task like grocery shopping requires a 2-hour rest afterward. This happens 3-4 times per week.”
What the examiner listens for:
Frequency, severity, impact on activities of daily living, whether fatigue is constant vs. episodic, and relationship to thyroid medication dosing or lab abnormalities
Understatements to avoid:
Do not say 'I'm just a little tired sometimes' - describe how fatigue limits specific functions. Do not say 'I manage fine' if you have reduced your activities, quit your job, or rely on others because of exhaustion.
Cognitive and Mental Symptoms (Mental Sluggishness)
How to describe:
Describe specific cognitive problems: slowed thinking, difficulty finding words, poor memory, inability to concentrate on tasks, problems following conversations or reading. Give concrete examples from work or daily life.
Worst-day example:
“I struggle to follow conversations at work and frequently lose my train of thought mid-sentence. I used to manage complex spreadsheets but now make errors I never would have before. I forget appointments and have to write everything down or I lose track of it completely.”
What the examiner listens for:
Whether mental sluggishness is truly disabling vs. mild inconvenience, impact on occupational function, and whether the veteran has been evaluated for or diagnosed with thyroid-related cognitive impairment or depression
Understatements to avoid:
Do not minimize brain fog as 'just forgetfulness.' If cognitive changes have cost you a job, reduced your work hours, or required accommodations, state this explicitly.
Cold Intolerance and Temperature Regulation
How to describe:
Describe how you feel in cold environments, whether you wear extra layers compared to others, whether cold prevents you from going outside or functioning normally. Describe impact on sleep and daily comfort.
Worst-day example:
“I wear a heavy sweater and socks indoors year-round. In winter I cannot tolerate being outside for more than a few minutes. I sleep with multiple blankets and a heating pad. My hands and feet are always cold and numb, even when others around me are comfortable.”
What the examiner listens for:
Severity and pervasiveness of cold intolerance, whether it is year-round or seasonal, and how it limits daily function or occupation
Understatements to avoid:
Do not say 'I get cold sometimes' - explain how cold intolerance interferes with work, social activities, or daily routines in a concrete way.
Muscle Weakness and Musculoskeletal Symptoms
How to describe:
Describe specific muscle groups affected, difficulty with tasks requiring strength or stamina (climbing stairs, lifting, walking distances), and any muscle pain or cramping. For hypoparathyroidism, describe tetany, muscle spasms, and tingling.
Worst-day example:
“My legs feel so weak some days that I have to use the handrail to get up the stairs. I can't carry grocery bags from the car without stopping to rest. I have muscle cramps in my calves and hands that wake me from sleep 2-3 nights per week.”
What the examiner listens for:
Specific muscle groups affected, functional limitations, whether weakness is constant or episodic, and whether it is associated with lab abnormalities (low calcium, thyroid hormone levels)
Understatements to avoid:
Do not omit muscle cramps or tetany if you have hypoparathyroidism - these are ratable symptoms. Do not say 'I'm just out of shape' if weakness is disproportionate to your activity level.
Cardiovascular Symptoms (Palpitations, Tachycardia, Dyspnea)
How to describe:
For hyperthyroidism or Graves' disease, describe heart palpitations, racing heart, shortness of breath, chest discomfort, and any cardiac diagnoses (atrial fibrillation, thyroid heart disease). Specify frequency, duration, and triggers.
Worst-day example:
“My heart races even when I'm sitting still - it can hit 130 beats per minute at rest. I wake up at night with my heart pounding. I get winded walking to my mailbox. I was seen in the ER twice for palpitations in the past year.”
What the examiner listens for:
Heart rate at exam, reported frequency of palpitations or tachycardia, any cardiac diagnoses secondary to thyroid disease, and whether cardiovascular symptoms warrant a separate cardiac DBQ
Understatements to avoid:
Do not omit ER visits, hospitalizations, or cardiac diagnoses related to thyroid disease. Hyperthyroid heart disease (DC 7008) can be rated separately under cardiovascular codes.
Eye Symptoms (Graves' Ophthalmopathy / Exophthalmos)
How to describe:
Describe eye bulging (exophthalmos/proptosis), double vision (diplopia), blurred vision, dry eye, eye pain, or light sensitivity if present due to Graves' disease or thyroid eye disease. Note any treatments received for the eyes.
Worst-day example:
“My eyes protrude noticeably and strangers comment on it. I have double vision when looking to the left that prevents me from driving. My eyes are dry and painful every morning. I had a corneal ulcer treated last year.”
What the examiner listens for:
Presence of exophthalmos or proptosis, visual disturbances including diplopia or blurred vision, corneal involvement, and whether eye conditions warrant separate evaluation under 38 CFR 4.79 (e.g., DC 6090 for diplopia)
Understatements to avoid:
Do not fail to mention eye symptoms if you have Graves' disease - per 38 CFR 4.119 Note (3), eye involvement must be separately evaluated under the eye schedule and can add significant combined rating points.
Gastrointestinal Symptoms (Constipation, Nausea, Anorexia)
How to describe:
Describe bowel habits specifically: how many days between bowel movements, whether laxatives are required, severity of nausea, and any unintentional weight changes from anorexia or hyperthyroid-related weight loss.
Worst-day example:
“I go 5-7 days without a bowel movement even with daily stool softeners and laxatives. The bloating and abdominal cramping are constant. I have no appetite and have lost 18 pounds in the past 6 months without dieting.”
What the examiner listens for:
Whether GI symptoms are directly tied to the thyroid condition, frequency and severity of constipation, and whether weight changes reflect metabolic dysfunction
Understatements to avoid:
Do not omit constipation or anorexia - these are specifically listed in the 30% and 60% rating criteria for hypothyroidism. Do not minimize them as 'manageable.'
Skin and Hair Changes
How to describe:
Describe characteristic skin changes of hypothyroidism (dry, coarse, thickened, non-pitting edema - myxedema) or hyperthyroidism (warm, moist, fine hair, pretibial myxedema in Graves'). Describe surgical scars in detail if present.
Worst-day example:
“My skin is so dry and thick it cracks and bleeds. My hair has thinned dramatically - I lose handfuls when I shower and my hairline has receded significantly. The skin on my neck is thickened and tight from surgery and feels numb.”
What the examiner listens for:
Classic myxedematous skin changes supporting a 100% rating, scar characteristics (size in cm-, induration, disfigurement of face/neck), and whether skin symptoms warrant a separate dermatology DBQ
Understatements to avoid:
Do not overlook surgical scars - the DBQ specifically evaluates scar size, induration, inflexibility, tissue loss, and whether there is disfigurement of the head, face, or neck that may warrant separate rating.
Functional Impact on Work and Daily Life
How to describe:
Explain specifically how your thyroid condition limits your ability to work, maintain employment, perform household tasks, care for yourself or family, socialize, and sleep. Quantify limitations with specific examples and durations.
Worst-day example:
“I had to reduce my work schedule from full-time to part-time because I cannot concentrate for more than 2-3 hours before my cognitive function deteriorates. I cannot stand for long periods due to muscle weakness, eliminating jobs that require physical activity. I have missed an average of 2 days of work per month due to fatigue and GI symptoms.”
What the examiner listens for:
Occupational impairment, whether the veteran has lost jobs or reduced hours, the number of days per month symptoms are limiting, and specific activities of daily living that are affected
Understatements to avoid:
Do not say 'I manage' or 'I push through it' without explaining what that costs you. If you have quit a job, declined promotions, or needed workplace accommodations, state this explicitly.
Common Mistakes to Avoid
Reporting only how you feel on your best days
VA raters are instructed to consider the full picture of your disability, including worst-day severity. Reporting only typical or good days systematically understates your condition.
Instead: Per M21-1 guidance, describe your worst-day symptom presentation. Explain the frequency of bad days and what they prevent you from doing. Use phrases like 'on my worst days, which happen X times per week...'
Impact: All levels - can be the difference between 10% and 60% or 100%
Saying 'my medication controls it fine' without mentioning residual symptoms
A veteran on medication who says they are well-controlled may be rated at only 10% (continuous medication required). If you still have fatigue, cognitive issues, constipation, or other symptoms despite medication, these must be documented to achieve a higher rating.
Instead: Clearly state that while you take medication daily, you continue to experience [specific symptoms] at a frequency and severity that limits [specific functions]. Note any dose adjustments, medication failures, or periods of decompensation.
Impact: 10% vs. 30%, 60%, or 100%
Failing to mention eye symptoms in Graves' disease
38 CFR 4.119 Note (3) explicitly requires that eye involvement (exophthalmos, corneal ulcer, blurred vision, diplopia) be separately evaluated under the eye schedule (38 CFR 4.79). Missing this can cost significant rating points.
Instead: If you have any eye involvement from thyroid disease - even mild proptosis or occasional double vision - mention it explicitly. Ask the examiner to document it and ensure a separate ophthalmological evaluation is requested.
Impact: Any level - missed opportunity for additional rating under DC 6090 (diplopia) or DCs 6061-6066 (visual acuity)
Not documenting post-thyroidectomy hypoparathyroidism symptoms
Surgically induced hypoparathyroidism is a common complication of thyroid surgery that can cause significant disability through hypocalcemia, muscle cramps, tetany, and neurological symptoms. These may be rateable separately under DC 7906 or as a complication.
Instead: If you developed low calcium, muscle spasms, numbness, or tingling after thyroid surgery, report this as a surgical complication and ensure it is captured on the DBQ. Bring calcium and PTH lab results.
Impact: Separate ratable condition - may add significant combined disability percentage
Omitting cardiovascular symptoms in hyperthyroidism
Hyperthyroid heart disease (DC 7008) is evaluated under cardiovascular diagnostic codes and can be rated separately from the thyroid condition itself. Veterans often do not realize their heart palpitations, atrial fibrillation, or cardiac enlargement may be rated as a secondary condition.
Instead: Document all cardiac symptoms associated with hyperthyroidism. If you have been diagnosed with atrial fibrillation, tachycardia requiring treatment, or heart failure related to thyroid disease, ensure a cardiovascular DBQ is also requested.
Impact: Missed secondary cardiovascular rating - can result in significant additional combined disability
Not distinguishing between thyroiditis in a euthyroid state vs. thyroiditis causing hypothyroidism
Thyroiditis with normal thyroid function (DC 7906) is rated at 0%. However, if your thyroiditis has caused hypothyroidism, it should be rated under DC 7903 for hypothyroidism, which carries up to 100%. Failing to distinguish this can result in a 0% rating.
Instead: If you have thyroiditis (Hashimoto's, subacute, etc.) AND hypothyroidism, ensure both conditions are documented. The examiner should rate the thyroid function status (hypo or hyper) rather than stopping at the thyroiditis diagnosis.
Impact: 0% vs. 10%-100%
Minimizing scar symptoms after thyroid surgery
The DBQ includes detailed evaluation of surgical scars including size, induration, inflexibility, tissue loss, and disfigurement of the face/neck. A significant neck scar may be rateable separately under the scar diagnostic codes.
Instead: Describe your surgical scar in detail: its length and width, whether it is raised, thickened, tight, painful, or numb, and whether it is visible and causes social or emotional distress. The examiner will measure it - ensure you do not downplay physical characteristics.
Impact: Missed separate scar rating - particularly relevant if scar causes disfigurement of the head, face, or neck
Failing to report psychiatric or neurological symptoms
Both hypothyroidism and hyperthyroidism can cause significant mental health symptoms including depression, anxiety, cognitive impairment, and in severe cases psychosis (myxedema madness). These are ratable and may support a 100% hypothyroid rating if part of myxedema.
Instead: Report all mental and neurological symptoms including depression, anxiety, cognitive slowing, memory loss, irritability, and sleep disturbances. If these have been separately diagnosed and treated, ensure mental health claims are filed concurrently.
Impact: Supports 60%-100% ratings and potential separate psychiatric claim
Prep Checklist
Before Your Exam
Day Of
During the Exam
After the Exam
Your Rights During a C&P Exam
- You have the right to record your C&P examination in most states - notify the examiner before beginning and verify your state's recording laws in advance.
- You have the right to have a VSO, attorney, or claims agent accompany you to the examination as an observer (not a participant) - verify current VA policy, as this varies by facility.
- You have the right to request a copy of the completed DBQ through the VA's records process or FOIA request after the examination.
- You have the right to request a new or supplemental C&P examination if the original exam was inadequate, incomplete, or based on an inaccurate review of your records - submit a written request with specific reasons to the VA Regional Office.
- You have the right to submit additional evidence (buddy statements, private medical opinions, updated lab results) after the C&P exam but before the rating decision is issued.
- You have the right to a Fully Developed Claim (FDC) or Standard Claim review process - you are not required to use the FDC lane if you need more time to gather evidence.
- Under 38 CFR 4.119, Note (3), you have the right to separate evaluation of eye conditions caused by thyroid disease under the eye schedule (38 CFR 4.79) - if eye involvement was not separately addressed, you can request it be evaluated.
- You have the right to request that your examiner review your entire claims file before forming opinions - examiners are required to review the C-file; if they did not, this is grounds for challenging the adequacy of the exam.
- You have the right to appeal any rating decision through the Supplemental Claim lane, Board of Veterans' Appeals (BVA), or Court of Appeals for Veterans Claims (CAVC).
- You have the right to a private medical nexus opinion that can be submitted to supplement or rebut the C&P examiner's findings - private opinions from endocrinologists or treating physicians carry probative value.
Related Conditions
- Hyperthyroidism / Graves' Disease Rated under 38 CFR 4.119, DC 7900. Thyroiditis manifesting as hyperthyroidism is evaluated under DC 7900. Graves' disease may also cause eye involvement separately rated under 38 CFR 4.79.
- Thyroid Eye Disease (Graves' Ophthalmopathy) Per 38 CFR 4.119 Note (3), eye involvement from thyroid disease (exophthalmos, diplopia, corneal ulcer, blurred vision) must be separately evaluated under 38 CFR 4.79 Schedule of Ratings Eye, including DC 6090 (diplopia) and DCs 6061 6066 (central visual acuity impairment).
- Hyperthyroid Heart Disease Rated under 38 CFR 4.104, DC 7008. Heart disease caused by hyperthyroidism is rated under appropriate cardiovascular diagnostic codes depending on specific findings (arrhythmia, cardiomegaly, heart failure). This is a separate ratable condition from the thyroid condition itself.
- Hyperparathyroidism Rated under 38 CFR 4.119, evaluated on the same Thyroid and Parathyroid DBQ. Rating depends on presence and severity of hypercalcemia (bone density T score, total/ionized calcium, creatinine clearance) and whether surgery was required.
- Hypoparathyroidism Often develops as a surgical complication of thyroid surgery (iatrogenic). Rated under 38 CFR 4.119. Symptoms include hypocalcemia, muscle cramps, tetany, paresthesia, and neurological manifestations. Evaluated on the same DBQ.
- Thyroiditis (Hashimoto's / Subacute) Rated under 38 CFR 4.119, DC 7906. Euthyroid thyroiditis = 0%; if manifesting as hypothyroidism, evaluate under DC 7903; if manifesting as hyperthyroidism, evaluate under DC 7900. Autoimmune thyroiditis may be service connected if related to service exposures.
- Peripheral Neuropathy Secondary to Hypothyroidism Hypothyroidism can cause peripheral neuropathy including carpal tunnel syndrome, sensorimotor neuropathy, and abnormal deep tendon reflexes. These may be separately rateable under 38 CFR 4.124a as secondary conditions.
- Depression / Anxiety Secondary to Thyroid Conditions Both hypothyroidism and hyperthyroidism are associated with psychiatric manifestations including depression, anxiety, and cognitive impairment. If diagnosed and treated separately, these may be filed as secondary conditions under 38 CFR 3.310.
- Osteoporosis Secondary to Hyperparathyroidism or Hyperthyroidism Chronic hypercalcemia from hyperparathyroidism and elevated thyroid hormone in hyperthyroidism can cause significant bone density loss. Osteoporosis and resulting fractures may be filed as secondary conditions with appropriate medical nexus.
- Benign or Malignant Thyroid/Parathyroid Neoplasm Thyroid cancer and parathyroid tumors are rated on the same DBQ under specific diagnostic codes. Active malignancy is rated at 100% under 38 CFR 4.119. Post treatment residuals are rated based on remaining disability. Ensure biopsy results, surgical pathology, and oncology records are in the claims file.
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This C&P exam preparation guide is for educational purposes only and does not constitute legal, medical, or claims advice. Always consult with a qualified Veterans Service Organization (VSO) representative or VA-accredited attorney for guidance specific to your claim. Never exaggerate, minimize, or fabricate symptoms during a C&P examination.