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VA Rating Assistant

DC 7914 · 38 CFR 4.119

Endocrine Neoplasm, Malignant C&P Exam Prep

To document the current status of a malignant endocrine neoplasm, assess whether the cancer is active or in remission, identify all treatment history, quantify residual disabilities remaining after treatment cessation, and determine the appropriate disability rating under 38 CFR 4.119, DC 7914. The examiner must determine whether the veteran is currently undergoing treatment (warranting an automatic 100% rating), has completed treatment (triggering the mandatory 6-month review process), or is rating on residuals only.

Format:
Interview + Physical
Typical duration:
30-45 minutes
DBQ form:
Endocrine_Other_than_Thyroid_Parathyroid_and_Diabetes_Mellitus (Endocrine_Other_than_Thyroid_Parathyroid_and_Diabetes_Mellitus)
Examiner:
Endocrinologist or Physician

What the examiner evaluates

  • Type, location, and ICD code of the malignant endocrine neoplasm
  • Date of initial diagnosis and disease course/history
  • Current status: active malignancy, in remission, or progressive disease
  • All treatment history including surgery, radiation, chemotherapy, immunotherapy, and hormonal therapy
  • Treatment completion dates or anticipated completion dates
  • Evidence of local recurrence or distant metastasis
  • Residual symptoms and complications from the malignancy or its treatment
  • Associated endocrine dysfunction signs and symptoms (e.g., Cushing's features, adrenal insufficiency, hypertension, glucose intolerance, muscle wasting)
  • Need for ongoing hormonal replacement or corticosteroid therapy
  • Impact of the condition on occupational and daily functioning
  • Diagnostic test results including imaging (CT, MRI, PET) and laboratory values
  • Whether additional DBQs are required for symptoms in other body systems

The exam will typically occur at a VA medical center, a contracted QTC/LHI/OptumServe facility, or via VA Video Connect telehealth. If conducted via telehealth or records review, the examiner must document how the examination was conducted. Bring all relevant oncology records, pathology reports, operative reports, imaging reports, and current medication lists. The examiner will review your claims file (C-file) prior to or during the exam.

Measurements and tests

Blood Pressure Measurement (x3 readings)

What it measures: Hypertension as a manifestation or residual of endocrine neoplasm (particularly pheochromocytoma, hyperaldosteronism-associated tumors, or Cushing's-related tumors). The DBQ specifically requires three BP readings if hypertension is checked.

What to expect: The examiner or technician will take your blood pressure three separate times, typically with brief intervals between readings. Results will be documented on the DBQ form.

Critical thresholds

  • Systolic -160 mmHg or Diastolic -100 mmHg May support a higher rating for hypertension as a secondary or associated condition, potentially warranting a separate DC 7101 rating for hypertension.
  • Systolic -140 mmHg or Diastolic -90 mmHg Meets the threshold for hypertension diagnosis, which is a documented manifestation of several endocrine neoplasms and their residuals.

Tips

  • Do not take blood pressure medications earlier than usual on exam day unless medically necessary - take them at your normal time to ensure readings reflect your actual controlled or uncontrolled status.
  • Inform the examiner of any antihypertensive medications you take and their dosages.
  • If your blood pressure fluctuates significantly, describe this to the examiner and bring any home monitoring logs.
  • Inform the examiner if you have had hypertensive crises (e.g., episodes associated with pheochromocytoma) in the past.

Pain considerations: Anxiety during the exam can transiently elevate BP readings; inform the examiner if you experience 'white coat hypertension' and whether your home readings differ significantly.

Proximal Muscle Strength Assessment (Upper and Lower Extremities)

What it measures: Proximal muscle wasting and weakness causing inability to rise from a squatting position, climb stairs, or raise arms - a key feature of Cushing's syndrome and related endocrine tumors producing excess cortisol. DBQ fields specifically assess proximal upper and lower extremity muscle wasting.

What to expect: The examiner may ask you to rise from a seated or squatting position without using your arms, walk up stairs, or raise your arms above your head. They will observe for signs of proximal muscle wasting. They may also assess grip strength and general muscle bulk.

Critical thresholds

  • Inability to rise from squatting position without assistance Directly corresponds to a DBQ checkbox for proximal lower extremity muscle wasting causing inability to rise from squatting - supports higher functional impairment documentation.
  • Inability to raise arms above shoulder level Corresponds to proximal upper extremity muscle wasting checkbox - supports documentation of significant functional limitation.

Tips

  • If you have difficulty rising from chairs or climbing stairs, demonstrate this honestly during the exam - do not push through pain or weakness to appear more capable.
  • Describe when this weakness started relative to your diagnosis and treatment.
  • Note whether weakness is constant or fluctuates with activity levels.
  • Bring documentation from physical therapy or treating physician describing functional limitations.

Pain considerations: Describe any pain, fatigue, or cramping that accompanies the weakness. Distinguish between true muscle weakness and pain-limited movement, as both are clinically relevant.

Physical Examination for Cushingoid Features

What it measures: Physical signs of hypercortisolism associated with adrenal or pituitary endocrine neoplasms, including central obesity, moon face, buffalo hump, abdominal striae, and skin changes. These are specifically listed as checkboxes on the DBQ.

What to expect: The examiner will visually inspect your appearance for moon face (facial rounding/plethora), truncal obesity, skin striae (purple stretch marks, particularly on the abdomen, thighs, and flanks), skin thinning, bruising, and vascular fragility. They may inspect your back for a dorsocervical fat pad (buffalo hump).

Critical thresholds

  • Presence of multiple Cushingoid features simultaneously Supports diagnosis of ongoing cortisol excess or residual dysfunction from a cortisol-secreting endocrine neoplasm, which may warrant rating on associated endocrine dysfunction.
  • Purple striae greater than 1 cm wide Clinically significant finding supporting active or recent Cushing's syndrome as a feature of the malignant endocrine neoplasm.

Tips

  • Wear loose-fitting clothing that allows the examiner to assess your abdomen, back, and upper extremities without excessive discomfort.
  • Point out any striae, bruising, or skin thinning even if the examiner does not ask - these are rated features.
  • If your Cushingoid features have resolved after treatment, still describe what they were like at their worst and when they resolved.
  • Bring photos from periods of active disease if available to document historical physical findings.

Pain considerations: Note any skin pain, tenderness, or easy bruising that affects your daily activities or self-care.

Laboratory and Diagnostic Test Review

What it measures: Tumor markers, hormone levels, metabolic panels, and imaging studies that confirm diagnosis, stage, response to treatment, and current disease status. The DBQ includes sections for MRI, CT, and laboratory results.

What to expect: The examiner will review existing lab results and imaging in your medical records. They may order or note recent laboratory values including cortisol, ACTH, catecholamines/metanephrines (for pheochromocytoma), aldosterone/renin ratio, IGF-1 (for acromegaly), calcium (for parathyroid tumors), glucose tolerance tests, and relevant tumor markers. Imaging results (CT, MRI, PET scan) will be documented.

Critical thresholds

  • Evidence of residual tumor on imaging or elevated tumor markers post-treatment Supports active or progressive disease classification - maintains 100% rating and may indicate need for continued treatment.
  • Fasting glucose -126 mg/dL or 2-hour glucose -200 mg/dL Glucose intolerance/diabetes is a documented DBQ feature of endocrine neoplasms (particularly Cushing's) and supports additional residual impairment.
  • Post-treatment hormone deficiency (e.g., hypocortisolism, hypothyroidism, hypogonadism) Supports requirement for continuous hormonal replacement therapy, which is a specific DBQ checkbox and influences residual disability rating.

Tips

  • Bring printed copies of all recent lab results and imaging reports from the past 12 months.
  • Organize records chronologically, showing pre-treatment, during-treatment, and post-treatment values.
  • Ensure your oncologist or endocrinologist has provided a recent note documenting current disease status (active, remission, surveillance).
  • If you have not had recent labs, request them from your treating provider before the exam so the examiner has current data.

Pain considerations: Not applicable for laboratory review, but note any symptoms that prompted additional testing (e.g., fatigue prompting cortisol testing).

Rating criteria by percentage

100%

Active malignant neoplasm of any specified part of the endocrine system, OR any period during which the veteran is undergoing surgical treatment, X-ray therapy, antineoplastic chemotherapy, immunotherapy, hormonal antineoplastic therapy, or other therapeutic procedures for the malignancy. Under 38 CFR 4.119 DC 7914, the 100% rating continues for a minimum of six months BEYOND the cessation of ALL active treatment. A mandatory VA examination is required at the six-month post-treatment mark to determine the appropriate residual rating.

Key symptoms

  • Active or progressive malignant endocrine neoplasm
  • Currently undergoing surgery, radiation, chemotherapy, immunotherapy, or other antineoplastic therapy
  • Evidence of local recurrence after prior treatment
  • Distant metastasis to other body systems
  • Within 6 months of treatment cessation (automatic continuation of 100%)

From 38 CFR: 38 CFR 4.119, DC 7914: 'A rating of 100 percent shall continue beyond the cessation of any surgical, X-ray, antineoplastic chemotherapy or other therapeutic procedure. Six months after discontinuance of such treatment, the appropriate disability rating shall be determined by mandatory VA examination.'

0%

When six months have passed since the cessation of all antineoplastic treatment AND there is no evidence of local recurrence or metastasis, the veteran is rated on residuals of the malignant endocrine neoplasm under the applicable endocrine dysfunction diagnostic code. A 0% rating under DC 7914 is possible if the cancer is in complete remission with no measurable residual endocrine dysfunction, but the veteran retains a compensable rating history that may be protected under 38 CFR 3.105(e). Any residual endocrine dysfunction (e.g., adrenal insufficiency, hypogonadism, hypopituitarism, diabetes insipidus, hypothyroidism) is rated separately under the corresponding diagnostic code.

Key symptoms

  • Complete remission - no evidence of recurrence or metastasis
  • All active treatment completed more than 6 months ago
  • Minimal or no residual endocrine dysfunction
  • No requirement for continuous hormonal replacement therapy
  • No ongoing functional limitations attributable to the malignancy or its treatment

From 38 CFR: 38 CFR 4.119, DC 7914 Note: 'If there has been no local recurrence or metastasis, rate on residuals.' Residuals are rated under the applicable endocrine dysfunction diagnostic code (e.g., DC 7911 for Addison's disease/adrenocortical insufficiency, DC 7900 for hyperthyroidism, DC 7904 for hypoparathyroidism, DC 7916 for hypopituitarism).

Describing your symptoms accurately

Active Malignancy and Treatment Status

How to describe it: Clearly state whether your cancer is currently active, in treatment, or in remission. Be specific about every treatment modality you have received or are currently receiving: surgery (dates, type, what was removed), radiation (dates, fields treated, total dose if known), chemotherapy (drugs, cycles, dates), immunotherapy, and hormonal antineoplastic therapy. State the date your most recent treatment was completed or, if ongoing, describe your current treatment schedule.

Example: I am currently receiving chemotherapy - my last infusion was [date] and my next is scheduled for [date]. The cancer has spread to my [location], which was confirmed on my CT scan dated [date]. Even on days I feel slightly better, the treatment side effects completely prevent me from working or performing normal daily activities.

Examiner listens for: The examiner needs to confirm active treatment status to document the 100% rating, or confirm that treatment has been completed and document the exact completion date to start the mandatory 6-month clock. They are listening for any indication of recurrence, metastasis, or new lesions.

Avoid: Do not say 'I finished treatment a while ago' - give the exact date. Do not minimize ongoing treatment by saying 'just maintenance therapy' - all antineoplastic treatment counts toward continuation of the 100% rating. Do not fail to mention adjuvant or maintenance therapies that may still be ongoing.

Fatigue and Energy Limitations

How to describe it: Describe your fatigue as it impacts daily function on your worst days. Distinguish between cancer-related fatigue (which is different from normal tiredness and does not resolve with rest), treatment-induced fatigue, and fatigue from hormonal deficiencies resulting from the cancer or its treatment. Quantify: how many hours per day can you be active before exhaustion? Do you require daytime rest or naps? Has fatigue caused you to reduce or stop working?

Example: On my worst days, which happen at least three or four times per week, I can barely get out of bed. After my morning routine - showering and getting dressed - I am completely exhausted and need to lie down for two hours. I cannot do any household tasks, drive, or engage in any social or occupational activities. This level of fatigue has persisted since I started [treatment type] in [month/year].

Examiner listens for: The examiner is documenting fatigue as a residual symptom under the functional impact section of the DBQ. They need specific examples of how fatigue limits occupational and daily activities - not just a statement that you feel tired.

Avoid: Do not say 'I get tired sometimes.' Describe the severity and frequency accurately. Do not conflate good days with your typical or worst days. The VA rates based on the condition as it actually exists across the range of your experience, not only your best days.

Hormonal Deficiency and Replacement Therapy

How to describe it: Describe any endocrine hormones that are now deficient as a result of the malignancy or its treatment (e.g., cortisol after adrenalectomy, thyroid hormone after thyroidectomy, sex hormones after gonadal surgery, growth hormone or other pituitary hormones after pituitary tumor treatment). State whether you require continuous hormonal replacement therapy, the medications and doses, and whether your hormone levels are well-controlled or difficult to regulate. Describe symptoms you experience when hormone levels are inadequate.

Example: Since my adrenal glands were removed as part of my cancer treatment, I require hydrocortisone replacement every day for the rest of my life. If I miss a dose or become ill or stressed, I can develop adrenal crisis - I have been hospitalized [number] times for adrenal crisis since my surgery in [year]. During a crisis I experience severe vomiting, dangerously low blood pressure, confusion, and extreme weakness. I wear a medical alert bracelet and carry an emergency hydrocortisone injection kit at all times.

Examiner listens for: The examiner is specifically checking the 'requires continuous hormonal therapy' and 'corticosteroid therapy required for control' boxes on the DBQ. They need to know whether deficiency is well-controlled or causes recurring crises, as this significantly affects residual ratings.

Avoid: Do not say 'I take my hormone pills and feel fine' without also describing what happens when levels are off or when you are stressed/ill, if applicable. Do not omit emergency doses or stress dosing requirements. Do not understate the burden of lifelong hormone monitoring and replacement.

Adrenal/Addisonian Episodes and Crisis Events

How to describe it: If you have a history of adrenal insufficiency or have experienced Addisonian episodes (acute adrenal insufficiency/crisis), document each episode with approximate date, precipitating cause, symptoms experienced, and what treatment was required (emergency room visit, IV hydrocortisone, hospitalization). Distinguish between Addisonian episodes (less severe, managed outpatient) and full adrenal crisis (severe, requiring emergency intervention).

Example: I have had [number] Addisonian crises requiring emergency room treatment in the past 12 months. Each crisis starts with severe nausea, vomiting, and abdominal pain, progresses to extreme weakness where I cannot stand, and my blood pressure drops so low I nearly lose consciousness. The last crisis required a 3-day hospital admission and IV hydrocortisone. These episodes occur any time I have an illness, undergo stress, or if I accidentally miss a dose.

Examiner listens for: The DBQ has specific checkboxes for Addisonian crisis and Addisonian episodes, as well as fields for episode frequency. The examiner is quantifying crisis frequency to support residual rating under the adrenal insufficiency diagnostic code.

Avoid: Do not fail to report all emergency room visits or hospitalizations for adrenal-related episodes. Do not describe crises as 'not that bad' to appear stoic. Accurately document the number and severity of episodes over the past 12 months.

Psychological and Cognitive Impact

How to describe it: Describe any anxiety, depression, cognitive difficulties (chemotherapy-related cognitive impairment, sometimes called 'chemo brain'), or psychological distress directly attributable to your cancer diagnosis, treatment, or residual effects. Note whether you have received mental health treatment and whether a separate mental health DBQ has been requested. The endocrine DBQ specifically flags mental and psychological symptoms for referral to an appropriate psychiatric DBQ.

Example: Since my cancer diagnosis, I have experienced severe anxiety about recurrence that prevents me from sleeping more than 3-4 hours per night. I have difficulty concentrating on tasks that used to be easy for me - I forget words mid-sentence, lose track of conversations, and cannot manage tasks that require sustained attention. My oncologist has referred me to a psychiatrist, and I am currently being treated for major depression with antidepressant medication.

Examiner listens for: The examiner needs to flag mental/psychological symptoms so that a separate mental health DBQ can be completed, which could support an additional service-connected psychiatric condition secondary to the endocrine cancer.

Avoid: Do not minimize psychological symptoms by saying 'I am handling it okay.' If you are struggling emotionally or cognitively, say so clearly. These symptoms may support a separate secondary mental health condition that can be rated independently.

Functional and Occupational Impact

How to describe it: Clearly describe how your endocrine malignancy and its treatment have affected your ability to work, perform household activities, care for yourself, and participate in social or recreational activities. Use specific examples: how many days per week are you unable to work? Have you been forced to reduce hours, change jobs, or stop working entirely? Can you perform activities of daily living independently? How has the condition changed your life compared to before diagnosis?

Example: I have not been able to return to work since my diagnosis in [year]. Before my cancer, I worked full-time as a [occupation]. Now, on my worst days - which occur approximately [X] days per week - I cannot drive, prepare meals, or manage personal hygiene without assistance. I rely on my spouse to help me with bathing, dressing, and transportation to medical appointments. I have had to give up [specific activities/hobbies] entirely.

Examiner listens for: The DBQ Section 11 (RG_11_Impact) specifically asks about the impact of the endocrine condition on occupational and daily functioning. The examiner uses this information to complete the functional impairment section, which directly influences the overall rating and potential eligibility for Total Disability based on Individual Unemployability (TDIU).

Avoid: Do not say 'I manage' or 'I get by' without elaborating on what that actually requires. Do not describe your best days as your typical days. Accurately represent the full range of your functional limitations, including on your worst days.

Metastasis and Recurrence History

How to describe it: If your endocrine cancer has spread to other parts of the body (metastasized) or has recurred after initial treatment, clearly describe the sites of metastasis, when recurrence was detected, and what additional treatment was initiated. Identify which body systems have been affected, as metastases to other systems may warrant separate ratings for those systems. Provide dates of imaging studies that confirmed metastatic spread.

Example: My endocrine cancer originally diagnosed in [year] was found to have spread to my [liver/bone/lung/lymph nodes] on a PET scan dated [date]. Since then I have required additional chemotherapy and two additional surgeries. The bone metastases cause me constant pain rated [X]/10 even with pain medication, and I can no longer bear weight on my [leg/hip] without assistive devices.

Examiner listens for: The DBQ has a specific field for secondary/metastatic status and asks the examiner to identify the primary site. The examiner needs this information to properly code the condition and determine whether separate ratings for other affected body systems are warranted.

Avoid: Do not omit any sites of metastatic disease. Do not minimize symptoms caused by metastatic lesions in other body systems. Each metastatic site and its functional impact should be clearly communicated.

Common mistakes to avoid

Not knowing the exact date treatment was completed

Why: The 100% rating under DC 7914 continues for exactly 6 months after treatment cessation, at which point a mandatory re-examination occurs. If the veteran cannot provide an accurate treatment end date, the examiner may record an imprecise date that could affect the timing of rating reductions.

Do this instead: Before your exam, confirm the exact date of your last treatment session (last chemotherapy infusion, last radiation treatment, discharge date after surgery) with your oncology team. Write this date down and bring documentation confirming it.

Impact: 100%

Failing to mention all forms of antineoplastic treatment, especially hormonal or targeted therapies

Why: Veterans sometimes mention surgery and chemotherapy but forget to report ongoing hormonal therapy (e.g., somatostatin analogs for carcinoid tumors, mitotane for adrenocortical carcinoma) or targeted molecular therapies. Under DC 7914, ANY antineoplastic therapeutic procedure - including these - continues the 100% rating.

Do this instead: Make a complete list of every treatment received: surgical procedures, all rounds of chemotherapy, radiation therapy, immunotherapy, hormonal antineoplastic therapy, and targeted therapies. Include drug names, start and end dates, and whether any are still ongoing.

Impact: 100%

Not documenting residual endocrine dysfunction after cancer treatment

Why: When a veteran transitions from the 100% active cancer rating to a residual rating, the VA rates on whatever endocrine dysfunction remains. Veterans who do not clearly document and communicate ongoing hormone deficiencies, need for replacement therapy, or functional limitations from treatment may receive a lower residual rating than they deserve.

Do this instead: Have your treating endocrinologist document all hormone deficiencies, replacement therapies, and functional limitations in a recent clinical note before your exam. Bring this documentation. Clearly describe each residual symptom separately during the exam.

Impact: Post-treatment residual rating

Describing only current symptoms without contextualizing severity across the full range of experience

Why: Veterans often describe how they feel on the day of the exam, which may not represent their typical or worst-day functioning. The VA rates based on the average and worst manifestations of the condition, not a single best-day snapshot.

Do this instead: Prepare specific examples of your worst days before the exam. Describe symptom frequency (e.g., 'I have severe fatigue preventing any activity 4-5 days per week'), not just severity. Keep a symptom diary for 2-4 weeks before the exam to have accurate data to report.

Impact: All residual rating levels

Not reporting symptoms in other body systems that may require separate DBQs

Why: Malignant endocrine neoplasms frequently affect multiple body systems (cardiovascular, musculoskeletal, neurological, renal, gastrointestinal, dermatological, reproductive, ophthalmological). The endocrine DBQ has specific checkboxes to flag these for separate DBQ completion. Veterans who do not report these symptoms miss out on additional separate ratings.

Do this instead: Before the exam, review all symptoms you experience across every body system and report them to the examiner. Specifically mention cardiovascular symptoms, musculoskeletal limitations, neurological symptoms, skin changes, genitourinary symptoms, gastrointestinal symptoms, respiratory symptoms, eye involvement, and mental health symptoms so the examiner can flag appropriate additional DBQs.

Impact: Secondary condition ratings

Failing to report adrenal crisis history or minimizing episode severity

Why: The DBQ has specific fields for Addisonian crisis and episodes, which directly influence the residual adrenal insufficiency rating. Veterans who do not report or underreport crisis frequency may receive a lower rating than the true severity warrants.

Do this instead: Before the exam, review your medical records and count the number of adrenal/endocrine crises, emergency room visits, and hospitalizations in the past 12 months. Report each one accurately with approximate dates and treatment required.

Impact: Adrenal insufficiency residual rating

Assuming remission means the claim is over or no longer ratable

Why: Veterans in remission still have important rights under DC 7914. Any change in rating is subject to 38 CFR 3.105(e) protections. Residual endocrine dysfunction (hormone deficiencies, functional limitations) is ratable even in the absence of active cancer, and recurrence immediately restores the 100% rating.

Do this instead: Understand that 'in remission' does not mean your disability is gone. File for and document all residual conditions. Monitor for recurrence and report any suspected recurrence to VA promptly, as this immediately triggers re-entitlement to 100%.

Impact: Post-treatment residual and recurrence ratings

Prep checklist

  • critical

    Gather complete oncology treatment records

    Obtain records including: pathology report confirming malignant diagnosis (with tumor type, grade, stage), operative reports for any surgeries, radiation oncology records (fields, total dose, treatment dates), chemotherapy infusion records (drugs, cycle dates, last treatment date), immunotherapy or targeted therapy records, and most recent oncologist/endocrinologist follow-up notes documenting current disease status.

    before exam

  • critical

    Confirm and document exact treatment end date

    Contact your oncology team to confirm the precise date your last active antineoplastic treatment was administered. For surgery, this is the operative date. For chemotherapy/radiation, the last session date. For ongoing maintenance or hormonal antineoplastic therapy, confirm this is still active. This date triggers the mandatory 6-month post-treatment examination and affects your 100% rating continuation.

    before exam

  • critical

    Obtain recent imaging reports

    Bring reports from your most recent CT scan, MRI, PET scan, or bone scan. These should document current disease status - active disease, remission, or evidence of recurrence or metastasis. Ensure reports are within the past 6-12 months if possible. Annotate key findings you want the examiner to see.

    before exam

  • critical

    Compile recent laboratory results

    Gather recent lab results relevant to your specific tumor type: hormone levels (cortisol, ACTH, IGF-1, aldosterone, catecholamines, thyroid panel, sex hormones), tumor markers, metabolic panel (glucose, electrolytes), and CBC. Organize chronologically to show pre-treatment, during-treatment, and post-treatment values. Bring reference ranges with results.

    before exam

  • critical

    Create a complete medication list

    List all medications with drug names, doses, and frequencies, especially: hormonal replacement therapies (hydrocortisone, fludrocortisone, levothyroxine, testosterone, estrogen, growth hormone), antineoplastic agents still being taken, medications for treatment side effects (antiemetics, pain medications, antihypertensives), and any emergency medications (injectable hydrocortisone, glucagon). This list helps the examiner identify ongoing treatment and residual needs.

    before exam

  • critical

    Prepare a written symptom summary

    Write a 1-2 page summary documenting: your diagnosis history, each treatment modality with dates, current symptoms (worst day description for each), functional limitations affecting work and daily activities, frequency of crisis events or hospitalizations, and how the condition has changed your life. Keep a symptom diary for 2-4 weeks before the exam recording daily symptom severity, fatigue levels, activity limitations, and any crisis events.

    before exam

  • recommended

    Review your VA claims file for accuracy

    Request access to your VA claims file (C-file) through eBenefits, VA.gov, or by submitting a Privacy Act request. Review it for completeness and accuracy. Ensure all medical records have been submitted. If key records are missing, submit them via VA Form 21-4142/21-4142a (Authorization to Release Information) before the exam.

    before exam

  • recommended

    Obtain a nexus letter or treating physician statement if needed

    If your endocrine malignancy is not yet service-connected, consider requesting a letter from your treating oncologist or endocrinologist that addresses the nexus (connection) between your military service and your cancer diagnosis. This is particularly important for claims involving radiation exposure, chemical exposure (Agent Orange, Camp Lejeune water), or other service-related carcinogens. The letter should state a medical opinion about the relationship between service and the malignancy.

    before exam

  • recommended

    Document crisis events with supporting records

    If you have had adrenal crises, thyroid storm, pheochromocytoma crisis, carcinoid crisis, or other endocrine emergencies, collect emergency room records, hospitalization records, and discharge summaries for each event. Count and list dates of all such events in the past 12 months to report accurately to the examiner.

    before exam

  • optional

    Check your state's exam recording laws

    Determine whether your state allows single-party or requires all-party consent for recording. If recording is legally permissible in your state, you have the right to record your C&P examination. Prepare a simple recording device (smartphone) if you wish to exercise this right. Inform the examiner at the start of the appointment that you intend to record the exam.

    before exam

  • critical

    Dress and prepare to accurately represent your condition

    Dress comfortably but in a way that allows the examiner to assess physical findings (e.g., loose-fitting clothing for abdominal/skin examination). Do not dress or groom in a way that minimizes visible symptoms (striae, bruising, moon face, muscle wasting). Take your medications at their normal time to reflect your actual managed condition. If you use mobility aids, bring them. If a family member helps care for you, consider having them attend (if VA policy permits) as a third-party observer.

    day of

  • critical

    Arrive early and bring all documentation

    Arrive 15-20 minutes early. Bring two copies of all medical records, lab results, imaging reports, medication list, symptom summary, and any DBQs completed by your own treating physicians. Keep one copy for yourself and offer one to the examiner. Bring a government-issued ID and your VA identification card.

    day of

  • critical

    Report your symptoms as they exist on your worst days

    Per M21-1 guidance, describe your symptoms as they are on your worst days, not your best days. If today is a better day than usual, say so explicitly: 'Today is actually a better day for me than most. On my worst days, which happen about [X] times per week, I experience...' This ensures the examiner documents the full range of your disability.

    day of

  • critical

    Correct any factual errors immediately

    If the examiner states something inaccurate about your history (wrong dates, missed diagnoses, incorrect treatment descriptions), politely correct it immediately and provide the accurate information with documentation. Do not assume errors will be corrected later - the DBQ is completed during or immediately after the exam.

    during exam

  • critical

    Ensure the examiner documents all body systems affected

    When discussing your symptoms, systematically cover every body system: fatigue, musculoskeletal (muscle weakness, joint pain, osteoporosis), cardiovascular (hypertension, palpitations), neurological (headaches, cognitive changes, peripheral neuropathy), gastrointestinal (nausea, vomiting, diarrhea), genitourinary (polyuria, sexual dysfunction), dermatological (skin changes, striae, bruising, wound healing), ophthalmological (visual changes), respiratory (shortness of breath), and mental health (anxiety, depression, cognitive impairment). Ask the examiner to note each symptom and whether additional DBQs are needed.

    during exam

  • recommended

    Confirm the examiner has reviewed your claims file

    Ask the examiner at the start of the appointment whether they have reviewed your VA claims file and the records you brought. If they have not reviewed key records, bring them to their attention explicitly rather than assuming they were read. Point out the most critical documents: pathology report, treatment records, and most recent oncology notes.

    during exam

  • recommended

    Ask for clarification if questions seem unclear

    If the examiner asks a question that seems confusing or you are unsure whether your answer covers what they are asking, request clarification. It is appropriate to ask: 'Are you asking about my worst days or how I am feeling today?' or 'Should I describe all my symptoms or just the ones related to [specific area]?'

    during exam

  • critical

    Document your recollection of the exam immediately afterward

    Immediately after the exam (in the waiting room or your car), write down or voice-record everything you remember: what questions were asked, what the examiner said, what physical tests were performed, what you reported, and any concerns you have about whether important symptoms were adequately documented. This record is essential if you need to submit a supplemental statement or appeal a rating decision.

    after exam

  • recommended

    Request a copy of the completed DBQ

    You have the right to obtain a copy of the completed DBQ through your VA claims file (accessible via VA.gov or a FOIA request). Review it for accuracy when it becomes available. If you find errors or omissions, you can submit a written statement (VA Form 21-4138) correcting the record or submit a personal statement addressing the deficiencies as evidence.

    after exam

  • critical

    Monitor for the mandatory 6-month post-treatment examination notice

    Under DC 7914, the VA is required to schedule a mandatory examination 6 months after your treatment ends to determine the appropriate residual rating. Watch for this exam notice - failure to attend without good cause can result in a reduction. When notified, prepare fresh documentation of all current residual symptoms and functional limitations.

    after exam

  • recommended

    File for secondary conditions if applicable

    If the exam revealed symptoms in other body systems (cardiovascular, neurological, musculoskeletal, psychological, genitourinary, dermatological) that were not previously claimed, consider filing secondary service connection claims for those conditions. Contact a VSO (Veterans Service Officer), VA-accredited claims agent, or VA-accredited attorney for assistance.

    after exam

Your rights during a C&P exam

  • You have the right to record your C&P examination in states that permit single-party or all-party consent recording. Verify your state's laws before the exam and notify the examiner at the start of the appointment if you intend to record.
  • You have the right to have your claims file (C-file) reviewed by the examiner before or during the examination. If the examiner has not reviewed your file, you may note this concern in a written statement after the exam.
  • You have the right to submit additional medical evidence, including a private medical opinion or nexus letter from your treating physician, at any time before a rating decision is made.
  • Under 38 CFR 3.105(e), any reduction in a disability evaluation that has been in effect for five years or more is subject to special protections - the rating cannot be reduced unless the evidence shows material improvement under the ordinary conditions of life. A rating in effect for 20 years or more cannot be reduced below the original rating level.
  • You have the right to a mandatory VA examination 6 months after the cessation of antineoplastic treatment under DC 7914. If the VA fails to schedule this exam, you may contact your Regional Office or VSO to request it.
  • You have the right to request that a personal statement (VA Form 21-4138) be associated with your claims file to describe your symptoms, functional limitations, and any concerns about the accuracy of the DBQ in your own words.
  • You have the right to bring a VSO representative, accredited claims agent, or VA-accredited attorney to your C&P examination as an observer, subject to the examining facility's space and policy constraints.
  • You have the right to have a family member or caregiver provide a buddy statement (VA Form 21-10210) documenting their observations of your symptoms and functional limitations as corroborating evidence.
  • You have the right to appeal a rating decision you disagree with through the Supplemental Claim, Higher-Level Review, or Board of Veterans' Appeals lanes under the Appeals Modernization Act (AMA).
  • If your endocrine malignancy is associated with service in the Republic of Vietnam (Agent Orange exposure), testing at Camp Lejeune, Radiation Risk Activity, or other presumptive service connections, you have the right to a presumptive service connection determination without needing to prove a direct causal link.

Related conditions

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This guide covers what to expect for any veteran with this condition. If you have already uploaded your medical records, sign in to generate a packet that maps your specific symptoms to the DBQ fields your examiner will fill out.

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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.