DC 7917 · 38 CFR 4.119
Hyperaldosteronism C&P Exam Prep
To evaluate the current severity of hyperaldosteronism (benign or malignant adrenal tumor/hyperplasia causing excess aldosterone production) for VA disability rating purposes under 38 CFR - 4.119, DC 7917. Because DC 7917 directs evaluation as a benign or malignant neoplasm, the examiner will assess both the underlying adrenal pathology and all resulting endocrine dysfunction, complications, and secondary conditions.
- 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
- Confirmation of hyperaldosteronism diagnosis (primary vs. secondary; unilateral adenoma vs. bilateral hyperplasia)
- Current disease status: active, in remission, or post-surgical resolution
- Presence and severity of hypertension directly attributable to excess aldosterone
- Degree of hypokalemia and associated neuromuscular symptoms (weakness, cramps, paralysis)
- Cardiovascular complications (left ventricular hypertrophy, arrhythmias, hypertensive heart disease)
- Renal complications (hypokalemic nephropathy, proteinuria, reduced GFR)
- Metabolic abnormalities including glucose intolerance
- Treatment history: adrenalectomy (surgical), mineralocorticoid antagonist therapy (spironolactone, eplerenone), or other medical management
- Residual symptoms and complications following surgical treatment or ongoing medical management
- Functional impact on occupational and daily activities
- Any associated endocrine neoplasms (MEN syndromes, concurrent benign or malignant growths)
Exam may occur in-person at a VA facility or contracted clinic, or via telehealth. If conducted remotely, ensure you can clearly describe all physical symptoms verbally. The examiner will review your entire claims file (eFolder) prior to or during the examination. Blood pressure will typically be measured three times. Bring a complete list of current medications, recent lab results, and any private provider records related to your adrenal condition.
Measurements and tests
Blood Pressure Measurement (x3)
What it measures: Resting systolic and diastolic blood pressure to document hypertension severity, a cardinal manifestation of hyperaldosteronism that directly affects rating under related cardiovascular diagnostic codes
What to expect: The examiner will take three separate blood pressure readings, typically seated after a 5-minute rest period. Results are averaged and documented on the DBQ. Your readings on the day of the exam must be recorded; note that single-day readings may not reflect your typical blood pressure, especially if medications have been recently adjusted.
Critical thresholds
- Systolic -160 or Diastolic -100 mm Hg Supports documentation of poorly controlled hypertension potentially warranting separate evaluation under DC 7101 (hypertension) at higher rating levels
- Systolic -200 or Diastolic -120 mm Hg Severe hypertension; may support 60% rating under DC 7101 with additional end-organ damage
- BP controlled on multiple medications but history of uncontrolled values Still supports hypertension rating; document that control requires two or more antihypertensive agents
Tips
- Do NOT manipulate your blood pressure readings - report your true, medically documented values
- Bring a log of home blood pressure readings over the past 30-90 days to show your typical range
- Inform the examiner if you recently adjusted medications or if today's reading is atypically low or high
- Note how many antihypertensive medications you currently take - the number required for control is rating-relevant
- If your BP is well-controlled on medications, still document the history of uncontrolled readings before treatment
Pain considerations: Severe headaches associated with hypertensive episodes should be described in detail, including frequency, severity (0-10 scale), and functional impact.
Serum Potassium / Hypokalemia Assessment
What it measures: Blood potassium level to document the severity of aldosterone-driven potassium wasting, which underlies muscular weakness, cramps, fatigue, cardiac arrhythmias, and polyuria in hyperaldosteronism
What to expect: The examiner may review existing lab results from your eFolder rather than ordering new labs at the exam itself. If recent labs are unavailable, blood may be drawn. Potassium levels below 3.5 mEq/L are clinically significant; levels below 3.0 mEq/L are severely low and associated with pronounced neuromuscular symptoms.
Critical thresholds
- Potassium < 3.5 mEq/L Hypokalemia documented; supports symptoms of weakness, fatigue, muscle cramps, and cardiac symptoms
- Potassium < 3.0 mEq/L Severe hypokalemia; supports profound weakness, paralytic episodes, and cardiac arrhythmia documentation
- Potassium requiring oral/IV supplementation Documents severity of aldosterone excess and ongoing medical treatment burden
Tips
- Bring copies of all recent metabolic panel results showing potassium levels
- Note whether you require potassium supplementation and at what dose
- Document episodes of muscle weakness or cramps that correlated with low potassium readings
- If your potassium is now normalized on spironolactone/eplerenone, explain prior levels before treatment
Pain considerations: Hypokalemia-related muscle cramping and weakness can be severely painful and disabling; describe the frequency, duration, and functional impact of these episodes accurately.
Aldosterone-to-Renin Ratio (ARR) and Confirmatory Testing Review
What it measures: Biochemical confirmation of primary aldosteronism; elevated aldosterone with suppressed renin confirms autonomous aldosterone production from adrenal source
What to expect: The examiner will review existing diagnostic labs in your file rather than performing new biochemical testing. Ensure your eFolder contains your diagnostic workup including ARR, saline infusion test or fludrocortisone suppression test results, adrenal CT/MRI imaging, and adrenal vein sampling results if performed.
Critical thresholds
- ARR > 30 with aldosterone > 15 ng/dL Confirms primary hyperaldosteronism diagnosis; foundational to the entire claim
- Adrenal adenoma on CT/MRI Supports benign neoplasm evaluation pathway under DC 7917 - DC 7915
- Bilateral adrenal hyperplasia confirmed Supports medical management pathway; documents ongoing need for mineralocorticoid antagonist therapy
Tips
- Ensure your eFolder contains all adrenal imaging (CT, MRI) with radiology reports
- Include adrenal vein sampling reports if you underwent this procedure
- Bring documentation of your initial diagnostic workup establishing the diagnosis
- If diagnosed at a private facility, submit those records to the VA before your exam
Pain considerations: Not directly applicable to this test, but document any pain or complications from the diagnostic procedures themselves if they occurred.
Cardiovascular and Renal Function Assessment
What it measures: End-organ damage attributable to chronic excess aldosterone: left ventricular hypertrophy (echocardiogram), cardiac arrhythmias (ECG/Holter), renal function (BMP/CMP with creatinine, GFR, urinalysis for proteinuria), and evidence of hypokalemic nephropathy
What to expect: The examiner will review available cardiac and renal studies from your medical records. An ECG may be performed at the exam. Document any history of atrial fibrillation, left ventricular hypertrophy, heart failure, or reduced kidney function that your physicians have attributed to your hyperaldosteronism.
Critical thresholds
- Left ventricular hypertrophy on echo or ECG Supports separate cardiovascular rating; documents aldosterone-mediated cardiac injury
- Atrial fibrillation or other arrhythmia May support separate cardiac evaluation; document all cardiology records
- Reduced GFR / proteinuria Supports renal complications as secondary conditions for separate rating consideration
Tips
- Bring recent echocardiogram and ECG reports
- Document any cardiology visits or hospitalizations for cardiac events
- Include nephrology records if renal function has been affected
- Note any symptoms of heart palpitations, irregular heartbeat, or shortness of breath
Pain considerations: Chest discomfort, palpitations, and dyspnea associated with cardiovascular complications should be described in detail including frequency and functional limitation.
Rating criteria by percentage
100%
Active malignant neoplasm of the adrenal gland (malignant hyperaldosteronism/adrenocortical carcinoma) - rated 100% during active malignancy phase under DC 7916 (malignant neoplasm of endocrine system). After treatment cessation, a mandatory VA examination must be scheduled at the 6-month post-treatment point to reassess residuals.
Key symptoms
- Active adrenocortical carcinoma with confirmed malignancy
- Currently undergoing surgical resection, chemotherapy, radiation, or targeted therapy
- Severe systemic symptoms: profound fatigue, cachexia, pain from tumor burden
- Metastatic disease to regional lymph nodes or distant sites
- Post-operative period following adrenalectomy for malignant tumor
- Severe hypertension refractory to multiple medications
- Profound hypokalemia requiring IV replacement
From 38 CFR: Under 38 CFR - 4.119, DC 7917 directs evaluation as malignant neoplasm where appropriate. Malignant adrenal neoplasms are rated at 100% during active disease and treatment per the general rule for active malignancies. After treatment, residuals are rated under the appropriate endocrine dysfunction criteria.
60%
For benign hyperaldosteronism (adrenal adenoma or bilateral hyperplasia), rated as benign neoplasm under DC 7915 based on residuals of endocrine dysfunction. A 60% rating is warranted when there is pronounced endocrine dysfunction with significant cardiovascular complications, refractory hypertension requiring multiple medications, or severe hypokalemia with neuromuscular manifestations. Alternatively, if hypertension is separately rated, it may warrant 60% under DC 7101 (diastolic -130 or systolic -200 mm Hg).
Key symptoms
- Severe, refractory hypertension (diastolic -130 or systolic -200 mm Hg) despite medical management
- Persistent severe hypokalemia (K+ < 2.5 mEq/L) requiring ongoing IV or high-dose oral supplementation
- Significant left ventricular hypertrophy with functional impairment
- Recurrent episodes of profound muscular weakness or hypokalemic periodic paralysis
- Poorly controlled diabetes mellitus or severe glucose intolerance as complication
- Cardiac arrhythmias (e.g., atrial fibrillation) attributable to aldosterone excess
- Significant reduction in renal function (CKD Stage 3+ from hypokalemic nephropathy)
From 38 CFR: DC 7917 evaluates benign hyperaldosteronism per DC 7915 (benign neoplasm of endocrine system - rate as residuals of endocrine dysfunction). Residual hypertension is separately evaluated under DC 7101. Combined ratings for the neoplasm and its secondary conditions may reach 60% or higher.
30%
Benign hyperaldosteronism with moderate endocrine dysfunction; hypertension controlled on one or two medications with documented diastolic pressure predominantly 100-129 mm Hg or systolic 160-199 mm Hg; moderate hypokalemia requiring oral supplementation; intermittent muscular weakness or fatigue; ongoing need for mineralocorticoid antagonist therapy.
Key symptoms
- Diastolic BP predominantly 100-129 mm Hg requiring medication
- Moderate hypokalemia (K+ 3.0-3.4 mEq/L) requiring oral potassium supplementation
- Persistent fatigue and generalized weakness affecting daily activities
- Requiring two antihypertensive medications for blood pressure control
- Ongoing spironolactone or eplerenone therapy with medication side effects
- Intermittent muscle cramps and weakness episodes
- Mild to moderate glucose intolerance
From 38 CFR: Rated as residuals of endocrine dysfunction per DC 7915. Hypertension component rated under DC 7101 at 30% (diastolic predominantly 100 or more, or systolic predominantly 160 or more, or requiring continuous medication for control). Combined evaluation of the neoplasm residuals and hypertension typically yields this level.
10%
Benign hyperaldosteronism in remission or well-controlled following adrenalectomy or medical treatment; residual hypertension controlled on a single antihypertensive (diastolic < 100, systolic < 160) but requiring continuous medication; minimal ongoing symptoms; documented need for continued monitoring and medication.
Key symptoms
- Diastolic BP < 100 mm Hg but requiring continuous antihypertensive medication
- Post-adrenalectomy with normalized potassium and aldosterone levels
- Residual mild fatigue
- Requiring one antihypertensive medication for blood pressure control
- No significant end-organ damage documented
- Biochemical cure but continued follow-up required
From 38 CFR: Under DC 7101, 10% is assigned when diastolic pressure is predominantly less than 100 with a history of diastolic pressure of 100 or more, OR when the condition requires continuous medication for control. Post-surgical residuals with minimal endocrine dysfunction may yield this level.
0%
Hyperaldosteronism fully resolved (biochemical cure post-adrenalectomy) with no residual hypertension, normal potassium levels off supplementation, no end-organ damage, and no ongoing medication requirement. Condition is still service-connected at 0% to maintain the connection and allow for future increases if symptoms recur.
Key symptoms
- Normal aldosterone and renin levels post-treatment
- Normal blood pressure without medication
- Normal serum potassium without supplementation
- No symptoms of endocrine dysfunction
- Annual surveillance only
From 38 CFR: Even at 0%, maintaining the service connection preserves the veteran's right to future rating increases and access to VA treatment for this condition. A 0% rating still confers important benefits.
Describing your symptoms accurately
Hypertension and Cardiovascular Symptoms
How to describe it: Describe your blood pressure history accurately and completely. Include: your highest documented readings, how many medications you take for blood pressure control, whether your BP is well-controlled or fluctuates, and any cardiovascular symptoms like palpitations, chest pain, or shortness of breath. Specify whether the hypertension was diagnosed at the same time as or before your hyperaldosteronism, and whether your treating physician has attributed it directly to your adrenal condition.
Example: On my worst days, my blood pressure spikes to 180/115 despite taking three medications. I get severe headaches behind my eyes, feel like my heart is pounding out of my chest, and experience shortness of breath just walking to the bathroom. On those days I cannot function at work and have called in sick multiple times.
Examiner listens for: Number of antihypertensive medications required for control; documented history of high BP readings in the medical record; presence of end-organ damage (cardiac, renal, ocular); whether hypertension predated or developed concurrently with the hyperaldosteronism diagnosis.
Avoid: Do not say your blood pressure is 'fine now' without noting how many medications achieve that control, or that it was 'a little high' when medical records show it was severely elevated. The need for medication is itself rating-relevant.
Muscle Weakness and Hypokalemic Symptoms
How to describe it: Describe the quality, frequency, severity, and functional impact of weakness and muscle symptoms. Be specific about which muscle groups are affected (legs, arms, generalized), whether weakness is episodic or constant, and what activities it prevents you from doing. Include episodes of muscle cramps, spasms, or any episodes of temporary paralysis. Connect these symptoms to your documented low potassium levels.
Example: During my worst episodes of low potassium, my legs give out entirely - I cannot climb stairs, stand for more than five minutes, or lift anything over ten pounds. The muscle cramps wake me from sleep and last 20-30 minutes. I have fallen twice because my legs buckled unexpectedly. During these episodes I am completely dependent on others for basic tasks.
Examiner listens for: Severity of neuromuscular symptoms correlated with hypokalemia; functional limitations in activities of daily living; frequency and duration of episodes; whether weakness is constant or episodic; any falls or safety incidents; need for assistive devices.
Avoid: Do not minimize episodes as 'just being tired.' Hypokalemic weakness can be profound and disabling - describe the actual functional impact, not just the sensation.
Fatigue and Generalized Debilitation
How to describe it: Describe the nature and impact of fatigue as a distinct symptom separate from weakness. Hyperaldosteronism-related fatigue is often pervasive, not relieved by rest, and significantly impairs occupational and social functioning. Quantify how many hours per day fatigue limits you, how it affects your work performance, and whether it has worsened over time.
Example: On bad days I need to sleep 12-14 hours and still wake up exhausted. I cannot complete a full workday - by noon I am too fatigued to concentrate or perform physical tasks. My supervisor has documented performance issues because of my attendance and productivity problems. I have had to reduce my work hours from full-time to part-time.
Examiner listens for: Whether fatigue is a constant feature or episodic; correlation with electrolyte abnormalities; impact on employment and daily activities; duration of symptoms; whether fatigue predates or followed the onset of documented hyperaldosteronism.
Avoid: Saying 'I'm just a little tired sometimes' when fatigue is actually a daily, limiting symptom. Document and communicate the actual occupational and functional impact.
Treatment Burden and Medication Side Effects
How to describe it: Document the full burden of your treatment regimen. For spironolactone users: describe any gynecomastia, sexual dysfunction, or menstrual irregularities. For post-surgical patients: describe recovery, residual symptoms, and whether a biochemical cure was achieved. Include the number, type, and dosing of all current medications and their side effects.
Example: The spironolactone causes significant gynecomastia that is painful and emotionally distressing. I also experience erectile dysfunction as a direct side effect that has severely impacted my quality of life and relationships. Despite taking four medications daily, my blood pressure still breaks through to dangerous levels several times per month.
Examiner listens for: Whether treatment achieves adequate control; number of medications required; documented side effects; post-surgical status and whether resection was curative; requirement for ongoing monitoring and lab work; treatment-related disability.
Avoid: Failing to mention medication side effects or treatment burdens. These are relevant to the overall evaluation of the condition's functional impact.
Polyuria and Renal Symptoms
How to describe it: Describe any persistent excessive urination (polyuria) and excessive thirst (polydipsia) accurately. Note frequency of urination (number of times per day/night), volume if measurable, and how this disrupts sleep, work, and daily activities. Include any kidney function test results showing impaired GFR or proteinuria.
Example: I urinate 15-20 times per day and wake up 4-5 times at night to urinate, which completely destroys my sleep. I cannot attend meetings or travel without constantly planning around bathroom access. My nephrologist noted I have Stage 2 CKD with proteinuria that she attributes to my longstanding hyperaldosteronism.
Examiner listens for: Presence of polyuria as an independent symptom of aldosterone excess; renal function parameters from lab work; nocturia frequency and sleep disruption; any nephrology referrals or diagnoses of hypokalemic nephropathy.
Avoid: Dismissing polyuria as normal or not worth mentioning. It is a specific, documentable symptom of hyperaldosteronism and supports the severity of the condition.
Functional and Occupational Impact
How to describe it: Clearly describe how hyperaldosteronism and its complications affect your ability to work, perform household activities, maintain relationships, and care for yourself. Include any job accommodations made, missed workdays, reduced productivity, inability to perform your military occupational specialty, or civilian career changes made because of the condition.
Example: I had to leave my job as a construction supervisor because I could not safely operate heavy machinery while taking my blood pressure medications, which cause dizziness and blurred vision. I now work a desk job at reduced pay. I average 8 missed workdays per month during flare-ups. I can no longer coach my son's sports team because I cannot stand or walk for extended periods.
Examiner listens for: Specific occupational limitations; frequency of missed work; need for job modifications or reassignment; impact on physical activities and hobbies; caregiver burden on family members; mental health impacts from chronic illness.
Avoid: Saying work is 'fine' or you 'manage' without describing the specific accommodations and limitations that make it possible. The examiner needs concrete details.
Common mistakes to avoid
Saying 'my blood pressure is controlled' without specifying how many medications achieve that control
Why: The VA rating system for hypertension under DC 7101 considers medication requirement as a rating criterion. Blood pressure 'controlled' on three antihypertensive medications represents significant disability even if the numbers appear normal on exam day.
Do this instead: State the exact number and names of your antihypertensive medications. Say: 'My blood pressure requires three medications - lisinopril, amlodipine, and spironolactone - to maintain borderline control, and it still breaks through to 160/100 or higher several times per month.'
Impact: 10-30%
Failing to bring home blood pressure logs to the exam
Why: Clinic readings may be artificially low (white coat effect) or artificially elevated due to exam-day stress. The examiner documents what they measure, but a 90-day home BP log provides the most accurate representation of your typical blood pressure burden.
Do this instead: Keep a daily blood pressure log for at least 30-90 days before your exam using a home monitor. Bring the printed log to the exam and offer it to the examiner for their review and documentation.
Impact: 10-60%
Not connecting secondary conditions (renal disease, cardiac complications, glucose intolerance) to hyperaldosteronism during the exam
Why: Hyperaldosteronism causes hypertension, hypokalemia, cardiovascular remodeling, and renal damage. Each of these may be separately ratable as secondary conditions, but the examiner must document the nexus. If you do not raise these connections, they may not be captured.
Do this instead: For each secondary condition, explicitly state: 'My treating physician told me that my [cardiac hypertrophy/kidney disease/glucose intolerance] is directly caused by or worsened by my hyperaldosteronism.' Bring supporting private provider statements or medical records documenting this nexus.
Impact: 30-100%
Describing symptoms only as they are on an average or good day rather than accurately representing the full spectrum including worst days
Why: VA M21-1 guidance and case law (DeLuca v. Brown) establish that ratings must account for the full range of symptoms including flare-ups and worst-day presentations. Examiners are required to consider and document how the condition presents across its full range.
Do this instead: When asked how you are doing, describe both your typical presentation AND your worst-day presentation. Say: 'On an average day I experience [X], but during flare-ups which occur approximately [X times per month], my symptoms include [worst-day description] and prevent me from [specific activity].'
Impact: All levels
Not disclosing post-adrenalectomy residuals or assuming surgical cure means no rating
Why: Even after successful adrenalectomy, many veterans retain residual hypertension requiring medication, medication-related complications, renal damage from years of disease, or emotional/psychological impact. These residuals remain ratable.
Do this instead: Clearly describe all symptoms that persist after surgery. Document whether a biochemical cure was achieved and whether any residual hypertension, weakness, or organ damage persists. Request that the examiner document all post-surgical residuals in the DBQ.
Impact: 0-30%
Failing to mention the malignant vs. benign nature of the tumor when it is malignant or unknown
Why: DC 7917 specifically instructs evaluation as malignant or benign neoplasm as appropriate. A malignant adrenocortical carcinoma causing hyperaldosteronism triggers a 100% rating during active disease. If pathology was performed and confirmed malignancy, this must be clearly communicated.
Do this instead: Bring your surgical pathology report to the exam if available. Clearly state whether your diagnosis was adenoma (benign), adrenocortical carcinoma (malignant), or bilateral hyperplasia. Ensure the examiner documents the correct pathological diagnosis.
Impact: 100%
Not raising the issue of separate ratings for secondary conditions to avoid pyramiding confusion
Why: Veterans sometimes incorrectly assume they cannot receive separate ratings for the same condition's manifestations. Under 38 CFR - 4.14, separate ratings for distinct disabilities with different symptom profiles are permitted. Hypertension, renal disease, and cardiac conditions caused by hyperaldosteronism may each be separately rated.
Do this instead: Ask your VSO or accredited claims agent to review whether your secondary conditions should be claimed separately. Raise all related conditions during the exam so the examiner can document them and refer to appropriate additional DBQs.
Impact: All levels
Prep checklist
- critical
Compile and organize all relevant medical records
Gather: initial diagnostic labs (aldosterone, renin, ARR), confirmatory test results (saline infusion, fludrocortisone suppression), adrenal imaging (CT/MRI with radiology reports), adrenal vein sampling results, surgical/operative reports and pathology if applicable, all follow-up endocrinology and cardiology notes, current medication list with dosages, and any private provider letters of nexus.
before exam
- critical
Prepare a 30-90 day home blood pressure log
Purchase or borrow a home blood pressure monitor. Take readings twice daily (morning and evening) for at least 30 days before your exam. Record each reading with date and time. Calculate your averages. This document objectively demonstrates your typical blood pressure burden beyond the single exam-day reading.
before exam
- critical
Write out a complete symptom narrative covering all affected body systems
Document in writing: (1) cardiovascular symptoms and hypertension history, (2) neuromuscular symptoms from hypokalemia, (3) fatigue and its functional impact, (4) polyuria and sleep disruption, (5) treatment side effects, (6) occupational limitations, (7) activities you can no longer perform, and (8) your worst-day experiences. Bring this written summary to the exam.
before exam
- critical
Contact your treating physicians for updated letters of nexus and severity statements
Ask your endocrinologist, cardiologist, and/or nephrologist to write letters documenting: (1) the diagnosis and its severity, (2) that any secondary conditions (hypertension, cardiac complications, renal disease) are caused or aggravated by your hyperaldosteronism, (3) your functional limitations, and (4) your prognosis. These letters are among the most powerful evidence you can provide.
before exam
- recommended
File for secondary conditions before the exam if not already claimed
If you have not already claimed secondary conditions like hypertension (DC 7101), hypertensive heart disease (DC 7007), or renal disease as secondary to hyperaldosteronism, consider filing those claims before or concurrent with this exam so the examiner can address them in the same evaluation.
before exam
- critical
Review your VA eFolder to confirm all records have been submitted
Log into VA.gov or ask your VSO to confirm that all your relevant medical records are in your eFolder before the exam date. The examiner is required to review your file, but they can only document what is present. Missing records mean missing documentation of your condition's severity.
before exam
- critical
Prepare a list of all current medications and dosages
Write out every medication you take, including the dosage, frequency, and the condition it treats. For antihypertensives specifically, note how long you have been on each one and whether it was added because the prior regimen was insufficient. Bring the actual pill bottles if possible.
before exam
- recommended
Research your right to record the examination in your state
Many states permit veterans to audio or video record their C&P examination. Research the law in your state and, if permitted, notify the examination contractor in advance that you intend to record. Recording creates an objective record of what was said and can be invaluable if the DBQ is later found to be inadequate.
before exam
- critical
Take all medications as prescribed - do not alter your regimen before the exam
Never stop or alter medications to manipulate exam findings. Take your medications exactly as prescribed. If your blood pressure is controlled with medications, that is precisely what the examiner should document - the fact that it requires those medications to be controlled.
day of
- critical
Bring all prepared documentation to the exam
Bring: home BP log, written symptom narrative, medication list, copies of key medical records (even if already in eFolder), private physician letters, and any assistive devices you use. Offer these to the examiner and ask them to review and reference them in the DBQ.
day of
- recommended
Arrive early and avoid excessive physical activity or caffeine before the exam
Arrive 15-20 minutes early. Avoid caffeine, heavy meals, and strenuous activity for 30 minutes before blood pressure readings. Sit quietly before BP measurements. However, do not artificially manipulate your state - the goal is an accurate reading of your resting blood pressure.
day of
- critical
Report your worst-day presentation, not just your current state
If you are having a relatively good day on exam day, proactively inform the examiner: 'Today is actually a better day for me. My typical presentation and my worst days are significantly more severe than what you are observing right now.' Then describe your worst-day symptoms in specific detail.
day of
- critical
Clearly describe functional impact on all activities of daily living and occupational duties
For every symptom you report, add a functional impact statement: 'This prevents me from [specific activity].' Be specific: 'I cannot stand at the stove to cook a meal without my legs giving out' is far more useful than 'I have weakness.'
during exam
- critical
Mention all secondary conditions and ask the examiner to document them
If you have hypertension, cardiac complications, renal disease, or glucose intolerance attributable to your hyperaldosteronism, raise each one specifically and ask the examiner whether they will be documenting them in the DBQ or whether a separate DBQ is needed.
during exam
- recommended
Confirm the examiner has reviewed your eFolder and private records
Politely ask: 'Have you had a chance to review my claims file and the medical records I brought?' If they have not reviewed key evidence, offer your copies and ask them to at least review the most critical documents (diagnosis confirmation, BP log, physician letters).
during exam
- recommended
Correct any factual errors you observe in real time
If the examiner states something factually incorrect (wrong diagnosis date, wrong medication, mischaracterizes your symptoms), politely correct it during the exam: 'I want to make sure the record is accurate - my diagnosis was in [year], not [year].' Do not argue opinions, only correct verifiable facts.
during exam
- critical
Request a copy of the completed DBQ as soon as it is available in your eFolder
After the exam, monitor your VA.gov account for the completed DBQ to appear in your eFolder. Once available, review it carefully for errors, omissions, or inadequate rationale. You typically have the right to see this document and to file for a supplemental claim or request an additional exam if it is inadequate.
after exam
- critical
Contact your VSO if the DBQ appears inadequate or contains errors
If the DBQ: (1) fails to address all claimed symptoms, (2) contains factual errors, (3) lacks adequate rationale for its conclusions, (4) does not address worst-day presentations, or (5) fails to consider all submitted evidence - contact your VSO immediately. You may be entitled to a new or corrected examination.
after exam
- recommended
Submit any additional evidence within one year of your claim date
You have one year from the date of your claim to submit additional evidence without losing your effective date. If you obtain new private physician statements, updated lab results, or additional medical records after the exam, submit them promptly through your VSO or via VA.gov.
after exam
Your rights during a C&P exam
- You have the right to be examined by a qualified examiner - for hyperaldosteronism, this should ideally be an endocrinologist or a physician with endocrine expertise. If you believe the examiner lacks the necessary qualifications, you may raise this concern with your VSO.
- You have the right to audio or video record your C&P examination in many states. Check your state's recording consent laws and notify the examination contractor in advance if you wish to record. Recording is permitted at all VA-conducted examinations.
- You have the right to review the completed DBQ by accessing your VA eFolder at VA.gov. This document becomes part of your official claims record and should be reviewed for accuracy.
- You have the right to request a new or additional examination if the completed DBQ is found to be inadequate, contains errors, fails to consider submitted evidence, or is the product of an unqualified examiner.
- You have the right to submit private medical opinions and evidence - including letters from your treating endocrinologist, cardiologist, or nephrologist - that address the severity of your condition and nexus to service. This evidence receives substantial weight.
- You have the right to a fully reasoned rating decision that explains how all submitted evidence was weighed. If your rating decision does not address evidence you submitted, this may be grounds for appeal.
- Under the VA's duty to assist (38 CFR - 3.159), the VA is required to obtain a medical examination or opinion when one is necessary to make a decision on your claim. If the VA fails to provide an adequate examination, this duty may not have been met.
- You have the right to bring a representative, VSO, or accredited claims agent to your C&P examination for support, though they typically observe rather than participate actively.
- Under the PACT Act and AMA (Appeals Modernization Act), you have multiple lanes for appealing an unfavorable rating decision: Supplemental Claim (new evidence), Higher-Level Review (different rater), or Board of Veterans Appeals (including hearing options).
- You are entitled to the benefit of the doubt under 38 CFR - 3.102 - when there is an approximate balance of positive and negative evidence regarding a material fact, the benefit of the doubt must be given to the veteran.
- Your effective date for benefits is generally the date of your claim, not the date of the exam or rating decision. Protecting your effective date by filing promptly is critical to maximizing retroactive benefits.
- If your hyperaldosteronism is confirmed as malignant (adrenocortical carcinoma), you may qualify for a 100% rating during active treatment under 38 CFR - 4.119, and potentially for Total Disability Individual Unemployability (TDIU) and Special Monthly Compensation (SMC) depending on functional impact.
Related conditions
- Hypertension (Primary) Hyperaldosteronism is a leading secondary cause of hypertension. Aldosterone excess directly drives sodium retention and vasoconstriction, causing hypertension that often requires multiple medications. Hypertension caused by hyperaldosteronism may be separately rated under DC 7101 as a secondary condition.
- Hypertensive Heart Disease Chronic aldosterone-mediated hypertension and direct aldosterone-driven cardiac fibrosis cause left ventricular hypertrophy, diastolic dysfunction, and increased risk of heart failure. Hypertensive heart disease caused or aggravated by hyperaldosteronism may be separately rated under DC 7007.
- Cardiac Arrhythmias Hypokalemia from aldosterone excess predisposes to ventricular and supraventricular arrhythmias including atrial fibrillation. Aldosterone also directly promotes atrial fibrosis. Arrhythmias secondary to hyperaldosteronism may be separately ratable.
- Chronic Kidney Disease Long-standing hypokalemia causes hypokalemic nephropathy. Aldosterone-mediated hypertension causes hypertensive nephrosclerosis. Both pathways lead to CKD that may be rated as secondary to hyperaldosteronism.
- Diabetes Mellitus / Glucose Intolerance Aldosterone impairs insulin secretion and promotes insulin resistance through hypokalemia and direct metabolic effects. Veterans with hyperaldosteronism have significantly elevated risk of developing glucose intolerance and type 2 diabetes mellitus, which may be claimed as secondary.
- Benign Neoplasm of Endocrine System Under DC 7917, benign hyperaldosteronism (adrenal adenoma / Conn's syndrome) is evaluated as a benign neoplasm per DC 7915 (rate as residuals of endocrine dysfunction). DC 7915 is the direct evaluation pathway for benign hyperaldosteronism.
- Malignant Neoplasm of Endocrine System Under DC 7917, malignant hyperaldosteronism (adrenocortical carcinoma) is evaluated as a malignant neoplasm per DC 7916 (100% during active disease/treatment). This is the evaluation pathway when pathology confirms adrenocortical carcinoma.
- Hypogonadism Adrenocortical carcinomas causing hyperaldosteronism may co-secrete other hormones affecting gonadal function. Additionally, spironolactone used to treat hyperaldosteronism is an anti-androgen that commonly causes gynecomastia and sexual dysfunction, which may be ratable as treatment-related conditions.
- Sleep Apnea Hyperaldosteronism-driven fluid retention and hypertension are associated with increased risk of obstructive sleep apnea. If you have been diagnosed with sleep apnea, consider whether it may be secondary to your hyperaldosteronism and hypertension.
- Anxiety / Depression (Secondary to Chronic Illness) Chronic management of a complex endocrine disorder with medication side effects (sexual dysfunction from spironolactone, body image concerns), persistent symptoms, and functional limitations frequently causes or aggravates anxiety and depression. Mental health conditions secondary to service-connected hyperaldosteronism may be separately ratable.
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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.