DC 7905 · 38 CFR 4.119
Thyroid and Parathyroid Conditions C&P Exam Prep
To accurately document the current severity of your thyroid or parathyroid condition, including diagnosis, functional impact, symptoms, lab findings, treatment history, and any residuals or complications, so that VA can assign an appropriate disability rating under 38 CFR 4.119.
- Format:
- Interview + Physical
- Typical duration:
- 15-30 minutes
- DBQ form:
- Thyroid_and_Parathyroid (Thyroid_and_Parathyroid)
- Examiner:
- Endocrinologist or Physician
What the examiner evaluates
- Current diagnosis (hypothyroidism, hyperthyroidism, thyroiditis, thyroid enlargement, hypo/hyperparathyroidism, neoplasms, etc.)
- Thyroid function status - whether normal, hypothyroid, or hyperthyroid
- Presence and severity of symptoms such as fatigue, constipation, nausea, anorexia, and weight changes
- Heart rate and blood pressure as indicators of thyroid function
- Presence of myxedema and whether it has been stabilized
- Eye involvement (exophthalmos, diplopia, corneal issues) that may require separate evaluation
- Skin findings including hypo/hyperpigmentation, abnormal texture, and scar/tissue changes
- Results and dates of relevant lab tests: TSH, Free T4, Free T3, thyroid antibodies, calcium, ionized calcium, parathyroid hormone (PTH)
- Imaging studies: thyroid ultrasound, thyroid scan, CT, MRI
- Biopsy results if applicable
- History of surgery (thyroidectomy, parathyroidectomy), radiation therapy, chemotherapy, or radioactive iodine treatment
- Presence and severity of hypercalcemia and its indicators (bone mineral density, creatinine clearance, serum calcium levels)
- Musculoskeletal, cardiovascular, neurological, GI, GU, skin, eye, and psychiatric manifestations
- Functional impact on occupational and daily activities
- Whether condition is in remission or active; whether neoplasm is benign or malignant, primary or secondary
The exam may be conducted in person at a VA facility or contracted exam site (e.g., QTC, VES, LHI). Virtual/telehealth exams are also possible. Bring all relevant records, medication lists, and prior lab results. You have the right to request that the exam be recorded in most states.
Measurements and tests
TSH (Thyroid-Stimulating Hormone)
What it measures: Primary indicator of thyroid function; elevated TSH suggests hypothyroidism, suppressed TSH suggests hyperthyroidism
What to expect: Examiner will review existing lab values from your medical records. No blood draw is typically performed during the C&P exam itself, but the examiner may note if recent labs are unavailable.
Critical thresholds
- TSH above normal reference range Supports hypothyroidism diagnosis; may affect rating under DC 7903
- TSH below normal reference range Supports hyperthyroidism diagnosis; may affect rating under DC 7900/7902
Tips
- Bring printed copies of your most recent TSH, Free T4, and Free T3 lab results with reference ranges
- If your labs fluctuate, bring results showing the worst values as well as your trend over time
- Note the date of each lab test - the examiner documents test dates on the DBQ
Pain considerations: N/A - lab value, not a pain measurement
Free T4 and Free T3
What it measures: Active thyroid hormones; low values indicate hypothyroidism, high values indicate hyperthyroidism
What to expect: Examiner will review prior lab results. Bring documentation of values with lab reference ranges.
Critical thresholds
- Free T4 below normal Corroborates hypothyroidism; supports higher ratings if symptomatic
- Free T3 elevated May support hyperthyroidism, including T3 toxicosis
Tips
- Bring labs from the past 6-12 months
- If your condition required medication adjustments, document the dates and reasons for changes
Pain considerations: N/A - lab value, not a pain measurement
Parathyroid Hormone (PTH) and Calcium Levels
What it measures: PTH regulates calcium; elevated PTH with hypercalcemia indicates hyperparathyroidism; low PTH with hypocalcemia indicates hypoparathyroidism
What to expect: Examiner reviews your documented lab results. Key thresholds for hypercalcemia include total calcium greater than 12 mg/dL (3.3 mmol/L) and ionized calcium greater than 5.6 mg/dL, or creatinine clearance less than 60 mL/min as a complication marker.
Critical thresholds
- Total calcium > 12 mg/dL Indicator of symptomatic hypercalcemia under hyperparathyroidism rating criteria
- Ionized calcium > 5.6 mg/dL Another threshold for hypercalcemia documentation
- Bone mineral density T-score - -2.5 Indicates hypercalcemia-related osteoporosis; affects hyperparathyroidism severity rating
- Creatinine clearance < 60 mL/min Indicates renal complications from hypercalcemia; increases severity documentation
Tips
- Bring documented PTH levels, serum calcium, and ionized calcium results
- If you have had a DEXA scan, bring those bone density results
- If you have had kidney stones from hypercalcemia, document those episodes
Pain considerations: Note any bone pain, muscle weakness, or joint pain associated with abnormal calcium levels, as these can affect secondary musculoskeletal ratings
Heart Rate and Blood Pressure (Vital Signs)
What it measures: Elevated resting heart rate (tachycardia) is a key finding in hyperthyroidism; bradycardia and elevated blood pressure can occur in hypothyroidism
What to expect: Examiner will record your heart rate and blood pressure during the exam. Your resting values at the time of the exam will be documented on the DBQ.
Critical thresholds
- Heart rate > 100 bpm at rest Supports hyperthyroid activity; may contribute to cardiovascular referral under DC 7008
- Heart rate < 60 bpm at rest May support hypothyroid activity
Tips
- Do not take extra stimulants (caffeine, decongestants) before the exam that could artificially elevate your heart rate
- If your resting heart rate is consistently elevated or depressed, mention this to the examiner as part of your typical presentation
- Tell the examiner if you are on beta-blockers or other heart rate-affecting medications for thyroid-related reasons
Pain considerations: Report any palpitations, racing heart, chest discomfort, or shortness of breath related to heart rate changes
Thyroid Ultrasound and Thyroid Scan
What it measures: Structural evaluation of thyroid size, nodules, and vascularity; radioactive iodine scan evaluates functional activity
What to expect: The examiner will review existing imaging results. No imaging is typically performed at the C&P exam itself.
Critical thresholds
- Enlarged thyroid with nodule(s) documented Supports diagnosis of thyroid enlargement (toxic or non-toxic); location and size matter for DBQ
- Cold vs. hot nodule on scan Relevant to neoplasm evaluation and malignancy risk
Tips
- Bring copies of ultrasound and scan reports with radiologist interpretations
- Note the date of each imaging study
- If you have had multiple ultrasounds showing growth or change, bring the series
Pain considerations: Note any neck pain, pressure, or difficulty swallowing related to thyroid enlargement
Rating criteria by percentage
100%
Hypothyroidism (DC 7903): Myxedema (severely decreased thyroid function) with associated symptoms including cold intolerance, muscular weakness, cardiovascular involvement, mental disturbance, bradycardia, and coarse dry skin. Also 100% for malignant neoplasm of the thyroid (DC 7905) that is active or requiring treatment.
Key symptoms
- Myxedema with cold intolerance
- Muscular weakness affecting daily function
- Cardiovascular manifestations (bradycardia, heart failure)
- Significant mental disturbance or cognitive impairment
- Coarse dry skin and edema
- Profound fatigue limiting all activity
- Active malignant thyroid neoplasm under treatment
From 38 CFR: DC 7903: Hypothyroidism rated at 100% when myxedema is present with the full constellation of severe systemic symptoms. DC 7905: Malignant neoplasm of the thyroid is rated at 100% while active or during and for six months following the cessation of any surgical, radiation, or other therapeutic procedure.
60%
Hypothyroidism (DC 7903): Hypothyroidism with symptoms including fatigability, constipation, and mental sluggishness, but not meeting the full criteria for myxedema. Also applicable to hyperthyroidism (DC 7900) with severe symptoms such as significant weight loss, cardiovascular involvement, and sympathetic nervous system excitability that disrupts daily activities.
Key symptoms
- Persistent fatigue severely limiting activity
- Constipation requiring ongoing management
- Mental sluggishness affecting work and daily tasks
- Significant weight loss (hyperthyroidism)
- Tachycardia and palpitations (hyperthyroidism)
- Heat intolerance and excessive sweating (hyperthyroidism)
- Tremor and nervousness (hyperthyroidism)
From 38 CFR: DC 7903 hypothyroidism with fatigability, constipation, and mental sluggishness. DC 7900 hyperthyroidism with symptoms of cardiac involvement or severe systemic effects.
30%
Hypothyroidism (DC 7903): Fatigability and other symptoms that are present but less severe. Hyperthyroidism (DC 7900) with moderate symptoms. Hyperparathyroidism (DC 7907) with symptomatic hypercalcemia not requiring surgical intervention. Hypoparathyroidism with tetany or other symptomatic manifestations.
Key symptoms
- Moderate fatigue affecting some but not all daily activities
- Mild to moderate constipation
- Symptomatic hypercalcemia (nausea, anorexia, muscle weakness)
- Bone pain related to calcium dysregulation
- Mild cardiac symptoms
- Tetanic episodes (hypoparathyroidism)
- Moderate nervousness or tremor
From 38 CFR: DC 7903 at 30%: Fatigability present but not incapacitating. DC 7907: Hyperparathyroidism with symptomatic hypercalcemia.
10%
Hypothyroidism (DC 7903): Symptom-free on continuous thyroid replacement therapy. Thyroiditis (DC 7906) with normal thyroid function (euthyroid) is rated 0%; however, residual endocrine dysfunction is rated at minimum 10% if requiring ongoing medication to maintain function. Thyroid enlargement (non-toxic, DC 7901) without functional dysfunction.
Key symptoms
- Requiring daily medication to maintain normal thyroid function
- Asymptomatic on replacement therapy but requiring monitoring
- Non-toxic thyroid enlargement without hormonal abnormality
- Mild symptoms occasionally noted despite treatment
From 38 CFR: DC 7903: A minimum 10% rating is assigned when a veteran requires continuous thyroid medication to maintain normal function, even if asymptomatic. DC 7901: Non-toxic thyroid enlargement without evidence of hyperthyroidism or hypothyroidism.
0%
Thyroiditis (DC 7906) with normal thyroid function (euthyroid). Benign neoplasm of the thyroid or parathyroid that has been excised with no residuals. Condition fully controlled with no functional impairment and no ongoing medication requirement.
Key symptoms
- Euthyroid status with no symptoms
- Post-surgical with no residuals and no medication requirement
- Incidental finding with no functional impact
From 38 CFR: DC 7906: Thyroiditis rated 0% when euthyroid. Note that if thyroiditis manifests as hyperthyroidism or hypothyroidism, evaluate under the applicable DC (7900 or 7903).
Describing your symptoms accurately
Fatigue and Energy Level
How to describe it: Describe fatigue in terms of specific functional limitations. How many hours per day are you functional? Can you complete a full workday? Do you need to rest during the day? Has fatigue affected your employment or ability to care for yourself?
Example: On my worst days, I wake up exhausted even after 10 hours of sleep. I cannot stand long enough to cook a meal without sitting down. I have had to leave work early multiple times per month and have missed entire days. Simple tasks like showering require me to rest afterward.
Examiner listens for: Specific activities limited, frequency of fatigue episodes, whether fatigue is constant or episodic, impact on work and self-care, whether fatigue is present despite treatment
Avoid: Do not say 'I get a little tired sometimes' if you mean that fatigue is a daily, significant problem. Avoid saying 'I manage okay' if managing requires you to significantly alter your life around the fatigue.
Cognitive and Mental Symptoms (Mental Sluggishness, Memory, Mood)
How to describe it: Describe how your thinking has changed. Are you slower to process information? Do you forget things you used to remember easily? Do you feel depressed, anxious, or emotionally blunted? Have colleagues, family, or supervisors noticed changes?
Example: On my worst days, I cannot follow a conversation without losing track. I have missed appointments and deadlines because I simply forgot them. I feel mentally foggy from the moment I wake up. My supervisor has commented on errors I never used to make.
Examiner listens for: Concrete examples of cognitive failures, frequency, impact on employment, whether symptoms pre-exist the thyroid condition, any formal neuropsychological testing
Avoid: Do not minimize cognitive symptoms as 'just getting older.' If they started or worsened with your thyroid condition, make that connection explicit.
Cardiovascular Symptoms (Palpitations, Tachycardia, Bradycardia, Chest Discomfort)
How to describe it: Describe frequency, duration, and triggers. How many times per week do you experience palpitations? Do they wake you at night? Have you sought emergency care? Do they occur at rest or only with exertion?
Example: On my worst days, I have episodes of my heart racing at over 120 beats per minute while sitting still. I have gone to urgent care three times in the past year for this. The episodes last 20-30 minutes and leave me feeling shaky and exhausted afterward.
Examiner listens for: Documented ER or cardiology visits, Holter monitor results, rate and rhythm abnormalities, connection to thyroid dysfunction, impact on physical activity tolerance
Avoid: Do not omit cardiac symptoms because you think they belong to a separate condition if they are caused by or worsened by your thyroid disease. These should be reported and linked.
Gastrointestinal Symptoms (Constipation, Nausea, Anorexia)
How to describe it: Describe frequency and severity. How often do you experience constipation? Do you require medications or dietary modifications? Has your appetite changed? Have you lost or gained significant weight?
Example: On my worst days, I go more than a week without a bowel movement despite using laxatives and stool softeners daily. I have no appetite and have lost 15 pounds over the past year without trying. Nausea keeps me from eating regular meals.
Examiner listens for: Weight changes documented in medical records, frequency of GI symptoms, medications used to manage symptoms, impact on nutrition and daily function
Avoid: Do not say constipation is 'not a big deal' if it is chronic and requiring medication. Weight loss or gain tied to thyroid dysfunction is clinically significant.
Eye Involvement (Exophthalmos, Diplopia, Vision Changes)
How to describe it: Describe any eye protrusion, double vision, or vision blurring in detail. When did it start? Is it constant or intermittent? Does it affect driving, reading, or working at a screen? Have you seen an ophthalmologist?
Example: On my worst days, my eyes protrude so significantly that I cannot fully close them at night, which has caused corneal irritation. I have double vision that prevents me from driving safely and requires me to close one eye to use a computer.
Examiner listens for: Ophthalmology referral documentation, degree of proptosis measured in mm, diplopia in specific gaze positions, corneal exposure issues, any surgical intervention for eye disease
Avoid: Do not fail to mention eye symptoms. Under 38 CFR 4.119 Note 3, eye involvement from thyroid disease can be separately rated under 38 CFR 4.79 (e.g., DC 6090 for diplopia). Failing to report it means it may not be separately evaluated.
Skin Manifestations (Dryness, Texture, Pigmentation, Scar Changes)
How to describe it: Describe visible skin changes, scarring from thyroid surgery, pigmentation changes, or pretibial myxedema. Where are they located? How large are the affected areas? Do they cause discomfort, itching, or cosmetic disfigurement?
Example: My thyroidectomy scar is thickened and inflexible, causing discomfort when I turn my neck. The skin on my neck and lower legs is hyperpigmented and has an abnormal leathery texture covering approximately 20 cm- on each leg.
Examiner listens for: Location, size (cm-), degree of tissue loss or distortion, disfigurement of head/face/neck, whether scar affects underlying soft tissue or movement
Avoid: Do not ignore scar changes from thyroidectomy. The DBQ specifically evaluates surgical scars for disfigurement, tissue loss, and underlying soft tissue involvement.
Hyperparathyroidism - Hypercalcemia Symptoms
How to describe it: Describe symptoms of high calcium: bone pain, muscle weakness, kidney stones, excessive thirst and urination, fatigue, confusion, and abdominal pain. Were you hospitalized? Did symptoms require IV fluids or bisphosphonates?
Example: On my worst days, bone pain in my hips and spine makes it impossible to stand for more than 10 minutes. I have passed two kidney stones in the past two years. I am constantly thirsty and urinating frequently, and I feel confused and unable to concentrate.
Examiner listens for: Documentation of kidney stones, bone density results, hospitalization for hypercalcemia, medications used (bisphosphonates, cinacalcet), whether surgery was required despite ongoing hypercalcemia
Avoid: Do not minimize hypercalcemia symptoms. The VA rating criteria specifically reference whether hypercalcemia required treatment, persisted despite surgery, and whether bone density or creatinine clearance are affected.
Common mistakes to avoid
Describing only your best days or your average days
Why: VA ratings under M21-1 are based on the full range of your condition's impact, including your worst days. Presenting only your good days leads to underrating.
Do this instead: Explicitly describe your worst days and their frequency. Tell the examiner: 'On my worst days, which happen approximately X times per month, I experience...'
Impact: All levels - can cause a lower rating at every tier
Failing to report eye symptoms
Why: Under 38 CFR 4.119 Note 3, eye involvement (exophthalmos, diplopia, corneal ulcer, blurred vision) from thyroid disease can be separately evaluated under 38 CFR 4.79. Failing to mention these symptoms means they will not be separately claimed or rated.
Do this instead: Report all eye symptoms to the examiner and ensure they are documented on the DBQ. If present, ask the examiner about referral to ophthalmology for a separate evaluation.
Impact: Separate rating under eye diagnostic codes - potentially significant additional compensation
Not bringing lab results, imaging reports, and treatment records to the exam
Why: The DBQ requires the examiner to document specific lab values (TSH, Free T4, Free T3, PTH, calcium), imaging dates, and treatment history. Without records, the examiner may document 'unavailable' or rely on memory, which can result in an incomplete DBQ.
Do this instead: Print and organize your lab results, imaging reports, and treatment records chronologically. Bring a medication list. Request a copy of your VA records in advance if possible.
Impact: All levels - incomplete documentation can result in denial or lower rating
Saying your condition is 'well-controlled' without context
Why: Even a well-controlled condition that requires continuous daily medication to remain controlled qualifies for a minimum 10% rating (e.g., hypothyroidism on thyroid replacement). Additionally, 'well-controlled' on medication does not mean symptom-free - residual symptoms still count.
Do this instead: Clarify that while medication helps, you still experience [specific symptoms]. Also confirm that you require ongoing medication and monitoring, which itself constitutes a ratable disability.
Impact: 10% to 30% - most commonly causes underrating at lower severity levels
Not disclosing the full range of body systems affected
Why: The thyroid and parathyroid DBQ includes checkboxes for musculoskeletal, cardiovascular, neurological, GI, GU, skin, eye, mental/psychological, and reproductive symptoms. Veterans often focus only on the primary hormonal symptoms and omit secondary system effects.
Do this instead: Before the exam, review every body system that your condition has affected and prepare to discuss each one. Bring any specialist records (cardiologist, neurologist, ophthalmologist, dermatologist) that document thyroid-related complications.
Impact: All levels - secondary conditions may qualify for separate ratings
Failing to mention prior radioactive iodine treatment, surgery, or chemotherapy
Why: Treatment history is a required element of the DBQ and is highly relevant to establishing severity, residuals, and stabilization dates. Residuals from treatment can qualify for their own ratings.
Do this instead: Document all treatments received, including dates, facilities, and outcomes. For malignant neoplasms, the 100% rating applies during treatment and for six months after cessation - knowing this date matters for your claim.
Impact: 100% while active - timing of treatment completion is critical
Not reporting hypercalcemia-related complications for hyperparathyroidism
Why: The VA's rating criteria for hyperparathyroidism hinge significantly on specific hypercalcemia thresholds (calcium levels, bone density, renal function). Failing to document kidney stones, bone density loss, or renal impairment means these severity markers will not appear in the DBQ.
Do this instead: Bring documentation of any kidney stones, DEXA scan results, creatinine/creatinine clearance labs, and hospitalizations for hypercalcemia. Report all related complications explicitly.
Impact: 30% to 60% - can mean the difference between a compensable and non-compensable rating
Prep checklist
- critical
Gather all thyroid/parathyroid lab results
Collect TSH, Free T4, Free T3, thyroid antibodies, PTH, total calcium, ionized calcium, and creatinine clearance results from the past 12-24 months. Include the lab name, date, result, and reference range for each test.
before exam
- critical
Collect all imaging reports
Gather thyroid ultrasound reports, thyroid scan results, CT, MRI, and any DEXA (bone density) scan results. Include radiologist interpretation reports, not just the images.
before exam
- critical
Document complete treatment history
List all treatments including dates: thyroidectomy (full or partial), parathyroidectomy, radioactive iodine ablation (with the condition treated), radiation therapy, chemotherapy, and all medications with start dates and any changes.
before exam
- critical
Prepare a written symptom summary covering your worst days
Write a one-to-two page summary describing your worst days for each symptom category: fatigue, cognitive/mental, cardiovascular, GI, musculoskeletal, skin, eye, and any others. Include frequency and functional impact. Per M21-1 guidance, worst-day reporting is appropriate and accurate.
before exam
- recommended
Request and review your VA claims file (C-file)
Request your C-file through a VA Form 20-5345 or through your VSO to ensure all prior records are in your file. This helps you identify any gaps in documentation before the exam.
before exam
- critical
Bring specialist records
Collect any records from endocrinologists, cardiologists, ophthalmologists, nephrologists, or neurologists who have treated complications of your thyroid or parathyroid condition.
before exam
- critical
Prepare medication list
Create a current list of all medications including name, dose, frequency, prescribing physician, and the condition being treated. Include thyroid replacement (levothyroxine, liothyronine), antithyroid medications (methimazole, PTU), calcium/vitamin D supplements, bisphosphonates, and any cardiac medications prescribed for thyroid-related heart issues.
before exam
- recommended
Document hospitalizations and ER visits
List any hospitalizations or emergency department visits related to your thyroid or parathyroid condition including dates, facilities, and reason for admission (e.g., thyroid storm, hypercalcemic crisis, cardiac arrhythmia).
before exam
- recommended
Research your diagnostic code and rating criteria
Review 38 CFR 4.119 for your specific diagnostic code(s) so you understand what symptoms and thresholds correspond to each rating level. Understanding the criteria helps you ensure all relevant symptoms are communicated.
before exam
- optional
Check your state's exam recording laws
Determine whether your state is a one-party or two-party consent state for audio recording. In most states, veterans have the right to record their C&P exam. If permitted, consider bringing a recording device to ensure accuracy.
before exam
- critical
Bring all documentation in an organized folder
Organize documents chronologically and by category (labs, imaging, treatment records, medications). Bring originals and copies. Do not assume the examiner has reviewed your entire claims file.
day of
- critical
Do not take medications or substances that artificially normalize your presentation
Take your normal prescribed medications as usual. Do not take extra stimulants or suppressants that would alter your heart rate or energy level in a way that does not reflect your typical condition.
day of
- recommended
Arrive early and note the examiner's name and credentials
Arrive 15 minutes early. Note the examiner's full name, specialty, and credentials. This information may be relevant if you need to challenge the exam's adequacy later.
day of
- critical
If in a flare or having a bad day, say so explicitly
If today happens to be a bad day, tell the examiner: 'Today is representative of my condition on a difficult day, which I experience approximately X times per week or month.' Conversely, if today is unusually good, say that too.
day of
- critical
Do not minimize symptoms
When asked about symptoms, describe them fully and accurately. Avoid phrases like 'it's not that bad' or 'I push through it' without also describing what 'pushing through' actually costs you in pain, fatigue, or lost function.
during exam
- critical
Report all body systems affected
The examiner will ask about multiple body systems. Be prepared to discuss cardiovascular, musculoskeletal, neurological, GI, GU, skin, eye, mental health, and reproductive symptoms. Do not skip a system just because it seems minor.
during exam
- critical
Describe the functional impact on work and daily life
The DBQ has a specific section on functional impact. Tell the examiner specifically how your condition limits your ability to work, perform household tasks, drive, socialize, exercise, and sleep. Use concrete examples.
during exam
- critical
Mention all eye symptoms explicitly
Per 38 CFR 4.119 Note 3, eye involvement from thyroid disease (exophthalmos, diplopia, corneal issues, blurred vision) can be separately evaluated. Make sure to report any eye changes so the examiner can check the appropriate boxes and potentially refer for ophthalmology evaluation.
during exam
- recommended
Clarify ongoing medication dependence even if 'controlled'
Ensure the examiner notes that you require continuous medication to maintain thyroid function. A minimum 10% rating applies when daily medication is required to keep hypothyroidism controlled, even if currently asymptomatic.
during exam
- critical
Request a copy of the completed DBQ
You are entitled to receive a copy of the completed DBQ. Request it in writing from the VA regional office or through your VSO. Review it for accuracy, completeness, and any missing symptoms.
after exam
- recommended
Write down everything you remember from the exam
As soon as possible after the exam, write down what questions were asked, what the examiner said, what was examined physically, and approximately how long the exam lasted. This contemporaneous record is valuable if you need to challenge the exam.
after exam
- recommended
Contact your VSO if the exam appears inadequate
If the exam lasted under 10 minutes, the examiner did not review your records, important symptoms were not documented, or the DBQ appears incomplete, contact your VSO or accredited claims agent immediately. You may have grounds to request a new examination.
after exam
Your rights during a C&P exam
- You have the right to a thorough, adequate C&P examination. An inadequate exam (one that does not address all symptoms, is too brief, or does not review available records) can be challenged and a new exam requested.
- You have the right to request a copy of the completed DBQ after the examination. This allows you to review it for errors or omissions before a rating decision is made.
- In most states, you have the right to record your C&P examination with an audio or video device. Check your state's consent laws - in one-party consent states, you can record without informing the examiner.
- You have the right to bring a representative (VSO, accredited claims agent, or attorney) to the C&P exam, though they typically may not speak during the medical portion.
- You have the right to submit a personal statement (buddy statement from you, VA Form 21-4142) and lay statements from family or coworkers describing the functional impact of your condition. These are evidence and must be considered.
- You have the right to submit a nexus letter or independent medical opinion (IMO) from your treating physician if you believe the C&P examiner's opinion is inadequate or incorrect.
- You have the right to appeal a rating decision if you believe the examiner's findings or the VA's rating are inaccurate. Options include a Supplemental Claim, Higher-Level Review, or appeal to the Board of Veterans' Appeals.
- Under the PACT Act, veterans exposed to toxic substances during service may have expanded presumptive eligibility for certain endocrine conditions. Ask your VSO whether any PACT Act presumptions apply to your claim.
- You are not required to accept the first rating decision. The benefit of the doubt standard (38 CFR 3.102) requires that when the evidence is in approximate balance, it must be resolved in your favor.
- Eye conditions separately caused by thyroid disease (e.g., Graves' ophthalmopathy) must be separately evaluated under 38 CFR 4.79 per 38 CFR 4.119 Note 3. You have the right to a separate rating for these conditions.
Related conditions
- Hypothyroidism Primary thyroid condition that may be caused by Hashimoto's thyroiditis, post-radioactive iodine treatment, or post-thyroidectomy; rated under DC 7903 with ratings from 10%-100% based on symptom severity and myxedema status
- Hyperthyroidism / Graves' Disease Primary thyroid condition including Graves' disease; rated under DC 7900; can cause secondary cardiovascular, neurological, and eye complications that may be separately rated
- Hyperthyroid Heart Disease Cardiovascular complication of hyperthyroidism; rated separately under DC 7008 using the appropriate cardiovascular diagnostic code; if heart disease is present, ensure separate evaluation is requested
- Graves' Ophthalmopathy / Thyroid Eye Disease Eye involvement secondary to thyroid disease (Graves' disease); per 38 CFR 4.119 Note 3, must be separately evaluated under 38 CFR 4.79 (e.g., DC 6090 for diplopia, DCs 6061-6066 for visual acuity impairment)
- Thyroiditis (Hashimoto's, Subacute, etc.) Inflammatory thyroid condition rated under DC 7906; rated 0% when euthyroid, but if it causes hypothyroidism or hyperthyroidism, evaluated under the applicable DC (7903 or 7900)
- Hyperparathyroidism Excess parathyroid hormone causing hypercalcemia with complications including kidney stones, osteoporosis, and renal impairment; separate from thyroid conditions but often evaluated on the same DBQ
- Hypoparathyroidism Low parathyroid hormone causing hypocalcemia and tetany; often a complication of thyroid surgery; evaluated on the same DBQ and may qualify for separate rating
- Malignant Neoplasm of the Thyroid Active or treated thyroid cancer rated at 100% during active treatment and for six months following cessation of surgery, radiation, or other therapy; residual conditions rated separately thereafter
- Depression / Anxiety Secondary to Thyroid Condition Mental health conditions caused or worsened by thyroid dysfunction (hypothyroid-related depression, hyperthyroid-related anxiety) may qualify as secondary service-connected conditions; separate mental health DBQ evaluation may be warranted
- Osteoporosis Secondary to Hyperparathyroidism or Hyperthyroidism Bone density loss caused by chronic hypercalcemia (hyperparathyroidism) or excessive thyroid hormone; may be separately ratable as a secondary condition with associated fracture risk and musculoskeletal limitations
Get a personalized prep packet
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.
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.