Reference: 38 CFR 4.119

Sources & Related Guides

What is the VA rating for Addison's Disease and Pheochromocytoma?

Understand Addison's Disease and Pheochromocytoma guidance under DC 7911 (Addison's disease, a real computable 60/40/20 crisis-and-episode ladder) and DC 7918 (Pheochromocytoma, disclosure-only, an open dispatch to a malignant or benign endocrine neoplasm code naming no residual destination), per COND-078.

What is Addison's Disease and Pheochromocytoma?

38 CFR 4.119 covers two diagnostic codes for these adrenal-gland conditions. DC 7911 (Addison's disease, adrenocortical insufficiency) is a real, independently computable 3-tier ladder (60/40/20 percent) keyed to the documented number of Addisonian crises and episodes during the past year, weakness and fatigability, and whether corticosteroid therapy is required for control. DC 7918 (pheochromocytoma, benign or malignant) carries no percentage of its own -- its entire text directs evaluators to "evaluate as malignant or benign neoplasm as appropriate," routing into DC 7914 (malignant endocrine neoplasm) or DC 7915 (benign endocrine neoplasm), neither of which names a destination code for the resulting residual rating. RatingScope computes DC 7911's crisis/episode ladder and discloses, but does not compute, DC 7918's entire open dispatch.

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Overview

How VA rates Addison's disease and pheochromocytoma

38 CFR 4.119 covers two diagnostic codes for these adrenal-gland conditions. DC 7911 (Addison's disease, adrenocortical insufficiency) is a real, independently computable 3-tier ladder (60/40/20 percent) keyed to the documented number of Addisonian crises and episodes during the past year, weakness and fatigability, and whether corticosteroid therapy is required for control. DC 7918 (pheochromocytoma, benign or malignant) carries no percentage of its own -- its entire text directs evaluators to "evaluate as malignant or benign neoplasm as appropriate," routing into DC 7914 (malignant endocrine neoplasm) or DC 7915 (benign endocrine neoplasm), neither of which names a destination code for the resulting residual rating. RatingScope computes DC 7911's crisis/episode ladder and discloses, but does not compute, DC 7918's entire open dispatch.

This guide is educational only. RatingScope does not diagnose Addison's disease or pheochromocytoma, does not infer a confirmed diagnosis, does not determine service connection, and does not predict a VA decision. This hub computes only DC 7911's 60/40/20 crisis-and-episode ladder. DC 7911's Note (3) (tuberculous Addison's disease, tuberculosis now inactive) is disclosed as a temporary sourcing gap, not computed: it requires comparing the resulting rating against 38 CFR 4.88b's non-pulmonary tuberculosis ratings and assigning the higher of the two, and RatingScope has not yet independently sourced 38 CFR 4.88b under its verification standard. DC 7918's entire text is disclosure-only and never computed, since neither DC 7914 nor DC 7915 names a destination code for the resulting residual rating.

Percentage Guides

Understanding Your Percentage

Select a pathway to see what the published criteria ask about, what records may clarify it, and what should not be assumed.

60%

Highest listed pathway

The 60% level applies to Addison's disease with four or more Addisonian crises documented during the past year.

What separates the next level: Three crises (rather than four or more) reaches only the 40 percent tier, even if five or more episodes are also documented -- four or more crises is this tier's own independent threshold.

Review CFR criteria, examples, and evidence
Official CFR language
Four or more crises during the past year -- 60 percent. Note (1): An Addisonian "crisis" consists of the rapid onset of peripheral vascular collapse (with acute hypotension and shock), with findings that may include: anorexia; nausea; vomiting; dehydration; profound weakness; pain in abdomen, legs, and back; fever; apathy, and depressed mentation with possible progression to coma, renal shutdown, and death.
Qualification explanation
Reached when the documented record shows four or more Addisonian crises, as Note (1) defines a crisis, within the past year.
Examples
Records documenting four or more distinct episodes of rapid-onset peripheral vascular collapse with acute hypotension and shock within the past 12 months.
Medical evidence
Endocrinology treatment records; Emergency or hospitalization records documenting each crisis; Cortisol and ACTH stimulation test results confirming adrenocortical insufficiency
Functional impact examples
Four or more hospitalizations or emergency treatments for acute adrenal crisis within the past year.
Common misconceptions
A general history of Addison's disease does not by itself reach 60 percent -- the count of Note (1)-defined crises within the past year is what this tier requires.
Related topics
Addisonian crisis; adrenocortical insufficiency; past-year crisis count
Source context
38 CFR 4.119; 7911; Confirmed via Cornell LII, eCFR versioner API, and govinfo XML, cross-checked. The Federal Register final rule 2017-23044 (89 FR ... published Nov. 2, 2017) revised DC 7907-7919 including DC 7911; no amendment since found via a direct Federal Register API search for 38 CFR 4.119 documents.

40%

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The 40% level applies to Addison's disease with three crises during the past year, or five or more episodes during the past year.

What separates the next level: One or two crises, or two to four episodes, reaches only the 20 percent tier. Four or more crises reaches the higher 60 percent tier regardless of episode count.

Review CFR criteria, examples, and evidence
Official CFR language
Three crises during the past year, or; five or more episodes during the past year -- 40 percent. Note (2): An Addisonian "episode," for VA purposes, is a less acute and less severe event than an Addisonian crisis and may consist of anorexia, nausea, vomiting, diarrhea, dehydration, weakness, malaise, orthostatic hypotension, or hypoglycemia, but no peripheral vascular collapse.
Qualification explanation
Reached by either three Note (1)-defined crises within the past year, or five or more Note (2)-defined episodes within the past year -- either path independently qualifies.
Examples
Records documenting three distinct Addisonian crises within the past 12 months.; Records documenting five or more less-acute episodes (without peripheral vascular collapse) within the past 12 months.
Medical evidence
Endocrinology treatment records; Records documenting each crisis or episode and its date; Cortisol and ACTH stimulation test results
Functional impact examples
Three hospitalizations or emergency treatments for acute adrenal crisis, or five or more less-severe symptomatic episodes, within the past year.
Common misconceptions
Episodes and crises are not interchangeable -- Note (1) and Note (2) define them differently, with peripheral vascular collapse present only in a crisis.
Related topics
Addisonian episode; adrenocortical insufficiency
Source context
38 CFR 4.119; 7911; Confirmed via Cornell LII, eCFR versioner API, and govinfo XML, cross-checked.

20%

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The 20% level applies to Addison's disease with one or two crises, or two to four episodes, or weakness and fatigability, or corticosteroid therapy required for control.

What separates the next level: This is the lowest compensable tier DC 7911 states; the regulation names no lower percentage of its own.

Review CFR criteria, examples, and evidence
Official CFR language
One or two crises during the past year, or; two to four episodes during the past year, or; weakness and fatigability, or; corticosteroid therapy required for control -- 20 percent.
Qualification explanation
Reached by any one of four independent paths: one or two crises within the past year, two to four episodes within the past year, documented weakness and fatigability, or a documented ongoing requirement for corticosteroid therapy to control the condition.
Examples
Records documenting one or two Addisonian crises within the past year.; Records documenting two to four less-severe episodes within the past year.; Records documenting ongoing weakness and fatigability attributed to Addison's disease.; A prescription record showing corticosteroid therapy is required to control the condition.
Medical evidence
Endocrinology treatment records; Prescription/medication records documenting corticosteroid therapy; Clinical notes documenting weakness and fatigability
Functional impact examples
Requiring daily corticosteroid medication to control adrenal insufficiency.; Persistent weakness and fatigability limiting daily activity.
Common misconceptions
Corticosteroid therapy being required does not need an accompanying crisis or episode count -- it is its own independent qualifying path at this tier.
Related topics
corticosteroid therapy; weakness and fatigability
Source context
38 CFR 4.119; 7911; Confirmed via Cornell LII, eCFR versioner API, and govinfo XML, cross-checked.

Learn

Understand the details behind the criteria

Use these short guides to connect published terms with the records and observations that may clarify them.

DC 7911's Notes (1) and (2) define "crisis" and "episode" differently

DC 7911's crisis/episode ladder depends entirely on which of these two defined terms applies to a given documented event -- a crisis involves peripheral vascular collapse, an episode does not.

  • Note (1), verbatim: "An Addisonian 'crisis' consists of the rapid onset of peripheral vascular collapse (with acute hypotension and shock), with findings that may include: anorexia; nausea; vomiting; dehydration; profound weakness; pain in abdomen, legs, and back; fever; apathy, and depressed mentation with possible progression to coma, renal shutdown, and death."
  • Note (2), verbatim: "An Addisonian 'episode,' for VA purposes, is a less acute and less severe event than an Addisonian crisis and may consist of anorexia, nausea, vomiting, diarrhea, dehydration, weakness, malaise, orthostatic hypotension, or hypoglycemia, but no peripheral vascular collapse."
  • This hub asks separately for the documented count of crises and the documented count of episodes during the past year, since either path can independently reach the 40 percent or 20 percent tier.

Records to review: Endocrinology and hospitalization records documenting each event and its date; Clinical notes distinguishing peripheral vascular collapse (crisis) from a less severe event (episode).

Tuberculous Addison's disease: a disclosed sourcing gap, not a computed comparison

DC 7911's Note (3) requires comparing a tuberculosis-caused Addison's disease rating against 38 CFR 4.88b's non-pulmonary tuberculosis ratings and assigning the higher. RatingScope has not yet independently sourced 38 CFR 4.88b under its verification standard, so this comparison is disclosed rather than computed.

  • Note (3), verbatim: "Tuberculous Addison's disease will be evaluated as active or inactive tuberculosis. If inactive, these evaluations are not to be combined with the graduated ratings of 50 percent or 30 percent for non-pulmonary tuberculosis specified under § 4.88b. Assign the higher rating."
  • This is a mechanical two-evaluation comparison the regulation itself defines (evaluate as active or inactive tuberculosis, compare against 38 CFR 4.88b's 50 percent or 30 percent non-pulmonary tuberculosis ratings, assign the higher), not an inherently ambiguous judgment call.
  • The reason this cannot be computed today is a missing input, not an ambiguity: RatingScope has not yet independently sourced 38 CFR 4.88b under its own verification standard (docs/RSCH_STANDARD.md). This is a temporary sourcing gap, and this hub will be updated once that section is sourced.
  • When a veteran's Addison's disease is documented as tuberculosis-caused with the tuberculosis now inactive, this hub stops and discloses this gap. It does not silently compute a result under Note (3), and it does not silently fall through to the ordinary 60/40/20 crisis/episode ladder either, since the §4.88b comparison could change the outcome.
  • Section 4.88b is a recurring unresourced cross-reference target across this repository -- other diagnostic codes (including in Skin, Eye, and Genitourinary conditions) route to the same section for the same reason, and it is a documented candidate for its own future dedicated sourcing pass.

Records to review: Records documenting the cause of Addison's disease as tuberculosis; Records documenting whether the underlying tuberculosis is currently active or inactive.

DC 7918 (pheochromocytoma) has no percentage of its own

DC 7918's own text carries no rating table for either a benign or malignant pheochromocytoma. It directs evaluators to rate as a malignant or benign endocrine neoplasm as appropriate -- an open dispatch RatingScope discloses but does not compute, for either branch.

  • DC 7918's text, verbatim, in full: "Evaluate as malignant or benign neoplasm as appropriate."
  • The malignant branch routes to DC 7914 (Neoplasm, malignant, any specified part of the endocrine system), which rates 100 percent during active treatment and for six months after treatment ends, verbatim Note: "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. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of § 3.105(e) of this chapter. If there has been no local recurrence or metastasis, rate on residuals." DC 7914 names no destination code for the post-six-month residual rating.
  • The benign branch routes to DC 7915 (Neoplasm, benign, any specified part of the endocrine system), whose entire text, verbatim, is: "Rate as residuals of endocrine dysfunction." DC 7915 names no destination code at all.
  • Because neither DC 7914 nor DC 7915 names a destination code for pheochromocytoma's own resulting residual rating, this is a genuinely open dispatch to an unnamed code, not a temporary sourcing gap the way DC 7911's Note (3) is -- the same category of thing RatingScope refuses to guess at, mirroring the treatment already used for DC 6820 (Respiratory Neoplasms) and DC 6820's own precedent, DC 7346/Hiatal Hernia.
  • No registry row, evaluator, or intake wiring exists for DC 7918's own rating, for either the malignant or benign branch.

Records to review: Pathology confirming pheochromocytoma as malignant or benign; Records documenting treatment type, dates, and any cessation date, for the malignant branch's active-treatment window.

No pending rulemaking found for 38 CFR 4.119

A direct check of the Federal Register for VA rulemaking touching 38 CFR 4.119, and of this repository's own tracked pending-rule list (RIN 2900-AQ72, AQ73, and AQ82), found no pending amendment to the Endocrine System schedule.

  • A direct Federal Register API search for VA documents referencing 38 CFR 4.119 returned only already-final rulemakings, the most recent being the final rule published Nov. 2, 2017 (document 2017-23044), which revised DC 7907 through 7919 -- covering both DC 7911 and DC 7918 -- and a 2015 proposed rule that preceded it. No document proposing a further amendment was found.
  • RIN 2900-AQ72 (ENT/Audiology and Respiratory), RIN 2900-AQ73 (Neurological Conditions), and RIN 2900-AQ82 (Mental Disorders), this repository's three highest-priority tracked pending rules, are each scoped to CFR sections other than 38 CFR 4.119 and do not touch the Endocrine System schedule.
  • This hub is built on the current, in-force regulatory text and will be updated in a future work order if and when any amendment to 38 CFR 4.119 is proposed or finalized.

Records to review: .

Evidence

Evidence that may clarify the published criteria

Endocrinology diagnosis and treatment records

Records confirming an Addison's disease or pheochromocytoma diagnosis, and documenting each Addisonian crisis or episode and its date, or pheochromocytoma treatment type and dates.

A diagnosis alone does not establish a specific tier without the documented crisis/episode count, weakness/fatigability, or corticosteroid therapy facts DC 7911 requires.

Cortisol and ACTH stimulation test results

Supports confirmation of adrenocortical insufficiency underlying an Addison's disease diagnosis.

Lab confirmation of the diagnosis does not by itself establish crisis or episode counts.

Pathology results

Confirms whether a pheochromocytoma is malignant (DC 7914 branch) or benign (DC 7915 branch), and whether Addison's disease is tuberculosis-caused.

Do not assume malignancy, benignity, or a tuberculous cause without documented pathology or clinical confirmation.

Endocrine Diseases (Other than Thyroid, Parathyroid, or Diabetes Mellitus) DBQ (VA Form 21-0960E-2) or examination records

May document the diagnosis, crisis/episode history, weakness and fatigability, corticosteroid therapy requirement, and tuberculous-cause status relevant to DC 7911, or pheochromocytoma treatment status relevant to DC 7918's dispatch.

A DBQ or exam record helps organize facts, but RatingScope still reviews only the facts provided.

DBQ

Addison's Disease and Pheochromocytoma exam findings to look for

This DBQ guide helps veterans find relevant fields. It does not diagnose Addison's disease or pheochromocytoma, decide service connection, or predict a VA decision.

  • The documented count of Addisonian crises and episodes during the past year
  • Whether weakness and fatigability, or a corticosteroid therapy requirement, are documented
  • Whether the Addison's disease is tuberculosis-caused, and whether that tuberculosis is currently active or inactive
  • Whether pheochromocytoma is documented as malignant or benign, and its treatment status

Terminology

Plain-English terms

Addisonian crisis

A severe, acute adrenal-insufficiency event. Four or more within the past year reaches 60 percent; three reaches 40 percent; one or two reaches 20 percent.

Distinguishing a crisis from a less severe episode determines which tier applies.

Addisonian episode

Five or more within the past year reaches 40 percent (independent of crisis count); two to four reaches 20 percent.

Episodes provide an independent path to the 40 percent and 20 percent tiers even without the corresponding crisis count.

Tuberculous Addison's disease (DC 7911 Note (3))

RatingScope discloses this as a temporary sourcing gap (38 CFR 4.88b not yet independently sourced) rather than computing it or defaulting to the ordinary ladder.

A documented tuberculous cause with inactive tuberculosis routes to a disclosure, not a computed tier.

Pheochromocytoma (DC 7918)

DC 7918 has no percentage of its own. Neither DC 7914 nor DC 7915 names a destination code for the resulting residual rating, so this code cannot be independently computed.

This code is disclosure-only in this hub, for both the malignant and benign branches.

TDIU

Even if the schedular rating for Addison's Disease and Pheochromocytoma does not reach 100 percent, TDIU may still provide a pathway to compensation at the 100 percent rate, based on unemployability from this and/or other service-connected disabilities combined.

A lower schedular percentage does not by itself foreclose TDIU eligibility -- this hub computes only the schedular percentage for this specific condition and does not determine TDIU eligibility.

Employment history; vocational impact documentation; occupational impairment

Common Questions

Questions veterans commonly ask

How does VA rate Addison's disease?

DC 7911 rates Addison's disease on a 60/40/20 percent ladder based on the documented number of Addisonian crises and episodes during the past year, weakness and fatigability, and whether corticosteroid therapy is required for control. 60 percent requires four or more crises; 40 percent requires three crises or five or more episodes; 20 percent requires one or two crises, two to four episodes, weakness and fatigability, or a corticosteroid therapy requirement.

What counts as a crisis versus an episode?

Note (1) defines a crisis as the rapid onset of peripheral vascular collapse with acute hypotension and shock. Note (2) defines an episode as a less acute, less severe event without peripheral vascular collapse. Both counts are tracked separately because either can independently reach the 40 percent or 20 percent tier.

What happens if my Addison's disease is caused by tuberculosis?

DC 7911's Note (3) requires comparing the resulting rating against 38 CFR 4.88b's non-pulmonary tuberculosis ratings (50 percent or 30 percent) and assigning the higher, once the tuberculosis is inactive. RatingScope has not yet independently sourced 38 CFR 4.88b under its verification standard, so this comparison is disclosed as a temporary sourcing gap rather than computed, and does not fall through to the ordinary crisis/episode ladder.

How does VA rate pheochromocytoma?

DC 7918's text carries no percentage of its own: "Evaluate as malignant or benign neoplasm as appropriate." This routes to DC 7914 (malignant) or DC 7915 (benign), and neither of those codes names a destination code for the resulting residual rating, so this is an open dispatch RatingScope discloses but does not compute.

Is a rule change coming?

No pending VA rulemaking touching 38 CFR 4.119 was found in a direct Federal Register check, and this section is outside the scope of the three highest-priority rulemakings this repository already tracks (RIN 2900-AQ72, AQ73, and AQ82). The most recent amendment to DC 7911 and DC 7918 is a final rule published Nov. 2, 2017.

If my schedular rating for Addison's Disease and Pheochromocytoma is below 100%, can I still be compensated at the 100% rate?

Possibly, through TDIU (Total Disability rating based on Individual Unemployability, 38 CFR 4.16) -- a separate pathway to 100 percent compensation based on unemployability, from this and/or other service-connected disabilities combined, independent of whether the schedular rating itself reaches 100 percent. This hub computes only the schedular percentage and does not determine TDIU eligibility.

Preparation

What to have nearby

  • Crisis and episode counts, and dates

    DC 7911's ladder is keyed to the documented number of Note (1) crises and Note (2) episodes within the past year.

  • Weakness/fatigability and corticosteroid therapy documentation

    Each is an independent path to DC 7911's 20 percent tier, even without a qualifying crisis or episode count.

  • Tuberculous-cause status, if applicable

    A documented tuberculous cause with the tuberculosis now inactive routes to a disclosed sourcing-gap message rather than a computed ladder tier.

  • Pheochromocytoma diagnosis and treatment records, if applicable

    Needed context for DC 7918's disclosed open dispatch to a malignant or benign neoplasm analogy, which this hub does not compute.

Ready when you are

Addison's Disease and Pheochromocytoma record comparison

RatingScope's assessment computes only DC 7911's 60/40/20 crisis-and-episode ladder. DC 7911's Note (3) tuberculous-Addison's-disease comparison against 38 CFR 4.88b is disclosed as a sourcing gap, not computed. DC 7918 (pheochromocytoma) is disclosure-only in full; neither its malignant nor benign branch is computed.

Informational guidance only. RatingScope does not predict, decide, or guarantee VA outcomes.

Try the Addison's Disease record comparison

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Continue Understanding

38 CFR 4.119, DC 7911 and DC 7918

Primary source for DC 7911 and DC 7918's current text.

Open resource

Cornell LII, 38 CFR 4.119

Independent cross-check source for DC 7911 and DC 7918's current text.

Open resource

Thyroid and Parathyroid Disorders guide

Sibling hub within the same 38 CFR 4.119 Endocrine System schedule.

Open resource

Tuberculosis guide

Relevant to DC 7911's Note (3) active/inactive tuberculosis evaluation.

Open resource

38 CFR 4.16 - Total disability ratings for compensation based on unemployability (TDIU)

Official source for TDIU, a separate pathway to 100 percent compensation based on unemployability, independent of the schedular percentage. This hub does not determine TDIU eligibility.

Open resource

Secondary conditions

Conditions commonly connected to Addison's Disease and Pheochromocytoma

No commonly documented secondary connections are tracked for Addison's Disease and Pheochromocytoma yet.

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