Thyroid Cancer

Thyroid cancer is rated at 100 percent under 38 CFR § 4.119, Diagnostic Code 7914, malignant neoplasm of any specified part of the endocrine system. That much is well covered elsewhere.

What is not well covered is what happens next. The 100 percent does not last, the examination that ends it is mandatory rather than discretionary, and the hypothyroidism code that nearly every treated veteran lands on is itself time-limited. I see the same wrong assumption repeated across the search results for this condition: that lifelong thyroid hormone replacement holds a 30 percent rating indefinitely. Under the criteria in force since December 10, 2017, it does not.

TL;DR

• DC 7914 assigns 100 percent for a malignant endocrine neoplasm, including thyroid cancer.
• The 100 percent continues beyond the end of surgery, radioiodine, chemotherapy, or other treatment.
• Six months after treatment stops, a mandatory VA examination sets the new evaluation.
• Any reduction from that examination must follow 38 CFR § 3.105(e), which requires notice and a chance to respond.
• If there is no local recurrence or metastasis, VA rates residuals.
• The usual residual is hypothyroidism under DC 7903. Its 30 percent level runs for six months after initial diagnosis, then VA rates residual effects under their own body-system codes.
• Being on levothyroxine is not a rating criterion at any level of DC 7903.
• Thyroid cancer is on the radiation-exposed veteran presumptive list at 38 CFR § 3.309(d)(2)(ii).

The 100 Percent Under DC 7914

DC 7914 covers malignant neoplasms of any specified part of the endocrine system. Papillary, follicular, medullary, and anaplastic thyroid carcinoma all fall inside it. The percentage does not vary by cell type, stage, or treatment intensity while the code applies.

The note attached to DC 7914 controls the timing:

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.

Three things follow from that sentence. The clock starts when treatment stops, not when the cancer is declared in remission. The examination is mandatory, so VA is obligated to schedule it. And the evaluation that comes out of it is a new rating decision, subject to § 3.105(e) if it lowers your percentage.

There is a related code worth knowing. DC 7919 covers C-cell hyperplasia of the thyroid. If antineoplastic therapy is required, VA evaluates it as a malignant neoplasm under DC 7914. If a prophylactic thyroidectomy is performed based on genetic testing and antineoplastic therapy is not required, VA evaluates it as hypothyroidism under DC 7903 instead.

What Happens at Six Months

If there has been no local recurrence or metastasis, VA rates on residuals. For most veterans that means hypothyroidism, because a total thyroidectomy or radioiodine ablation removes the gland's function.

Here is the part that the guides get wrong. Current DC 7903 has exactly two levels:

100 percent. Hypothyroidism manifesting as myxedema, meaning cold intolerance, muscular weakness, cardiovascular involvement (including hypotension, bradycardia, and pericardial effusion), and mental disturbance (including dementia, slowing of thought, and depression). Note (1) continues this evaluation for six months beyond the date an examining physician determines crisis stabilization, after which residual effects are rated under the appropriate body-system codes.

30 percent. Hypothyroidism without myxedema. Note (2) reads: "This evaluation shall continue for six months after initial diagnosis. Thereafter, rate residuals of disease or medical treatment under the most appropriate diagnostic code(s) under the appropriate body system."

The 30 percent is a window, not a destination. It expires six months after the hypothyroidism is first diagnosed. After that, VA rates whatever residual effects the record documents, each under its own code in its own body system. Eye, digestive, and mental disorders are the examples the regulation itself gives.

A veteran on well-controlled hormone replacement with no documented residual effects can therefore land at 0 percent for the thyroid itself. That is not an error by the rater. It is what the current criteria say. The tiered fatigability and constipation ladder that produced durable 30, 60, and 100 percent hypothyroidism ratings was replaced by the December 10, 2017 endocrine amendment.

The Residuals Worth Documenting

Because the percentage after the windows close depends entirely on documented residual effects, the useful work happens before the examination, not after the decision.

• Hypoparathyroidism. If the parathyroid glands were damaged or removed during thyroidectomy, DC 7905 applies. It assigns 100 percent for three months after initial diagnosis, then rates chronic residuals such as nephrolithiasis, cataracts, decreased renal function, and congestive heart failure under their own codes. Note the window here is three months, not six.
• Voice impairment. Recurrent laryngeal nerve injury during surgery causes hoarseness or vocal cord paralysis. Rate under the larynx codes in § 4.97.
• Neck scarring. Surgical scars of the head, face, or neck are rated under DC 7800. This is separate from the endocrine evaluation.
• Cardiovascular, mental, digestive, and eye effects. These are the categories § 4.119 points to by name. Each needs a diagnosis and findings in the record, not just a symptom mentioned in passing.

Ask the endocrinologist to document specific measured effects during the six-month window, while the 30 percent is still in place. A note that says "patient stable on levothyroxine" supports nothing after the window closes. A note that records documented cognitive slowing, a cardiac finding, or a measured calcium abnormality supports a rating under a code that has no expiration.

Service Connection: The Radiation Routes

Thyroid cancer has two radiation pathways, and they work differently.

Section 3.309(d), the radiation-exposed veteran presumption. Cancer of the thyroid is listed at § 3.309(d)(2)(ii). If you participated in a radiation-risk activity as that term is defined at § 3.309(d)(3), the disease is presumed service connected, subject to § 3.307. No dose reconstruction and no nexus opinion are required.

The definition is narrow and worth reading rather than assuming. Radiation-risk activity means onsite participation in a test involving the atmospheric detonation of a nuclear device; the occupation of Hiroshima or Nagasaki by United States forces between August 6, 1945 and July 1, 1946; internment as a prisoner of war in Japan under comparable exposure conditions; and certain service at named gaseous diffusion plants. Working near a radiation source in a general sense does not qualify.

Section 3.311, the radiogenic disease route. Thyroid cancer is listed as a radiogenic disease at 38 CFR § 3.311(b)(2)(ii). This route is for ionizing radiation exposure that does not meet the § 3.309(d) definition. VA must obtain a dose estimate and refer the claim for a causation opinion. That development is mandatory, so a decision that skips it is worth appealing on procedure alone.

Direct service connection. Under 38 CFR § 3.303, a thyroid nodule documented in service and later confirmed malignant can support direct service connection with a medical opinion on onset timing. Section 3.303(d) allows service connection for a disease first diagnosed after separation when the evidence establishes it was incurred in service.

Common Failure Modes

• Assuming the 100 percent is permanent because the cancer was serious.
• Missing the mandatory six-month examination and treating the resulting reduction as final.
• Accepting a reduction that did not follow the § 3.105(e) notice procedure.
• Believing that a lifelong levothyroxine prescription holds a 30 percent rating.
• Letting the DC 7903 six-month window pass without documenting specific residual effects.
• Missing hypoparathyroidism, voice impairment, or neck scarring as separately ratable residuals.
• Assuming any radiation exposure meets the § 3.309(d) radiation-risk activity definition.
• Letting VA skip the § 3.311 dose estimate when § 3.309(d) does not apply.

Bottom Line

Thyroid cancer pays 100 percent while it is being treated and for six months afterward. What you hold after that depends on what the record documents, not on what you take daily. The two six-month windows, one under DC 7914 and one under DC 7903, are the whole game. Use them to build a residual-by-residual record under codes that do not expire, and check whether a radiation route applies to your service before you rely on a direct nexus opinion.

Related Conditions and Tools

Compare hypothyroidism, hyperthyroidism, and scars. Review DC 7903 for the residual code you are most likely to be rated under, and organize treatment records and residual findings with the Statement Builder and the C&P Exam Prep tool.

Legal sources: 38 CFR § 4.119, § 3.309, § 3.311, § 3.105, and § 3.303, checked against the eCFR snapshot for August 14, 2026.