Diagnostic Code 7911 · 38 CFR §4.119
Addison disease (primary adrenal insufficiency) occurs when the adrenal glands do not produce enough cortisol and aldosterone. Without these essential hormones, the body cannot properly respond to stress, regulate blood pressure, or maintain electrolyte balance. Symptoms include severe fatigue, weight loss, low blood pressure, darkening skin, salt cravings, and potentially life-threatening adrenal crises. Veterans may develop this from autoimmune destruction triggered by service stress, infections affecting the adrenal glands, or as a consequence of stopping long-term steroid medications prescribed during service.
| Rating | Criteria |
|---|---|
| 60% | Four or more Addisonian crises during the past year. A crisis is defined as rapid onset of peripheral vascular collapse with acute hypotension and shock, potentially including loss of appetite, nausea, vomiting, dehydration, profound weakness, pain in abdomen, legs, and back, fever, depressed mental state with possible progression to coma, kidney shutdown, and death. |
| 40% | Three crises during the past year, OR five or more Addisonian episodes during the past year. An episode is less acute than a crisis and may involve loss of appetite, nausea, vomiting, diarrhea, dehydration, weakness, malaise, orthostatic hypotension, or low blood sugar, but without peripheral vascular collapse. |
| 20% | 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. This is the baseline rating for veterans on daily replacement steroids. |
Lab tests showing low cortisol and high ACTH (for primary disease) confirm the diagnosis. ACTH stimulation test results provide definitive evidence. Treatment records showing steroid replacement dosing demonstrate management needs. Records of adrenal crises (ER visits, hospitalizations) are critical for higher ratings — the specific number of crises and episodes per year directly determines the rating level. Documentation of episodes (less severe events with nausea, weakness, low blood pressure) also matters for the 40% level.
The VA defines these differently and counts them separately. A crisis involves rapid onset of peripheral vascular collapse with acute hypotension and shock, potentially progressing to coma or death. An episode is less severe — it may include nausea, vomiting, weakness, and low blood pressure, but without vascular collapse. Four or more crises per year earns 60%, while five or more episodes earns 40%.
Yes. Primary Addison disease (autoimmune destruction of the adrenal glands) is irreversible and requires lifelong hormone replacement. The VA should assign a permanent rating for this condition. If your rating is not already designated as permanent, request a review.
The CFR has a special note: tuberculous Addison disease is evaluated as active or inactive tuberculosis. If inactive, the VA assigns either the tuberculosis rating or the Addison disease rating, whichever is higher — they are not combined.