Type 2 Diabetes and VA Disability Compensation
What is Diabetes Mellitus Type 2 (Type II Diabetes)?
Type 2 diabetes is a chronic condition that causes a person to experience increased blood glucose levels due to insulin resistance or deficiency. The severity of this condition varies on a case-by-case basis. Some people are able to control their type 2 diabetes with a restricted diet, whereas others may find it difficult to control blood sugar levels, even with regular insulin injections. As type 2 diabetes progresses, blood sugar may become harder to control, resulting in complications that can lead to an increased degree of disability.
How Does the VA Rate Type 2 Diabetes?
Diabetes mellitus type 2 is rated by the VA under 38 CFR 4.119, Diagnostic Code 7913; under this schedule, Veterans can be assigned a 100%, 60%, 40%, 20% or 10% disability rating. Ratings for diabetes vary among veterans based on the progression or severity of their condition. Below are the criteria VA has set in place to rate veterans with type 2 diabetes:
100% disability ratings are reserved for veterans who:
- Require insulin injections more than once per day;
- Must remain on a restricted diet;
- Need to regulate their activity (such as avoiding “strenuous occupational and recreational activities”);
- Are hospitalized three or more times per year or require “weekly visits to a diabetic care provider” due to hypoglycemic reactions or episodes of ketoacidosis;
- Are experiencing progressive weight loss or strength reduction; OR complications that “would be compensable if separately evaluated.”
60% disability ratings are assigned to veterans who:
- Need one or more injection(s) of insulin daily;
- Require a restricted diet;
- Require regulated activity;
- Experience hypoglycemic reactions or episodes of ketoacidosis that render them hospitalized once or twice per year, or warrant “twice a month visits to a diabetic care provider”
- Are suffering complications NOT compensable if evaluated separately.
40% schedular ratings are given to veterans who:
- Need one or more insulin injection(s) daily;
- Require a restricted diet;
- Require regulated activity.
20% ratings are assigned to veterans who:
- Require insulin injections one or more time(s) daily;
- Require a restricted diet; OR
- Need to take an oral hypoglycemic agent while also remaining on a restricted diet.
10% ratings are awarded if the veteran can manage their blood sugar levels using only a restricted diet.
Service Connection for Type 2 Diabetes and Agent Orange Exposure
Diabetes mellitus type 2 is included on VA’s list of presumptive conditions associated with exposure to Agent Orange or other herbicides. Veterans who served in the following areas during the specified time periods and later developed diabetes mellitus type 2 do not have to prove a connection between their condition and military service to receive disability compensation or VA healthcare:
- Veterans with “boots on the ground” and those serving on inland waterways in Vietnam between January 9, 1962 and May 7, 1975;
- “Blue Water” Navy Veterans who served within 12 nautical miles seaward of the demarcation line of Vietnam between January 9, 1962 and May 7, 1975;
- Veterans “who flew on or worked on C-123 aircraft” during the Vietnam War era;
- Veterans who served along the Korean Demilitarized Zone (Korean DMZ) between September 1, 1967 and August 31, 1971;
- Veterans who served on or near Thailand military bases between February 28, 1961 and May 7, 1975 and can prove they were near the perimeter of the base where Agent Orange was used.
Instead, VA will presume that your type 2 diabetes was caused by your in-service exposure to herbicide agents. As a result, service connection should be awarded on a presumptive basis. Importantly, veterans who served on or near the perimeter of certain Thailand military bases between February 28, 1961 and May 7, 1975 may also be eligible for presumptive service connection if other requirements are met
This is not an all-encompassing list of qualified veterans. For more information on Agent Orange in Thailand, read our report “The Truth about Agent Orange in Thailand.”
Service-Connected Conditions That Can Cause Type 2 Diabetes
Another way to establish service connection for type 2 diabetes is on a secondary basis. Secondary service connection means getting service connection for a condition that developed as a result of an already service-connected condition. One of the most common ones that we see is the development of diabetes being caused by sleep disorders or sleep apnea. VA and the Department of Defense (DoD) did a study that showed individuals with sleep apnea or poor sleep quality typically develop diabetes. For sleep apnea specifically, the risk of developing diabetes increases by 78 percent. Those that have trouble sleeping had a 21 percent increase in terms of a risk of developing diabetes. Therefore, there is a significant connection between the two conditions.
Another example of secondary service connection for type 2 diabetes involves medications that may be prescribed to you to treat things like high cholesterol or a heart condition. If you are already service-connected for a heart condition, there may be certain medications that you are taking for that condition that can actually increase the risk of diabetes as well. There is medical literature that supports that possible connection. As such, it is something to keep in mind when applying for benefits for your type 2 diabetes.
Obesity as an Intermediary Step: VA Secondary Service Connection for Diabetes
As a general matter, obesity is not actually a disability for VA compensation purposes. In other words, you cannot receive service connection for obesity; however, you can use obesity as an intermediate step to get secondary service connection. This is important when discussing secondary service connection for type 2 diabetes, because type 2 diabetes and obesity are actually linked. If you have obesity, you are more prone to develop type 2 diabetes.
Many veterans experience this for multiple reasons, whether they have different service-connected conditions that preclude exercise or they are on certain medications that cause weight gain. For example, you have a service-connected knee condition that prevents you from being able to move around a lot. As a result, you become obese, and as a result of obesity, you develop type 2 diabetes. As long as the knee condition is service-connected, diabetes can be service connected as well.
Due to the chronic nature of type 2 diabetes, complications can develop that may warrant separate disability ratings for secondary conditions. Secondary conditions stemming from type 2 diabetes must be “at least as likely as not” caused or aggravated by diabetes in order for a veteran to be compensated for them. To be rated separately for secondary conditions or complications, the conditions must not have been considered in your initial rating decision. Below are some secondary conditions that can emerge when type 2 diabetes progresses or is uncontrolled:
- Diabetic Peripheral neuropathy (nerve damage)
- Renal (kidney) dysfunction
- Diabetic Retinopathy
- Erectile Dysfunction
- Cardiac Conditions such as coronary artery disease, heart attack, stroke
- Hypertension (high blood pressure)
- Peripheral Vascular Disease (narrowed blood vessels)
- Skin Conditions
- Eye conditions other than diabetic retinopathy, such as cataracts
Evidence Veterans Can Use to Support Their VA Disability Claim
There are many types of evidence that veterans can submit in conjunction with their claims for type 2 diabetes. Arguably the most important form of evidence is medical evidence, whether it is from your VA treating provider or your own private physician. The reason for this is that the rating criteria is very technical. It has to do with what you are prescribed and what you are required to do in order to control your condition. While lay evidence may be helpful in certain situations, it is more beneficial to get medical evidence.
Private Medical Opinions for Veterans’ Diabetes Claims
Oftentimes, the results of the VA exam are unfavorable. If this is the case, you have the right to obtain your own outside medical opinion from a private healthcare provider. This may be especially helpful when you are trying to link your diabetes to an already service-connected condition. Since you are going to need a strong medical nexus opinion, getting a private medical opinion might help you establish that element of service connection.
Again, type 2 diabetes is a more specialized condition and is not really capable of lay observation. For example, it is not like a knee condition in which you can observe the pain or limitation of motion. With diabetes, you need a statement from a doctor to outline the severity of the condition.
Was your VA Disability Claim for Type 2 Diabetes Denied?
Often times, veterans must go through one or many denials in order to be awarded the VA disability benefits to which they are entitled. If your VA disability claim was denied, we may be able to help you. The skilled attorneys at Chisholm Chisholm & Kilpatrick LTD have successfully handled VA disability claims for Type 2 Diabetes. Contact our office today for a free consultation at (800) 544 9144.
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