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Filing a VA Disability Claim for Diabetes Mellitus

 

Filing a VA disability claim for diabetes mellitus involves understanding various VA regulations and programs. Veterans need to gather comprehensive medical records documenting the diagnosis and treatment of diabetes, including its onset and progression. Service records demonstrating exposure to Agent Orange or other toxic substances are crucial. A nexus letter from a qualified healthcare provider should clearly link the veteran’s diabetes to their military service, addressing the VA’s criteria for establishing a service connection.

 

Personal statements outlining in-service events that led to the condition, its progression, and impact on daily life, along with corroborative statements from family members, fellow service members, or friends, are vital. Submitting a Fully Developed Claim (FDC) expedites the process by including all evidence at once. Veterans should also be prepared for a VA Compensation & Pension (C&P) examination to assess the current severity of their condition, ensuring they can effectively discuss their symptoms and impact on their life. Following these steps enhances the chances of a successful claim for diabetes, securing deserved benefits due to service.

Diabetes Mellitus Symptoms:

  • Frequent Urination: A common symptom where the body attempts to get rid of excess glucose through urine, leading to increased urination.

  • Excessive Thirst: As a result of frequent urination, the body becomes dehydrated, causing an intense feeling of thirst.

  • Extreme Hunger: Despite eating, the body’s cells are not getting enough glucose, leading to constant hunger.

  • Unexplained Weight Loss: The body may start breaking down muscle and fat for energy when it can’t get glucose into cells, leading to weight loss.

  • Fatigue: Lack of glucose in the body’s cells leads to low energy levels and chronic fatigue.

  • Blurred Vision: High blood sugar levels can cause swelling in the lens of the eye, leading to blurred vision.

  • Slow-healing Sores: High glucose levels can impair circulation and affect the body’s ability to heal wounds.

  • Frequent Infections: High sugar levels in the blood and urine create an environment where bacteria and fungi can thrive, leading to frequent infections.

Understanding TERA, PACT Act, and Agent Orange Exposure

Exposure to toxic substances during military service, known as Toxic Exposure Risk Activities (TERA), has significant health effects, including an increased risk of diabetes. Prolonged exposure to chemicals, burn pits, and other hazardous materials can lead to metabolic disruptions, resulting in the development of diabetes. This condition, characterized by high blood sugar levels, can cause severe complications such as nerve damage, kidney disease, and cardiovascular issues. Veterans exposed to these toxic environments are at a higher risk and require ongoing medical evaluation and treatment to manage and mitigate the adverse health impacts of their service-related exposures.

Temporary Early Retirement Authority (TERA): This program allows certain military members to retire early with benefits. Veterans who retired under TERA may be eligible for VA disability benefits if they develop conditions like diabetes that are connected to their service. TERA benefits provide a pathway for veterans to receive early retirement pay, which can be particularly beneficial for those whose careers were cut short by health issues.

 

PACT Act: The PACT Act expands the list of conditions presumed to be related to service-connected toxic exposures, including diabetes. This act is part of the VA's efforts to ensure that veterans exposed to harmful substances during their service receive the benefits they deserve. The PACT Act makes it easier for veterans to establish a service connection for conditions caused by toxic exposures, reducing the burden of proof required.

 

Agent Orange Exposure: Veterans who served in Vietnam or other areas where Agent Orange was used are presumed to have been exposed to this herbicide. The VA has recognized diabetes mellitus (Type 2) as a condition that can be related to Agent Orange exposure, simplifying the process of obtaining disability benefits for affected veterans.

VA M21 Rating Scale and Symptoms for Diabetes Mellitus

 

The VA uses the M21-1 Adjudication Procedures Manual to guide the evaluation of disability claims. For diabetes, the rating is based on the severity of symptoms and their impact on daily life, as per the VA Schedule for Rating Disabilities (VASRD).

 

Secondary Conditions Related to Diabetes Mellitus

Peripheral Neuropathy: Peripheral neuropathy involves nerve damage causing pain, numbness, and weakness, particularly in the hands and feet. High blood sugar levels damage the nerves over time, leading to burning sensations, tingling, and sensitivity to touch, affecting daily activities and quality of life.

Retinopathy: Diabetic retinopathy can lead to blindness due to high blood sugar damaging the blood vessels in the retina. Over time, these vessels can swell, leak, or close off, leading to severe vision loss if untreated. Regular eye exams are essential for early detection.

Nephropathy: Diabetic nephropathy is kidney damage caused by high blood sugar levels, leading to kidney disease or failure. This condition can impair the kidneys' ability to filter waste from the blood, potentially requiring dialysis or a transplant if it progresses to end-stage renal disease.

Cardiovascular Disease: Diabetes increases the risk of heart disease and stroke by contributing to plaque buildup in the arteries. High blood sugar affects blood vessels and heart function, necessitating regular monitoring of glucose, cholesterol, and blood pressure to mitigate cardiovascular risks.

Foot Complications: Diabetes can cause ulcers and infections in the feet, potentially leading to amputations. Poor circulation and nerve damage reduce sensation and hinder healing. Routine foot care, proper footwear, and regular check-ups help prevent serious complications.

Skin Conditions: Diabetics are prone to bacterial and fungal infections due to high blood sugar levels fostering pathogen growth. Maintaining skin hygiene and managing blood sugar levels are crucial in preventing and managing skin infections.​

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VA Rating Schedule for Diabetes Mellitus

According to 38 CFR § 4.119, Diagnostic Code 7913, the VA assigns disability ratings for diabetes based on the severity and management of the condition:

  • 10% Rating: Assigned for diabetes mellitus that is manageable by a restricted diet only. Symptoms are generally mild and can be controlled without medication.

  • 20% Rating: Assigned for diabetes mellitus requiring insulin and a restricted diet, or; oral hypoglycemic agent and a restricted diet. This indicates a need for medication to manage blood sugar levels.

  • 40% Rating: Assigned for diabetes mellitus requiring insulin, restricted diet, and regulation of activities. This level indicates that the condition is more severe and impacts the veteran’s ability to perform daily activities.

  • 60% Rating: Assigned for diabetes mellitus requiring insulin, restricted diet, and regulation of activities, with episodes of ketoacidosis or hypoglycemic reactions requiring one or two hospitalizations per year, or twice a month visits to a diabetic care provider, plus complications that would not be compensable if separately evaluated. This level reflects significant management challenges and more frequent complications.

  • 100% Rating: Assigned for diabetes mellitus requiring more than one daily injection of insulin, restricted diet, and regulation of activities, with episodes of ketoacidosis or hypoglycemic reactions requiring at least three hospitalizations per year or weekly visits to a diabetic care provider, plus either progressive loss of weight and strength or complications that would be compensable if separately evaluated. This rating reflects the most severe form of the disease with major health impacts.

 

The VA Disability Advocate's Advice:

Talking to Your Doctor: When discussing your diabetes with your doctor, ensure they document all symptoms and their impact on your daily life. Ask them to provide detailed notes on the severity and frequency of your symptoms, such as frequent urination, excessive thirst, extreme hunger, fatigue, and blurred vision. Additionally, request that they include any secondary conditions related to your diabetes, like peripheral neuropathy or retinopathy. It’s important that your medical records clearly reflect the connection between your service and your condition.

Documenting Evidence: Gather all relevant medical records from both VA facilities and private healthcare providers. Ensure these records include detailed information about the onset, progression, and treatment of your diabetes. Also, collect service records that demonstrate exposure to Agent Orange or other toxic substances. By following these steps and understanding the relevant VA regulations and programs, veterans can significantly enhance their chances of successfully filing a claim for diabetes and securing the benefits they deserve.

Seek Assistance from an Accredited VA Disability Advocate: An accredited VA Disability Advocate can provide valuable guidance in navigating the claims process. They can help you gather the necessary documentation, prepare your claim, and represent your interests during the review process. Their expertise can significantly enhance your chances of a successful claim.

What to Expect During a C&P Exam for Diabetes

A Compensation & Pension (C&P) exam is a crucial part of the VA disability claims process. It is used to evaluate the severity of your condition and to determine whether it is connected to your military service. Here’s what you can expect during a C&P exam for hypertension and diabetes.

 

Endocrinological DBQ's

 

General Procedures

The C&P exams for hypertension and diabetes are generally straightforward. The examiner will review your medical history, conduct a physical examination, and perform necessary lab tests. There’s no right or wrong information you need to provide; the exam is based on objective medical readings and your reported symptoms.

​​Diabetes Exam

Procedures:

  1. Medical History Review: The examiner will review your medical records, focusing on your diabetes diagnosis, blood sugar levels, and any related complications.

  2. Lab Tests: You will likely have blood tests to check your current blood sugar levels (A1C test), kidney function, and cholesterol levels.

  3. Physical Examination: The doctor will examine you for signs of diabetes-related complications, such as neuropathy (nerve damage), retinopathy (eye damage), and foot issues.

  4. Questions You May Be Asked:

    • When were you first diagnosed with diabetes?

    • What symptoms do you experience regularly (e.g., frequent urination, excessive thirst, fatigue)?

    • Have you had any episodes of low blood sugar (hypoglycemia) or high blood sugar (hyperglycemia)?

    • What medications and treatments are you using, and how well are they managing your condition?

    • Do you have any complications like vision problems, kidney issues, or nerve pain?

 

Key Points to Remember

  • Be Honest and Detailed: Describe your symptoms accurately and discuss how they affect your daily life. This helps the examiner understand the impact of your condition.

  • Documentation is Crucial: Ensure all your medical records are up to date and comprehensive. Bring any recent lab results or medical reports to the exam.

  • No Right or Wrong Answers: The exam is based on medical facts. You either have the condition and it’s connected to your service or it’s not. Provide clear and concise information about your health.

  • Understanding Denials and Ratings: If your claim is denied or you receive a lower rating than expected, it might be because your condition hasn’t reached the severity required for a higher rating or the connection to your service wasn’t adequately established. In such cases, gathering more evidence or seeking a second opinion may be necessary.

 

What Happens After the Exam?

After the exam, the examiner will compile a report summarizing their findings. This report will include your medical history, current symptoms, test results, and the examiner’s opinion on whether your condition is related to your military service. The VA will use this report to make a decision on your disability claim.

What Happens Once the C&P Exam is Complete

After completing your Compensation and Pension (C&P) exam, the next steps involve a review and decision-making process by the VA to determine your disability rating and benefits. Here's an overview of what you can expect:

 

Examination Report and Review:

Examiner's Report: The examiner will compile a detailed report based on the findings from your C&P exam. This report includes your medical history, the results of the physical examination, and any diagnostic tests performed. The examiner will also assess your condition, noting the severity, symptoms, and how the condition impacts your daily life and work.

Submission to VA: The completed report is sent to the VA Regional Office handling your claim. This report becomes part of your official VA file and is reviewed along with your other medical records and evidence submitted in support of your claim.

Second Opinions and Delays: After the veteran's exam is complete and the examiner submits their report to the VA, the VA may send the report back for corrections, clarification, or a second opinion if it finds the report incomplete or unclear. This process can delay your claim, as the VA requires thorough and accurate information to make a decision. Your claim will only move to the decision phase once the VA is satisfied with the evidence and documentation provided. This ensures that all aspects of your condition are thoroughly considered, ultimately impacting the outcome of your claim.

The VA Decision Process:

  • Rating Decision: A VA Rating Veterans Service Representative (RVSR) will review the examiner's report, along with all other evidence in your file, to determine your disability rating. The rating is based on the VA's Schedule for Rating Disabilities, which assigns percentages to various conditions based on their severity and impact on your ability to work and perform daily activities.

  • No Time Frame for Decision: It’s important to understand that there is no set time frame for the VA to make a final decision after all exams are complete. If there’s a delay in the process, it often means the VA is deliberating over something in your case. It's crucial not to count your chickens before they hatch, as the VA can request follow-up exams or medical opinions before making a decision.

  • Deferred Decisions: Sometimes, the VA may defer rendering a decision on certain conditions while it processes your claim. This approach allows the VA to decide on ready portions of your claim without holding up the entire process. Deferred conditions often mean the VA will almost certainly ask for a second opinion or request an additional exam. This can cause frustrations and delays, but it’s essential to be patient as this is out of your and our control.

  • Notification of Decision: The VA will send you a Rating Decision letter once a decision is made. This letter details the outcome of your claim, including the disability rating assigned to each condition, the effective date of the rating, and the amount of monthly compensation you will receive. If your claim is approved, the letter will also explain how and when you will receive your benefits.

  • Possible Outcomes:

  • Approval: If your claim is approved, you will receive monthly disability compensation based on the assigned rating percentage.

  • Denial: If your claim is denied, the letter will explain the reasons for the denial. You have the right to appeal the decision if you disagree with the outcome.

Next Steps and Appeals:

Appeals Process: If you disagree with the VA's decision, you have the option to appeal. The appeal process involves several steps, including submitting a Notice of Disagreement (NOD) and possibly presenting additional evidence or attending a hearing. It’s important to understand the timelines and procedures for filing an appeal.

The VA Disability Advocates Main Office is Located in Las Vegas, NV. We Represent Veterans throughout the United States. 702-992-4883 

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