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7913
§ 4.119 Schedule of ratings—endocrine system.

Type 2 diabetes

Metabolic disease characterized by high blood sugar due to insulin resistance

What the rating means

VA rates diabetes mellitus under Diagnostic Code 7913. The possible ratings are 10%, 20%, 40%, 60%, and 100%, and they are separated by how much treatment your condition requires and how severely it affects your body.

A 10% rating applies when your diabetes is manageable by restricted diet only. A 20% rating applies when you require either insulin injections and a restricted diet, or an oral hypoglycemic agent and a restricted diet. A 40% rating applies when you require one or more daily insulin injections, a restricted diet, and regulation of activities. A 60% rating applies when you meet the 40% criteria and also have episodes of ketoacidosis or hypoglycemic reactions requiring one or two hospitalizations per year or twice-monthly visits to a diabetic care provider, plus complications that would not be separately compensable. A 100% rating applies when you require more than one daily insulin injection, a restricted diet, and activity regulation, with episodes 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 separately compensable.

Complications of diabetes that are themselves compensable are rated separately, unless they are already part of the criteria supporting a 100% rating. Noncompensable complications are considered part of the diabetic condition itself.

Evidence that helps

Medical records showing your current treatment plan are central to supporting any rating level. Records confirming a restricted diet, prescriptions for oral hypoglycemic agents, or insulin prescription records showing how many injections per day you require help establish the 20% and 40% levels. Records documenting that your provider has restricted your occupational or recreational activities support the 40% level and above.

For a 60% rating, hospital admission records or clinic visit logs showing one or two hospitalizations per year or twice-monthly diabetic care visits for ketoacidosis or hypoglycemic reactions are important, along with records of any complications. For a 100% rating, records showing three or more hospitalizations per year or weekly diabetic care visits, combined with documentation of progressive weight and strength loss or separately compensable complications, are relevant.

Your own statements, and statements from people who know you, describing how symptoms affect your ability to work, carry out physical tasks, or maintain a healthy weight can also help show the severity of your condition. Treatment notes from endocrinologists or primary care providers that track the progression of your diabetes over time are useful at every level.

Secondary conditions

Conditions that are often caused or made worse by this one. If you have any of these, they may be claimable as secondary service connection.

  • Diabetic kidney disease
  • Diabetic retinopathy
  • Erectile dysfunction
  • Ischemic heart disease
  • Peripheral neuropathy
  • Peripheral neuropathy (nerve damage)
  • Sleep apnea