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Sean Kendall

Three Ways to Win an Increased Rating for Service Connected Diabetes


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10/30/2017
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The complex variety of diabetes complications and treatments present opportunities for veterans already service connected for diabetes to seek increased ratings. Because each higher rating criteria includes the same criteria as the lower rating plus a distinct new criterion, a higher disability rating will not be assigned unless you demonstrate all of the required criteria of the higher rating. This differs from other ratings schedules where you might be able to prevail by showing you exhibit the majority of symptoms in the rating tier. VA ratings for diabetes mellitus are as follows:

Rating Schedule for Diabetes Mellitus

10 percent

  • Restricted diet only

20 percent

  • Requires insulin
  • Restricted diet or hypoglycemic agent and restricted diet

40 percent

  • Requires insulin
  • Restricted diet
  • Regulation of activities

60 percent

  • Requires insulin
  • Restricted diet
  • Regulation of activities
  • Episodes of ketoacidosis or hypoglycemic reactions requiring one or two hospitalizations per year or twice a month visits to a diabetes care provider
  • Complications that would not be compensable if separately evaluated

100 percent

  • More than one daily injection of insulin
  • Restricted diet
  • Regulation of activities (avoidance of strenuous occupational and recreational activities)
  • Episodes of ketoacidosis or hypoglycemic reactions requiring at least three hospitalizations per year or weekly visits to a diabetic care provider
  • Either progressive loss of weight and strength or complications that would be compensable if separately evaluated

 

Consider the following ways to win an increased rating for service-connected diabetes:

1. Maximize secondary service connection

A secondary condition is a condition that is due to, or caused by, the presence of a preceding primary condition. Diabetes is a condition with many secondary conditions. Diabetes can lead to a higher frequency and earlier onset of, among other things, peripheral vascular disease, coronary arteriosclerosis, peripheral neuropathy, and premature cataracts of the eyes. These are secondary manifestations because they are due to your underlying diabetes and share the same underlying cause.  

Examinations for diabetes are generally more complex and time-consuming than an average examination due to possible complications of diabetes. A common VA error is for examiners to not adequately evaluate the complications of diabetes, which may be eligible for secondary service connection. Complications of diabetes are rated separately, unless used to support a 100-percent evaluation.

Two of the most common complications of type 2 diabetes are arteriosclerosis and cataracts. Hypertension is another common complication of type 2 diabetes. Scientific evidence shows that many other conditions may result from type 2 diabetes, including the following:

  • Diabetic nephropathy
  • Diabetic neuropathy
  • Autonomic neuropathy
  • Cataracts
  • Retinopathy
  • Glaucoma
  • Macula edema
  • Hypoglycemia
  • Hyperglycemia
  • Hyperosmolar hyperglycemic nonketotic syndrome
  • Atherosclerosis
  • Hypertension or high blood pressure
  • Coronary artery disease
  • Heart attack
  • Stroke
  • Bacterial infections
  • Fungal infections
  • Diabetic dermopathy
  • Necrobiosis lipoidica diabeticorum
  • Disseminated granuloma annulare
  • Acanthosis nigricans
  • Depression

Conditions that occur as a result of medications taken to control service-connected diabetes can also qualify for secondary service connection. Ask your doctor about the side effects of any medications you are taking for diabetes, and watch for those conditions.

You may also get secondary service connection for a condition if service-connected diabetes aggravates that condition, even if diabetes is not the underlying cause of the condition. VA will assess whether your service-connected diabetes aggravates a preexisting condition beyond the natural progress of the disease.

To support a claim for service connection secondary to diabetes, consider submitting medical literature supporting a connection between diabetes and the secondary condition. The Board of Veterans’ Appeals has shown a willingness to have VA reconsider cases where it failed to adequately address medical literature showing a connection between conditions like diabetes and hypertension. (See BVA Decision Nr. 1700147).

2. Maximize your rating for diabetic neuropathy

Diabetic neuropathy is damage to nerves in the arms and legs. This damage can cause numbness and pain in the hands, arms, legs, and feet. When combined with poor circulation, neuropathy can result in diabetic foot ulcers and leg infections. Neuropathy is often a secondary condition to diabetes, and you can receive a separate rating for each extremity that exhibits symptoms of neuropathy if it is connected to service-connected diabetes.

VA has provided the following chart with symptoms peripheral neuropathy:

Symptoms

Description

Paresthesia

  • Numbness
  • Tingling

Hyperesthesia

Increased sensitivity to touch

Hypesthesia (or hypoesthesia)

Decreased sensitivity to touch

Loss of sensation

Lack of feeling

Pain

  • Burning
  • Lacinating
  • Lightning sensations

Dysethesia

Unusual and unpleasant sensation after normal stimulation

Muscle weakness

Lack of strength

 

                Establishing secondary service connection for peripheral neuropathy can greatly increase your VA rating, but it is often overlooked. The rating schedule that is applied to neuropathy is based on the level of incomplete paralysis for each extremity (hands and feet). VA uses the following general guidelines for rating the level of incomplete paralysis of peripheral nerves:

If the level of incomplete paralysis regarding peripheral nerves is…

Then the evidence will indicate the following criteria…

Mild

Subjective symptoms, and/or decreased sensation

Moderate

Absence of sensation confirmed by objective findings

Severe

More than sensory findings are demonstrated, such as atrophy, weakness, diminished reflexes, and so on

 

                Because you can be rated separately for each extremity (hands and feet) that has diabetic neuropathy, you can significantly increase your combined rating by making sure that your doctor assesses your neuropathy symptoms and makes a finding about your level of impairment due to neuropathy.

3. Ask your doctor whether your occupational or recreational activities should be restricted

VA raters often fail to apply the correct rating criteria. For example, the examiner may assign a 20 percent evaluation even though a doctor has restricted your activities. Regulation of activities, in addition to needing insulin and a restricted diet, qualifies a veteran for a 40-percent rating.

The VA Disability Benefits Questionnaire for type 2 diabetes defines the regulation of activities as “avoidance of strenuous occupational and recreational activities with the intention of avoiding hypoglycemic episodes.” Notably, this definition includes occupational activities. If you are working in a physically strenuous job and a doctor advises you to cut back on certain activities at work, this counts as regulation of activities. You will qualify for a 40 percent rating as long as you also meet the other criteria. Regulation of activities under the ratings schedule means it must be medically necessary for you to avoid strenuous occupational and recreational activities, so you will need a doctor’s opinion on whether you should restrict activities.

If you need help with a VA disability claim or appeal related to diabetes, make sure to get in touch with my office at 877-629-1712. 



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