As of June 6th 2024, the VA has made changes effective to the rating criteria for diabetes regarding VA disability benefits. Diabetes is a chronic disease that occurs when the body is unable to produce enough insulin (a hormone that regulates blood sugar). VA research has found that diabetes affects around 25% of the VA's patient population, sometimes leading to blindness, end-stage renal disease, or even amputation. Through VA disability benefits, veterans can get the care they need to prevent worsening symptoms of diabetes.
In this blog, we'll cover everything veterans need to know about these recent changes. But in case you missed it, the VA also recently updated ratings for…
Here's what's new for veterans seeking VA disability benefits for diabetes:
New diabetes medications are now recognized
Now, the VA has recognized new medications that are used to treat diabetes. They instruct NOT to consider them the same as insulin for rating purposes, however. They're considered to be the same as oral hypoglycemic agents. The following medications are now included for consideration:
Ozempic
Victoza
Trulicity
And all of their generic versions
Veterans must meet all lower rating criteria before consideration for a higher rating level
When considering rating levels for diabetes, the veteran MUST meet all criteria of the lower ratings before being considered for the higher rating level. This was originally outlined in the precedent case and VA regulation Camacho v. Nicholson, back on July 6th in 2007, when a veteran's claim for diabetes mellitus was denied because they did not meet all criteria for a 40 percent evaluation. The court upheld the VA's decision to deny the veteran a higher disability rating, and his evaluation of 20 percent remained.
To learn more about how the VA evaluates disabilities, see M21-1, Part V, Subpart ii, 3.D.2.a.
Regulation of activities to avoid hypoglycemic episodes has been further defined
Now, "regulation of activities to avoid hypoglycemic episodes" has been further clarified. This basically means that “avoidance of strenuous occupational and recreational activities” is required as a rating criteria, but only if the avoidance is absolutely required to help control the veteran's blood sugar.
So, if the avoidance is voluntary – then it does not meet criteria. Evidence has to document that the avoidance of strenuous activities is required or prescribed as part of the medical management of the veteran's diabetes. Prescribed or voluntary exercise also does not satisfy the regulation-of-activities criterion. It can be difficult to prove this, but the right documentation (or a well-written personal statement) can help greatly.
Of note: It's the Department of Veterans Affairs (VA’s) policy to concede that an individual’s diabetes mellitus requires insulin, restricted diet, and regulation of activities when the diabetes has caused episodes of ketoacidosis that have resulted in hospitalization.
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