How Do I Prove VA Disability for Diabetes and Its Complications? A Guide to Diabetes Ratings 

The VA awards disability for diabetes mellitus and diabetes insipidus, with ratings that can range from 0% to 100% (depending on treatment required, diet and activity regulation, number of hospital stays, diabetic care provider visits, and medication regimen). Because diabetes often causes serious long-term complications, the VA may also award disability compensation for secondary conditions related to diabetes. 

This veteran guide to establishing service connection and getting VA disability for diabetes explains how the VA rates the condition, the supporting documentation to meet VA criteria for a diabetes disability rating, and how veterans may pursue a higher rating when the condition worsens or complications develop. 

Diabetes in Veterans and VA Medical Requirements 

Diabetes is a common health condition among veterans. According to the Veterans Administration, diabetes affects nearly 25% of VA patients, compared to only 10% of the general population. Veterans may face a higher risk of Type 2 diabetes due to service-related factors, like chronic pain, orthopedic injuries, and herbicide exposure, including Agent Orange.  

The VA recognizes diabetes as a compensable condition (with the exception of gestational diabetes, which is temporary), but eligibility depends on meeting specific requirements. For example, clinical testing is used to approve a diabetes rating, rather than relying solely on reported symptoms. Medical records must show specific levels of elevated blood sugar, including: 

• An A1C reading of 6.5 percent or higher (on at least two occasions) 
• Fasting plasma glucose at or above 126 mg/dL (confirmed on separate tests) 
• A random glucose level above 200 mg/dL with classic symptoms of high blood sugar (hyperglycemia)  

Classic symptoms of diabetes include: 

• Frequent urination 
• Fatigue 
• Blurred vision 
• Excessive thirst 

Medical Evidence Required by the VA  

• A current diabetic diagnosis conducted by a licensed healthcare provider 
• Symptoms (including home blood sugar readings) 
• Lab tests (e.g., A1C test, fasting plasma glucose, and random glucose test results) 
• Diabetic treatment and management modalities (e.g., insulin or oral hyperglycemic medication administration, diet plans, consultations with nutritionists, healthcare provider visits, and hospital stays)  

How Do You Prove Diabetes Is Service Connected? 

Beyond the medical aspect of getting a diabetes rating, the VA requires evidence of military service connection. Service connection involves showing that the condition began during a veteran’s military service or developed as a result of service. There are three main ways veterans can establish service connection for diabetes: direct, presumptive, and secondary (granted when another service-connected disajbility or its treatment caused or worsened diabetes). 

Establishing Direct Service Connection 

Proving service connection requires documented evidence showing that the diabetes began or was caused by events during active duty (e.g., stress, certain medications, injury-related inactivity, or other causes). Direct service connection requires 3 essential elements, including:  

• A diagnosis: A qualified healthcare provider must document a current diabetes (mellitus, [Type 1 or Type 2] or insulin-dependent diabetes insipidus) diagnosis.  
• An in-service event: Evidence of an in-service illness, event, or injury that led to your diabetes.  
• A nexus: The connection between the medical condition and an event, injury, or illness during military service that links a veteran’s disorder to military service. This will be a written statement by a licensed healthcare provider, explaining how specific experiences during military service contributed to the onset of diabetes or describing that symptoms first appeared while the veteran was on active duty. 

The VA’s standard of proof is the “benefit of the doubt.” This means that if the evidence for and against a claim is in approximate balance, the veteran wins. Nexus opinions explaining that a disability is “at least as likely as not” (a 50/50 probability) related to military service are sufficient to establish service connection under this standard. 

Veterans should also submit medical records during and after military service documenting diabetes symptoms and treatment, service history, personal statements about the impact of diabetes on daily life and buddy statements written by fellow service members or others who can attest to the severity of the diabetic symptoms. 

Presumptive Service Connection: Are You Eligible? 

In some instances, service connection is “presumed,” meaning that you don’t have to prove diabetes is connected to something that happened during service. Veterans who can benefit from presumed service connection by the VA include those who: 

• Received at least a 10% diabetes rating from the VA within one year after military discharge 
• Served in Vietnam during qualifying periods in areas where Agent Orange toxic exposure is recognized 
• Had specific toxic exposures covered under the PACT Act that indirectly contributed to diabetes 

PACT Act Presumptions 

Agent Orange has been directly linked to Type 2 diabetes in the PACT Act since 2001 as an addendum to the original Agent Orange Act. But the PACT Act also created new pathways to connect diabetes secondarily to other conditions (especially respiratory, cardiovascular and endocrine), when they are presumed by the VA to be connected to toxic exposures such as burn pits. 

Agent Orange

Veterans diagnosed with Type 2 diabetes who served in areas where Agent Orange and other herbicides were used and were discharged under conditions other than dishonorable are presumed exposed. These areas include: 

• The Republic of Vietnam between January 9, 1962, and May 7, 1975 
• The Korean DMZ between September 1, 1967, and August 31, 1971 
• Specific locations where herbicides were stored or tested 

Burn Pits and Diabetes 

While the PACT Act does not add diabetes mellitus itself to the list of new presumptive conditions for burn pit exposure, it allows veterans to establish secondary or aggravation-based service connection for diabetes when a presumptive toxic exposure illness: 

• Causes metabolic or hormonal changes (e.g., from long-term steroid use for lung disease), 
• Restricts activity, leading to weight gain and insulin resistance, or 
• Requires medications known to increase diabetes risk (such as corticosteroids or certain psychotropics). 

For example, a veteran with chronic sinusitis and sleep apnea (both linked to burn pit exposure) who develops obesity and then Type 2 diabetes, due to metabolic disruption and poor oxygenation, could claim diabetes as secondary to sleep apnea. 

Diabetes as a Secondary Service-Connected Condition 

Diabetes mellitus often occurs secondary to or is worsened by other disabilities or their treatment; these include conditions known to cause weight gain, limit activity, or that are otherwise associated with insulin resistance. Insulin resistance increases the likelihood of diabetes or makes diabetes more challenging to manage.  

Medications Linked to Diabetes 

• Systemic corticosteroids (prednisone, dexamethasone) used to treat respiratory diseases 
• Antipsychotics or mood stabilizers for veterans with PTSD, depression, or cancer-related anxiety 
• Beta-blockers, used for cardiovascular complications 
• Immunosuppressants, part of treatments post-cancer or for autoimmune conditions 

If these medications are prescribed for a service-connected illness, a diabetes rating can be obtained through secondary service connection. 

Respiratory Illnesses 

Long-term use of systemic corticosteroids (prednisone, dexamethasone, etc.) for respiratory diseases can raise blood sugar and cause insulin resistance. Physical inactivity due to breathing limitations also promotes obesity and metabolic dysfunction, increasing diabetes risk. 

Example: A veteran exposed to burn pits develops COPD, a PACT Act presumptive condition. Long-term use of corticosteroids leads to elevated blood sugar and eventual Type 2 diabetes. The veteran can then file for a diabetes VA disability rating secondary to the already service-connected COPD. 

Certain Cancers and Their Treatment 

• Pancreatic cancer or surgery directly damages insulin-producing cells 
• Steroid-based chemotherapy regimens and radiation can induce secondary diabetes 
• Post-transplant medications (for cancer or organ failure) may worsen glucose control 

Example: A veteran diagnosed with non-Hodgkin’s lymphoma (presumptive cancer under the PACT Act) undergoes steroid-based chemotherapy. A year later, he is diagnosed with Type 2 diabetes. The diabetes could be service connected as secondary to treatment for the presumptive lymphoma.

Endocrine System Dysfunctions and Other Disorders 

Chronic inflammation and oxidative stress from exposure-related illnesses (e.g., fine particulate matter, burn pit chemicals, dioxins) can damage pancreatic beta cells and impair insulin sensitivity, something strongly linked to Type 2 diabetes development. 

Radiation exposure can lead to hypothyroidism or affect the pituitary gland. Thyroid and pituitary disorders can cause metabolic slowing or hormonal imbalances that predispose veterans to insulin resistance and Type 2 diabetes. 

How the VA Rates Diabetes Mellitus 

The VA disability rating for diabetes mellitus (Diagnostic code 7913) is 10%, 20%, 40%, 60%, or 100%. The VA evaluates diabetes according to the rating criteria for the endocrine system under 38 CFR § 4.119, which considers factors such as: 

• Treatment (i.e., diet-controlled, medication-controlled, or insulin-dependent) 
• Type of medication (e.g., oral antihyperglycemics or insulin injections) 
• Frequency of medication 
• Diet and activity restrictions 
• Hospitalizations to treat hypoglycemia or ketoacidosis 
• Frequency of diabetic care provider visits 

Higher diabetes ratings (e.g., 40% or 100%) require documentation of solid medical evidence showing “regulation of activities,” which means the healthcare provider ordered avoidance of strenuous work and activities. Other parameters for higher ratings include frequent visits to healthcare providers or recurring hospitalizations for ketoacidosis.  

The VA Ratings Table for Diabetes Mellitus 

• 10% rating: Manageable by a restricted diet only 
• 20% rating: Requiring one or more daily injections of insulin and a restricted diet, or an oral hypoglycemic agent and a restricted diet 
• 40% rating: Requiring one or more daily injections of insulin, a restricted diet, and regulation of activities 
• 60% rating: Requiring one or more daily injections of 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 
• 100% rating: Requiring more than one daily injection of insulin, restricted diet, and regulation of activities (avoidance of strenuous occupational and recreational 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 

Note: Compensable complications of diabetes are evaluated separately unless they are part of the criteria to support a 100% rating. For example, peripheral neuropathy, retinopathy, or kidney disease may each receive separate ratings under their respective diagnostic codes, which are then combined with the primary diabetes rating under VA’s combined ratings table.  

Diabetes Insipidus VA Disability

Diabetes insipidus is an uncommon condition caused by impaired hormone signaling that regulates urine output in the kidneys. Unlike diabetes mellitus (Type 1 or Type 2), this condition is unrelated to glucose levels. Diabetes insipidus symptoms include: 

• Excessive urination 
• Extreme thirst 
• Dehydration 
• Frequent nighttime urination 

The prognosis for Diabetes insipidus is excellent with proper treatment. The condition is often transient, and there are effective medications for long-term symptom management. Therefore, the VA initially allows for a 30% rating until the condition becomes stable; then, the need for ongoing treatment can be established and rated accordingly. 

The VA Ratings for Diabetes Insipidus 

The VA evaluates diabetes insipidus under diagnostic code 7909 and assigns a 30% rating for three months after initial diagnosis. After 3 months, a rating of 10% is given for veterans with long-term polyuria or those who require continuous hormonal therapy. Other diagnostic codes may apply for lingering effects (residuals) of the diabetes. 

How To Increase a Diabetes VA Rating 

Many diabetes claims are underrated because VA examiners don’t properly evaluate the regulation of activities or secondary complications. If the VA examiner didn’t review the full medical history, ignored evidence of restricted activities, or failed to address complications like neuropathy or retinopathy, veterans can submit a Supplemental Claim with a private medical opinion or request a new diabetes C&P exam to correct the error. 

A veteran may also be able to increase a diabetes rating by showing that the condition has worsened over time. Medical evidence documenting disease progression or the need for more intensive treatment (such as a transition from oral medications to daily insulin use) must link the increased severity, treatment changes or secondary conditions directly to the veteran’s diabetes.  

Diabetes Complications and Secondary Conditions 

• Renal dysfunction (DC 7541): Diabetes can damage the small blood vessels in the kidneys, which often results in reduced kidney function. This condition may progress to chronic (i.e., long-term) kidney disease or renal failure. The VA rates kidney conditions based on the severity of impaired function, with more advanced disease, including dialysis or transplant needs, qualifying for higher ratings. 
• Diabetic peripheral neuropathy (DC 8520 or 8720): Prolonged elevated blood sugar levels can injure peripheral nerves, often affecting the feet and hands. The nerve damage causes pain, burning sensations, tingling, or numbness in the extremities. The VA rates each extremity separately; if neuropathy is present in both feet and both hands, there could be 4 separate ratings, depending on its severity. 
• Erectile dysfunction (DC 7522): Diabetes can impair circulation and nerve signaling, both of which are necessary for normal erectile function. As a result, erectile dysfunction is a recognized complication linked to diabetes. Erectile dysfunction is typically rated at 0%, but veterans may qualify for special monthly compensation based on loss of use.  
• High blood pressure (DC 7101): Diabetes can damage blood vessels and contribute to hypertension, potentially increasing the risk of serious complications, such as stroke, atherosclerosis, or heart attack. When diabetes contributes to or worsens hypertension, it may qualify as a secondary condition. 
• Heart disease (DC 7005): Diabetes accelerates damage to blood vessels, which promotes plaque buildup  — such as in atherosclerosis — increasing the risk of coronary artery disease, heart attacks, and other cardiac complications. Heart disease that develops alongside diabetes is rated by the VA using factors such as activity tolerance, heart function tests, and required medical treatment.  
• Stroke (DC 8007): Poor blood sugar control in diabetes increases the risk of stroke over time by damaging blood vessels and promoting clot formation. A 100% rating is given for the first six months after a stroke, then the VA rates the residual effects, such as hemiparesis, speech impairment, cognitive changes, and other disabilities.  
• Bacterial or fungal skin infections (7820 or 7813): Diabetes can increase a person’s risk of skin infections by weakening the immune response and adversely affecting circulation. Specific skin changes, such as diabetic dermopathy, are linked with long-term diabetes. These skin disorders are rated by body area and severity of the affected skin. Treatment-resistant and chronic skin conditions may qualify for higher ratings. 
• Diabetic retinopathy (DC 6040): High blood sugar can damage the small blood vessels in the retina, leading to severe eye conditions like cataracts, glaucoma, or retinal detachment. If undiagnosed or left untreated, diabetic retinopathy may progress to significant vision loss or blindness. Eye conditions caused by diabetes are rated based on visual acuity, visual field loss, and incapacitating episodes. 
• Diabetic foot complications (DC 7800-7805 or 7826): In diabetes, foot complications are often caused by nerve damage and reduced circulation, which can impair wound healing. Ulcers and infections are common; in severe instances, diabetics may need amputations. Diabetes-related foot problems are rated based on factors such as loss of function, infection severity, or amputation level. Each foot may be rated separately. 
• Mental health conditions: Veterans with long-term diabetes may also develop depression or anxiety due to lifestyle limitations and disease burden. Mental disorders linked to diabetes may qualify as secondary disabilities if supported by medical evidence. 

Case Example: Winning Service Connection for  Diabetic Neuropathy 

A Vietnam War veteran who served honorably from May 1969 to March 1971 was initially granted service connection and a 10% disability rating for Type II diabetes based on herbicide exposure. The veteran then sought a higher disability rating for diabetes and for peripheral neuropathy affecting the lower extremities. 

After reviewing updated medical evidence, the Board of Veterans’ Appeals increased the diabetes rating to 20 percent (with retroactive pay) and also awarded an additional increase for diabetic peripheral neuropathy. 

How The Veteran Won This Claim  

• Medical documentation of disease progression: The veteran submitted detailed medical records showing that, beginning in 2009, his diabetes required both dietary management and medication. His hemoglobin A1C results continued to reflect poor glucose control, supporting entitlement to a higher rating. 
• Testimony regarding symptom impact: At the Board hearing, both the veteran and his spouse described how his condition worsened over time. Their testimony included details on the frequency of emergency room visits and ongoing difficulty managing his diabetes. These details helped demonstrate that the disability had become more severe, requiring greater compensation. 
• Increased ratings for neuropathy: The Board also determined that the veteran’s diabetic peripheral neuropathy had progressed. Medical documentation consistently revealed moderate pain, numbness, and tingling in both lower extremities. Based on the medical evidence, the Board awarded separate 20 percent ratings for diabetic peripheral neuropathy in the right and left lower legs, effective December 4, 2013. 

 Understanding how the VA evaluates diabetes and related conditions can shape the outcome of a disability claim. Hill & Ponton helps veterans navigate this complex process by identifying relevant evidence, addressing rating issues, and supporting claims built on VA-recognized medical findings and documented military service records.