VA Disability Benefits for Diabetes

VA Disability Benefits for Diabetes


Courtney Ross: Good afternoon and welcome
to Facebook Live with Chisholm Chisholm & Kilpatrick. I’m Courtney Ross. I’m joined today by Alyse
Galoski and Alec Saxe. Today, we’re going to be talking about diabetes. So, I want to
get started just by generally talking about what diabetes is. So, there’re two types:
Type 1 and Type 2. For purposes of this broadcast, we’re going to really be focused on Type 2
diabetes which is a chronic condition that affects the body’s blood glucose levels due
to either insulin deficiency or being insulin resistant. Type 1 is a similar condition but
it typically develops in adolescence so you usually have it earlier on in your life. And
for VA adjudication purposes, there’s actually a distinction between Type 1 and Type 2. We’re
going to get to this later in the broadcast which is to give you an example, Type 2 diabetes
is a condition that VA will presume is due to the veteran’s exposure to herbicides and
Agent Orange where Type 1 is not for that same presumption. So, the severity of the
condition can vary case by case. Some individuals are able to control Type 2 diabetes with a
restricted diet while other people have a more difficult time doing that. As the condition
progresses, it can become a little bit more difficult to really control those blood glucose
levels. So, for veterans who may already be service-connected for this type of condition,
it’s important to kind of monitor how your disease progresses because the more severe
it gets, you may be entitled to a higher rating from VA, which means additional compensation
for that benefit. And that’s kind of a good segway into the next thing I want to talk
about, which is, how VA rates Type 2 diabetes. What they’re looking at to decide what rating
is appropriate for a veteran’s condition. So, Alyse, can you talk a little bit about
that? Alyse Galoski: Sure. So there are various
different ratings that you could get for Type 2 diabetes. They range from a 10% rating all
the way up to 100% rating and as Courtney was touching upon it, a big factor is how
you are having to control your diabetes. A 10% rating, for example, would be somebody
who can control it just with a restricted diet, whereas, 20% is someone who requires
a restricted diet or they require a certain exercise routine or they require insulin.
Then we go up to 40% based on how often you might need that insulin, if you need it more
than just once a day. You may– you’re starting to look into those higher ratings. You’re
also looking at some reactions that you might have in the higher ratings. For example, if
you are hypoglycemic, if you have those types of reactions, that’s when you’re going to
start getting into those 40%, 60%. Excuse me, 60% ratings, 100% ratings. You can also
suffer complications from your diabetes. For example, we’re going to touch upon this a
little bit later but maybe if you have an eye condition or a neuropathy condition, the
rating criteria right in the criteria tells– directs adjudicators that they are to rate
those complications separately so long as they basically come up to a compensable level.
But if you have ratings, excuse me, if you have complications rather that are not what
VA would consider compensable, that may entitle you to a 60% rating. Hospitalizations also
come into effect if you are having to be hospitalized, that might warrant a 100% rating. So these
are just the factors but a very common theme that we’re seeing that Courtney touched upon
is how you are actually having to control and manage your blood sugar levels. Courtney: Thank you, Alyse. So, I want
to back up a little bit. We talked about how VA rates diabetes once a veteran is service-connected
for it. Let’s back up a little bit and talk about ways to actually get service-connection
for diabetes. So, Alec, can you talk a little bit about one way that a veteran might be
able to seek. Alec Saxe:Sure. Yes, of course. As we
touched on the most prevalent way we see a veteran becomes service-connected for diabetes-related
to service is through the exposure to these harmful chemical herbicides, specifically,
Agent Orange and that would be for veterans who serve with boots on the ground on in the
inland waterways of Vietnam, specifically between these certain dates that VA has set,
January 9, 1962, and May 7, 1975. If you are a veteran who served, again boots on the ground
in the Republic of Vietnam, or in the waterways which I’ll expand on a little later, VA presumes
that you are exposed to those harmful chemical agents and if you have the diagnosis of diabetes,
then you’re entitled to service-connection and disability compensation benefits for it.
So, for a long time, no one really knew what these inland waterways were up until recently
really, last year the Federal Circuit in a case called Procopio, decided that under the
statute and the term of Republic of Vietnam and what does that refer to, it’s built its
landmass but also a 12-nautical mile territorial sea, seaward of the demarcation line of Vietnam
which is a little technical. We have some literature on our website and some visual
representations that can kind of help you out with that territory off the coast of Vietnam.
So, Congress has essentially codified the decision and now called the Blue Water Navy
Vietnam Veterans Act. So, VA terms it if you are a Blue Water Navy Veteran, again, who
served within this 12-nautical-mile range between the same dates, again, January 1962
and May 1975, you are entitled to that same presumption that your fellow veterans who
have boots on the ground receive. So, again, those are the common ways this exposure to
Agent Orange as a Vietnam era veteran but in addition to that, veterans who flew on
or worked on specific aircraft C-123’s between 1969 and 1986, these aircraft are used to
spray the actual chemical Agent Orange over the forested areas in Vietnam during Operation
Ranch Hand. So, if you were a part of that operation or working on those aircraft, that
presumption can extend to you. We have information, again, on that on our website. So, in addition
to that, we have veterans who served near the Korean DMZ or along the DMZ between September
1967 and August 1971, actually, the Blue Water Act recently expanded those dates as well.
So, those are the dates 1967 to 1971. And then last, we have Thailand. If you served
on or near Thailand military bases between February 1961 and May 1975, again, Agent Orange
was used to spray the surrounding forested areas in preparation for attacks from the
enemy. So, there’s bountiful evidence that veterans serving in those Thailand military
bases were exposed to Agent Orange and they’re presumed to have the presumption as well.
So, those are all the chemical herbicides, Agent Orange links. In addition to that, I’ll
just note that VA considers diabetes a chronic disease under 38 CFR 309/7, both of them,
I think. So, if you developed diabetes within a year of your discharge, you may be entitled
to service connection and compensation benefits for that. Courtney: Yes. We’ve recently done some
other Facebook Live videos that specifically discuss the Blue Water Navy Act and the recent
extension of the presumption of exposure to those veterans as well. So, you can check
those out on our website as well. So, you talked a lot about presumptive service connection,
one other way that you may be able to seek service connection for diabetes is as a secondary
condition. Secondary service connection means getting service connection for a condition
that developed not as duty or service but instead as due to a condition that you’re
already service-connected for. So, one of the most common ones that we see with diabetes
is the development of diabetes being caused by sleep disorders or sleep apnea. VA and
DOD, or the Department of Defense, actually did a study that showed individuals with sleep
apnea or poor sleep quality typically develop diabetes. So, for sleep apnea, it actually
increases the risk of diabetes by 78% which is a pretty significant number. And those
that have trouble sleeping had a 21% increase in terms of a risk of developing diabetes.
So, there’s a significant connection there. That’s just one example. It could be possible
that there’s other conditions that may cause or reach the development of diabetes as well.
So, in addition to considering trying to connect diabetes directly to the time of service or
as a presumptive condition due to exposure, you should also consider whether the condition
may have developed later in life and may be connected to a condition you’re already getting
service-connected benefits for from VA. Another example is actually drugs that may be prescribed
to you to treat things like high cholesterol or a heart condition. So, if you are already
service-connected for a heart condition, there may be certain drugs that you’re taking for
that condition that can actually increase the risk of diabetes as well. There’s medical
literature that supports the possible connection there too. So this is just a different way
that you may be able to get service-connected from diabetes. So, just other things that
you want to consider as well. A third way which relates to secondary service connection
but isn’t exactly the same is actually using obesity as an intermediate step. Alyse, can
you talk a little bit about what is meant by that? Alyse: Sure. Just as a general matter,
obesity is not actually a disability for VA purposes. So, you cannot receive service connection
for obesity; however, you can use obesity as you had just said, Courtney, as an intermediate
step to get your secondary service connection. And this is really a hot button topic right
now and the reason for that is that obesity is very common among the veterans’ population
and so is diabetes. The reason for that is that they’re actually linked. If you have
obesity, you are more prone to develop Type 2 diabetes and a lot of veterans do suffer
from obesity due to multiple reasons, whether they have different disabilities that preclude
exercise or they’re on certain medication, or whatever it might be. So, the court has
recently determined that you can’t get service-connected for obesity but you can have that linked.
So, what that would mean is if you have a condition that is service-connected that causes
your obesity and then your obesity causes diabetes, you can use that as a link to get
the secondary service connection. So, for a specific example, maybe you have a severe
knee disability that prevents you from being able to move around a lot. As a result, you
have become obese, and as a result of obesity, you have developed diabetes. So, as long as
that knee condition is service-connected, the diabetes can be service-connected.
So, you can’t get direct service connection from obesity but it is a useful tool to get
you service-connected for a different condition that you might have developed. Courtney: That’s really helpful. So, something
else to consider and think about if you’re suffering from diabetes and you’re looking
to try to get VA benefits. I just want to pause quickly and remind our viewers that
if you have any questions throughout the broadcast, please feel free to leave the questions in
the comments section. We’ll do our best to answer them as we go. So, we’ve talked a little
bit about secondary service connection for diabetes. So, getting benefits for diabetes
as due to an already service-connected condition, I want to switch gears now and talk about,
and Alyse alluded to this a little bit in the beginning of the broadcast, conditions
that may have developed due to your diabetes. So, these conditions you may be able to get
service-connected for secondary to your diabetes once that’s service-connected. So, Alec, can
you talk a little bit about what some of those conditions are and what are the most common
examples. Alec: Sure. So, according to VA actually,
diabetes is the leading cause of blindness, end-stage renal disease, and amputation for
VA patients. Some other common conditions we see secondary to diabetes are diabetic
peripheral neuropathy which is characterized by weakness, numbness, pain from nerve damage,
and typically, we see that in the extremities. There’s also renal or kidney dysfunction;
diabetic retinopathy which refers to damage to the retinas of your eyes, can be caused
by diabetes as well as other eye conditions actually such as cataracts; erectile dysfunction;
cardiac conditions such as coronary artery disease, heart attacks, strokes, and this
one is always hard for me to pronounce, arteriosclerosis, it’s a build-up of fat cholesterol in your
arteries so that’s kind of linked with the heart disease there, and then hypertension
or high blood pressure. There are skin conditions sometimes as well that can be secondary
to diabetes. Courtney: And so, while you may be able
to only get maybe a 20% for your diabetes under the criteria that Alyse talked about
before, if you’re also suffering from any of these other conditions and you’re able
to establish to VA that it is due to your diabetes, again as Alyse alluded before, you
should get separate rating for each of these conditions which should increase your overall
combined rating and therefore, you’re monthly compensation that you’ll get from VA. So,
it’s really important to kind of keep this in mind too if you do have the condition and
you start to develop some of these other conditions. You want to make sure that you’re aware of
this and possibly file a claim with the VA for them as well. So, just, generally speaking,
starting with service connection, if a veteran is seeking service connection for diabetes,
what are the types of evidence that he or she can submit to VA to help establish the
service connection? Alyse: Sure. The number one type specifically
with diabetes is going to be medical evidence whether it’s from your VA treatment provider
or from your own private physician. The reason for that being that, especially rating criteria,
it’s very technical. It has to do with what you’re prescribed, what you’re required to
do. While lay evidence might be helpful in certain situations, I think you really do
want to get some of that medical evidence for these diabetes cases because you will
be running into competency issues you aren’t working with the doctor. Other types of evidence
like you might attend what’s called a VA exam, we’ve done multiple– or we’ve touched upon
this in multiple Facebook Lives, VA exams are extremely important. They will order one
for you. If they order one for you, please attend them and that’s going to be another
way that you’ll be able to get evidence and they will ask you questions if it’s service
connection. They’ll probably ask you questions about when you look into your file as to when
you started to experience the diabetes. They will also look and see if you have any exposure
or any other risk factors. If it’s an increased rating claim, they’ll probably be more looking
at how you’re treating whether you have weight loss, if you have any hospitalizations, any
other factors that are going to go into our rating you would be entitled to. Courtney: Yes and you could also consider
getting your own outside medical opinion as well. Sometimes VA exams come back negative
and don’t support your case so you can get your own opinion, especially if you are trying
to link your diabetes to an already service-connected condition or if you’re trying to link some
of those conditions we talked about that’s secondary to your diabetes. For those,
you’re going to need a nexus medical opinion, specifically if you’re attributing those conditions
to diabetes or your diabetes to the other condition. And so, getting outside medical
opinion might help you to establish that element of service connection. The benefit of presumptive
service connection, if you are a veteran who was exposed to herbicides including Agent
Orange, is that you really only need to establish either show you fit within the presumptive
exposure periods and then the diagnosis so you don’t have to include that nexus element
but for the other service-connection avenues you will. So, that’s important to keep
in mind too. Alec, do you have anything additional in terms of evidence that might be helpful? Alec: No. I just want to echo that diabetes
is a more specialized condition as we say it’s really not capable of lay observation.
So, it’s not like an orthopedic condition or your knee hurts, something that happens
where residuals from a gunshot wound that caused your knee to hurt. You can’t really
observe that. So, that’s why you need a statement from the doctor whether a VA doctor or a private
physician as we noted and that nexus to either another service-connected condition or service
in general. So, I think that kind of hits on the key point. Courtney: Yes. I think that’s a great transition
to final thoughts. Alyse, do you have anything to add in terms of final thoughts. Alyse: Yes, I would say that diabetes is
unique, the rating criteria in that they do specifically direct the adjudicators to separately
rate any complications that you might have; however, I wouldn’t just totally rely on that
to assume that they will automatically separately rate your conditions. So, what that means
is I would work with your attorney or your VSO rep and figure out how you want to file
claims for those conditions that are secondary. It kind of just protects you because even
though they are directed to do so, they might miss it. Courtney: All right. Well, that’s all that
we have for you. Thank you for joining us on Facebook Live with Chisholm Chisholm
& Kilpatrick.

2 Replies to “VA Disability Benefits for Diabetes”

  1. Here's one for the record books. I had right foot surgery at the Veteran’s Administration Medical Center (VAMC) in Feb 1999. The doctor placed the cast on too tightly and after 2 days the cast was removed due to horrific pain, and I returned to the hospital 13 times within 4 months after the cast removal mostly due to continued severe pain. The VA doctors never referred me to neurology despite obvious nerve damage. I had a C&P (Compensation and Pension) exam Sept 1999 and the VA doctor noted "peripheral neuropathies secondary to compression injury, ie., tight cast". The two VA rating specialists only granted code 8622 neuritis of the superficial peroneal nerve (10%) despite the C&P exam notes indicating multiple nerves damaged, the VA medical records stating nerve damage numerous times in the months after surgery, the VA nurse stating nerve damage, and the VA physical therapist stating nerve damage. The decision letter stated "residual compression neuropathy due to tight casting" but didn't specify which nerve and only granted 10% because they noted I can move my foot to some extent. I thought the 10% was for the entire foot and the VA doctors hid their error and even they didn't know which nerves were damaged. The rating specialists seemingly guessed that only the superficial peroneal nerve was damaged because there was a large wound on top of the ankle from the cast near that nerve, but the cast squeezed the entire leg damaging most leg nerves.
    In May 2000 I had a detailed nerve study at Tufts Medical Center; "In summary, the above electrophysiological studies revealed severe losses of sural sensory, peroneal sensory and motor, and tibial sensory and motor fibers in the right foot, consistent with multiple nerve injuries in the right foot.” According to VA regulations for nerves, the VA missed more than 12 codes for compensation. Only in July 2017 I discovered by accident after logging onto the VA e-benefits website that I have been grossly under-compensated for the last 18 years. I was forced to stop work in Aug 2006 due to severe nerve pain and lived in poverty and was homeless, and have been attending a pain clinic plus treatment for severe depression for years, and suffer sleep deprivation due to chronic severe pain. According to VA regulations, I am due Clear and Unmistakeable Error (CUE) from the date of injury 1999 due to the VA cover-up, Special Monthly Compensation (SMC) for the loss of use of right foot, Total Disability Individual Unemployability (TDIU) from the last date of work 2006, and more. From 1999 to 2017 I was rated only 20% disabled.
    In 2017 I started to file numerous claims. I submitted 4 Disability Benefits Questionnaires (DBQ) by 4 private neurologists all stating chronic severe nerve pain and 2 stated loss of use of right foot (I have no balance or propulsion), nerve studies, photos, pain clinic records, psychology records, and more. I suffer neuritis, neuralgia, atrophy, paralysis, trophic changes, depression, chronic sleep deprivation, chronic headaches, chronic severe pain, and contemplating amputation as the only way to find relief.
    In March 2018 I had a VA C&P exam and the VA physician assistant and rating specialists simply ignored most of the information in the DBQs and nerve study and denied any increase and I was enraged. In Feb 2019 the VA psychologist granted 70% for chronic severe depression bringing my rating to 80% total. But on Feb 7, 2020 the VA denied yet again TDIU and any neuropathy increase which is still only 20%. If this doesn’t prove a coverup and that the VA is simply a denial machine then I don’t know what does. I have nothing to date to show for years of immense pain and suffering since 1999. If this happened in a private hospital I would have been able to sue and be compensated back in 2000 without any doubt. But because it’s the VA, they simply continue to cheat with no oversight and continue to add insult to injury. To say I’m angry is an understatement. I suffer every second of every waking day, lose hours of sleep every night, am house-ridden, no social life or partner, and the VA simply mocks me with no end in sight. The VA ruined my life. I signed with CCK in spring of 2019 and hope they can help me obtain justice.

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