Diabetes Mellitus (Type 1 and Type 2)
Diabetes mellitus is rated under DC 7913 based on the level of treatment required to manage the condition. Type 1 occurs when the pancreas does not produce enough insulin, while Type 2 involves the body not responding properly to insulin. Ratings increase with treatment intensity, from diet-only management up to multiple daily insulin injections with frequent hospitalizations. Important: non-insulin injectable medications like Ozempic, Victoza, or Trulicity are classified as oral hypoglycemic agents for VA purposes and are NOT considered equivalent to insulin. Additionally, gestational diabetes (Type 3) is not ratable because the condition is temporary. The VA will concede that a veteran's diabetes requires insulin, restricted diet, and regulation of activities when episodes of ketoacidosis have led to hospitalization.
VA Rating Levels
Manageable with a restricted diet alone.
Requires one or more daily injections of insulin and a restricted diet, OR an oral hypoglycemic agent and a restricted diet.
Requires one or more daily injections of insulin, a restricted diet, AND medically prescribed avoidance of strenuous occupational and recreational activities.
Requires one or more daily injections of insulin, restricted diet, and regulation of activities, with episodes of ketoacidosis or hypoglycemic reactions needing 1-2 hospitalizations per year or twice-monthly visits to a diabetic care provider, plus complications that would not be compensable if separately evaluated.
Requires more than one daily injection of insulin, restricted diet, and regulation of activities, with episodes of ketoacidosis or hypoglycemic reactions needing at least 3 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.
Exam Tips & Key Evidence
- →Diabetes is a presumptive condition for veterans exposed to Agent Orange, provided the severity ever warranted at least a 10% evaluation. It is also presumptive if diagnosed within one year of separation at a compensable level.
- →Non-insulin injectables like Ozempic, Trulicity, Victoza, and Mounjaro are GLP-1 receptor agonists. The VA treats them as oral hypoglycemic agents, not insulin. You need actual insulin injections to qualify for 20% or higher.
- →Regulation of activities must be medically prescribed. Voluntarily avoiding strenuous activity or engaging in prescribed exercise does not satisfy this criterion. Your medical records need to document that avoidance of strenuous activities is required as part of your diabetes management.
- →Diabetes commonly leads to secondary conditions that can be rated separately, including peripheral neuropathy, erectile dysfunction, kidney disease (nephropathy), hypertension, and vision problems (retinopathy). If a secondary condition rates at 0%, it will not get a separate rating but will be listed alongside your diabetes rating.
- →Request a Diabetes Mellitus DBQ from your provider to document all treatment details and complications. This ensures the examiner captures every element the VA needs for proper rating.
Commonly Related Conditions
38 CFR Reference
38 CFR 4.119, Diagnostic Code 7913