Diabetes Mellitus: VA Rating Criteria

Plain-language guide

What this rating actually turns on

Diabetes is rated on treatment burden, not blood sugar. No tier of Diagnostic Code 7913 mentions A1C or glucose numbers; the ladder is built from what it takes to manage the disease: a restricted diet alone (10 percent), insulin or an oral hypoglycemic agent plus restricted diet (20 percent), then insulin, restricted diet, and regulation of activities (40 percent). The top tiers add episodes of ketoacidosis or hypoglycemic reactions with hospitalizations or frequent diabetic-care visits plus complications that would not be compensable if separately evaluated (60 percent), and at 100 percent more than one daily insulin injection plus either progressive loss of weight and strength or compensable complications.

The gate almost every claim turns on is regulation of activities, which the criteria define in the 100 percent row: “avoidance of strenuous occupational and recreational activities.” It is the only element of the 40 percent tier that is not a prescription, so what carries it is documentation: a restriction written by the provider, not a habit you adopted on your own.

A worked example

A veteran manages type 2 diabetes with metformin and a restricted diet. Under the criteria that is an “oral hypoglycemic agent and restricted diet,” the 20 percent row. Two years later his endocrinologist starts daily insulin and writes in the treatment plan that he must avoid strenuous occupational and recreational activity because exertion is triggering hypoglycemic episodes. Now all three elements of the 40 percent row sit in the record: insulin, restricted diet, and regulation of activities. The move from 20 to 40 percent more than doubles the monthly amount, the exact figures are in the pay table on this page. Note the order of operations: insulin plus diet without the documented activity restriction is still the 20 percent row. The prescription changed his treatment; the written activity restriction changed his rating.

Note (1) matters just as much for the long game: compensable complications of diabetes are evaluated separately unless they are used to support the 100 percent level. Neuropathy, kidney disease, and eye disease each carry their own ratings on top of DC 7913, which is why the secondary service connection guide pairs with this page.

If the decision came back lower

If your records already document all three 40 percent elements and VA rated 20 percent, the usual culprit is the activity restriction being read as advice rather than requirement, a fit for a Higher-Level Review. If your provider restricts your activities but never wrote it down, get it added to the treatment plan and file a Supplemental Claim; under DC 7913 an undocumented restriction does not exist.

If your rating came back lower than this

A decision that ignores the criteria above is a frequent reason veterans are underpaid. Line your decision up against the levels on this page. If the evidence supports a higher level than VA assigned, you have three ways to challenge it, and the right one depends on why it went wrong:

• Something was missing from the record (an exam finding, a prescription, a flare-up statement, a nexus letter): add it with a Supplemental Claim.
• The evidence was already there and VA misread it: ask for a Higher-Level Review by a more senior rater, with no new evidence needed.
• A legal or judgment error: take it to the Board of Veterans' Appeals.

Before you file, recombine this rating with your others (VA math does not add ratings), check how long each lane is taking right now, and remember a VA-accredited representative or VSO will help you for free. You can also browse every other condition's criteria to make sure you are claiming everything you are owed.