VA Diabetes Ratings

Discussion in 'Diabetes' started by stumpy, Jun 26, 2004.

  1. stumpy

    stumpy New Member

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    7913 Diabetes mellitus
    Requiring more than one daily injection of insulin, restricted 100
    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..........................
    Requiring insulin, restricted diet, and regulation of 60
    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....................................................
    Requiring insulin, restricted diet, and regulation of 40
    activities...................................................
    Requiring insulin and restricted diet, or; oral hypoglycemic 20
    agent and restricted diet....................................
    Manageable by restricted diet only............................ 10
    Note (1): Evaluate compensable complications of diabetes
    separately unless they are part of the criteria used to
    support a 100 percent evaluation. Noncompensable
    complications are considered part of the diabetic process
    under diagnostic code 7913.
    Note (2): When diabetes mellitus has been conclusively
    diagnosed, do not request a glucose tolerance test solely for
    rating purposes.
  2. John Gibson

    John Gibson New Member

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    I am presently in process of applying for crsc with a total of 70% disability and with 40% for diabetes type II. I have anther 20% due to numbness in my feet and legs caused from diabetes. Does the code 7913 that you refer to cover all Diabetes related conditions?
  3. TinCanMan

    TinCanMan Active Member

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    No, complications of diabetes are rated separately. Peripheral Neuropathy is rated under 38CFR4.124a and could carry a diagnostic code of 8510-8530 depending on the nerve involved. Look at your decision paper, it should list the codes.
  4. USMCMustanger

    USMCMustanger New Member

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    Hey, newbe here. After 36 years, I just became aware of the D&C for DMII. I have SSDI now due to complications from DMII. I also have a host of secondary complications and upcoming D&C appointments. Any suggestions how to proceede? I filed for D&C in November, just now getting appointments for evaluation. Being new, where do I find a list of DMII related complications, diseases. Anything, I should know before the VA administered C&P evaluation?
    Thanks,
    Rick
  5. TinCanMan

    TinCanMan Active Member

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    Rick:


    I have no idea what you mean by a D&C unless you are having female problems :). You must mean Compensation & Pension (C&P) exam. Is that right?

    The normal procedure is to file a claim for compensation due to service connected (SC) disabilities with the nearest Veterans Administration Regional Office (VARO) and it will be looked at eventually by a Rating Veterans Service Representative (RVSR). The RVSR will decide if a C&P exam is in order and what kind/s. He will then instruct the nearest Veterans Administration Medical Center (VAMC) or contractor to schedule specific exams and to notify you of the schedule. You will be examined according to a certain protocol to identify your limiting conditions and make a diagnosis if needed.

    There is no official list of what the VA considers to be a complication of DMII. You should be working with your doctor to identify those. There are also many web sites that outline those possibilities. Some are and some are not accepted by the VA. Way to complex to list here. Tell us what you have and we can offer general opinion if the VA will buy it or not.

    As far as the exam goes, understand it is not treatment for your condition and is only for issues the RVSR requested. You cannot raise new conditions at a C&P. If the Exam is for DMII, the examiner doesn't care if you have back problems or headaches. If you didn't raise secondary conditions with your claim, the examiner won't be worrying about them. He can only examine you for the issues requested by the RVSR.

    Every good claim has 3 elements:
    1. the appropriate military service
    2. a diagnosis of a compensable condition or disease
    3. a nexus, or connection between 1 & 2 ( usually made by a medical professional)

    You haven't told us why you think your DMII is SC? Did you have it in service or were you a Vietnam vet with service in-country?
  6. USMCMustanger

    USMCMustanger New Member

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    reply to TinCanMan

    Thanks for a quick reply. Yes, I meant C&P (sorry, too new to know better).

    The claim is for AO exposure while in Vietnam (69-70).

    I have diagnosis of DMII from both Kaiser and VA.

    I have already filed for disability and have received C&P exam dates for DMII, PTSD, General Med. and Neuro. All scheduled for next week.

    I sent in all paperwork in December, 2005. VA has acknowledged receipt of the paperwork, and I will not miss the C&P exams. Disability request made for PTSD, hearing loss, tennitus, DMII, related conditions to DMII: HTN, Hypothyroid, CAD, w/stent LAD, arteriosclerosis, neuropathy B/L both hands to palmer and feet to ankles, stroke, hyperlidemia, cerabellar ataxia, tremors. Also for knee injury while in service (in med. recs.), stroke(s), MI (times 3), pectoris angina, HCN, and COPD. Does not yet include a stroke that landed me in non-VA hospital for 10 days, and the resultant speech abnormality.

    As for getting Dr. nexus of connecting secondary disease, my current physicians are all VA employed. Think they would provide the necessary opinion? Given more time, and money, I can get them from Kaiser for about $250.00 and about a 6 week wait.

    Thanks again TinCanMan,

    Rick
  7. TinCanMan

    TinCanMan Active Member

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    Rick:

    VA physicians are permitted to provide opinions but are not required to do so. Ask them. FWIW, $250 is a cheap investment considering the potential payback. A couple of thoughts come to mind; DMII is pretty much a slam dunk if you were an in-country vet. CAD/various heart problems can be rated secondary to DMII fairly easily if the CAD was diagnosed after the diagnosis for DMII. The same applies to peripheral neuropathy, pretty much a done deal if DMII is connected. Hyperlipidemia is a lab finding not a disease or condition and is not ratable. Some of the other things you mention are symptoms and not conditions.

    Just because a condition is shown in your medical record doesn't mean the VA will service connect it. You'll need a continuous history of treatment post discharge to make it fly. A rather simplistic example is the common cold. If you had one in service and you have one now, does that mean you can get it connected? No, unless you can prove the cold you have now is the same cold you had 40 years ago. You do that by showing a continuous record of treatment.

    I don't know squat about PTSD, but RainVet does and he outta be somewhere about. Perhaps he can lend his expertise there. I understand some folks have connected COPD secondary to PTSD but it isn't real common. Think that's going to be a tough sell.
  8. rainvet

    rainvet New Member

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    USMCMustanger, just wrote you a long post and then I submit it and all was gone , so I'm not going to do it again tonight but will get back with you real soon. I read TinCanMan post and he had alots of good respond , but I hope I will be able to give you a little insign to you.

    TinCanMan, I tough about you today on the way back from all day appts today. It was brough up in our VA TRP group meeting about what we both was posting about yesterday. Let me explain to you if I can, because I've never be one with words, but I never meant for anyone to think that I was nor will tell notting but the truth. Now having stated that, what I am trying to get across to others Vets is, that the least you say about your and or your family history is the best thing to to because your words will come back to hurt you. When I said that you have to learn to play the games that the VA and others want you too is to stated words in a special way to beable to help your VA Claim. Just two example is something like this : From a doctor that is not with nor used by the VA. Doctor statement should be written down on paper stating that "It in my own opinion, that Mr. X health problems are more likely than not to have been caused by his pass service. Like Agent Orange. Next you must watch the way you stated your words when you in a doctor office and or VA caseworkers, you should use your words to state that Some days are better than others. As soon as you state that you feel ok something and not others days; you just gave the Person a way to get your Claim turned down becausae you was telling the truth but because of that the VA will evertime state that the Veteran said his fell good most of the time. Just little words like this will kill most if not all Claims. It not right but that the way you have to play these little game to get a Claim most of the time should be a givin, but little words will come back to hurt you. Not you are not lieing to anyone but if you don't be careful with your words you will be there for the long hual. Please save you time and pain. RainVet !
  9. TinCanMan

    TinCanMan Active Member

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    If you are asked during a C&P visit how you are doing and you tell the examiner how you feel on your worst day, then you are being deceptive and that is fraudulent. IOW, it's a lie.

    You have two choices in this situation, You either tell the examiner how you feel right now because that is what you were asked or you tell the examiner how you feel on your best day followed by how you feel on your worst day and then state on average how you feel.

    If you lie, and it is a lie, in the expectation the examiner will twist your words, you are no better than he is and you still have committed a fraud on the VA and the public. If you obtain your rating by fraud it can be removed in it's entirety despite statutes that protect ratings after a time. Do you really want to wonder for the rest of your life if you're going to lose it. Personally I hope they put people in jail for committing fraud on the public. They are no better than the wanna be that applies for compensation or pretends to be a decorated veteran.

    If the examiner twists your words you have every right to correct them. Just get a copy of the C&P report and file a rebuttal with the VARO. There's no need to lie about it.
  10. rainvet

    rainvet New Member

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    TinCanMan, it not your job to say who is telling the truth or not. That the Gov't job and all your respondable is to serve the Veterans on there claim and let the Gov't do there won investigation and that not for you to determent. You will be working for the VStates Veterans and not for the Federal Gov't. You want to instill you views and ideal and if you feel that way then your not deserving to be a VRO. If you can't serve your follers Vets then don't become a VRO because if not your job to tell and nor tell a Vet what he camn do nor not do per his right to fill a claim weather if legal nor not. That the Federal Gov't job and you need to get over your personal feeling and pressige for others vets. I deal with your kind and I'm out to help Vets that need answer and what there rights and not hate them decause you couldn't nor didn't walk in there shoes. You are to concerner a different job, maybe work for the VA or sometimg like that, because you sound just like one of them. enought said on this subjust so now I will turn my attantion to Veterans who need answer and not leturter. GOD Speed and GOD Bless. RV
  11. TinCanMan

    TinCanMan Active Member

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    Sorry Rainvet, it is every citizens duty to point out illegal activity. It doesn't matter if it is theft or fraud. I can identify fraud when I see it.

    In addition to anything else I may be, I'm also a taxpayer. You know, one of those people that contribute their hard earned dollars to disabled veterans. The government hasn't got two nickels to rub together. It all belongs to the people that work for a living and I just gotta tell ya, If I see someone attempting to steal my money thru deception I'm gonna say something. If it comes to my attention that a fraud was committed, you can bet I'm gonna report it. If I hear someone encouraging others to defraud the government, you can bet they'll hear from me.
  12. jimmymac2

    jimmymac2 New Member

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    TinCanMan,

    You appear to be very bright and quite knowledgeable in the Veterans Affairs arena and what one must do to prosecute their claim.

    As a retired agent with the U.S. Treasury, I learned that the elements of fraud are:

    • A representation about a material fact
    • Which is false
    • And made intentionally, knowingly, or recklessly so
    • Which is believed
    • And acted upon by the victim
    • To the victim’s damage

    How did you learn to see fraud just by looking at it? Have you testified in court on fraud cases? Did you testify that you knew it was fraud because you can see fraud? If so, I can get you a job with the IRS in a heart beat!

    I did testify in court and I had to prove beyond a shadow of doubt that the fraudulent act was committed. I could not rely on the preponderance of evidence. I had to “SLAM THE DOOR.”

    I agree with you that it is our duty to report crimes and no one should ever assist other's in the furtherance of fraud. If you are an employee of Dept. of Vet. Affairs I sure hope you are not the person reviewing my file. I would hope for some one more open minded.

    This is just my opinion and I may be wrong!
  13. ZoWhat

    ZoWhat New Member

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    Just a quick question here. Just retired about a year ago. Was recently diagnosed with Diabetes II. Receiving oral meds. Feel fine.

    My VA rating is 70% with some various issues (sleep apnea, hypertention, hyperthroid).

    Just wondering if it's worth my time to get rated on this issue. It's something that came about after my retirement.

    Any thoughts out there.

    Many thanks.
  14. sooner1938

    sooner1938 New Member

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  15. TinCanMan

    TinCanMan Active Member

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    Sooner:

    His combined rating is 70% for sleep apnea, hypertension, hyperthyroid. It does not include DMII. He is considering a claim for that.

    You didn't say when you were diagnosed with sleep apnea but it is generally only compensable if diagnosed in service. It is not considered secondary to DMII but your hypertension might be if it was diagnosed after the onset of DMII and I believe must be at least 140 (the first number) medicated. Never can remember systolic/diastolic and which one comes first.
  16. TinCanMan

    TinCanMan Active Member

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    ZoWhat:

    You bet. Per 38 CFR 3.309, DMII is one of those chronic conditions considered presumptive of military service provided it was diagnosed as 10% compensable within 1 year of discharge.
  17. sooner1938

    sooner1938 New Member

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    ........................
  18. TinCanMan

    TinCanMan Active Member

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    Sooner:

    If you're entitled to the compensation, go for it. If ya get to 50% it'll start putting cash in your pocket today. Don't worry about "dealing" with govt. agencies. Ya fill out the claim as best ya can, submit it and forget about it. Don't obsess over it. Just go fishin'. You don't "need" the gelt so you can relax. If it's approved, nice surprise. Otherwise, so what.
  19. sooner1938

    sooner1938 New Member

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  20. ZoWhat

    ZoWhat New Member

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    Thanks for the advice. I'll definately get going on it.

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