How VA rates diabetes
DC 7913 uses combined treatment and complication requirements. At 40% and above, insulin, restricted diet, and regulation of activities are required together. Regulation means avoidance of strenuous occupational and recreational activities; meal timing or voluntarily doing less is not a substitute for documented medical restriction.
Rating criteria from the tool data
| Rating | What VA looks for |
|---|---|
| 10% | Diabetes managed by a restricted diet only. |
| 20% | One or more daily insulin injections and a restricted diet, OR an oral hypoglycemic agent and a restricted diet. |
| 40% | One or more daily insulin injections, a restricted diet, AND regulation of activities. |
| 60% | One or more daily insulin injections, a restricted diet, AND regulation of activities; ketoacidosis or hypoglycemic reactions requiring one or two hospitalizations per year OR twice-monthly diabetic-care visits; AND complications that would not be compensable if evaluated separately. |
| 100% | More than one daily insulin injection, a restricted diet, AND regulation of activities; ketoacidosis or hypoglycemic reactions requiring at least three hospitalizations per year OR weekly diabetic-care visits; AND either progressive loss of weight and strength OR complications that would be compensable if evaluated separately. |
DBQ and symptom topics to review
Review these topics against your own records and symptoms. Do not exaggerate or minimize; describe functional impact accurately.
- Diabetes managed by a restricted diet only.10%Compare the complete criterion with documented findings; not a personal rating.
- One or more daily insulin injections and a restricted diet, OR an oral hypoglycemic agent and a restricted diet.20%Compare the complete criterion with documented findings; not a personal rating.
- One or more daily insulin injections, a restricted diet, AND regulation of activities.40%Compare the complete criterion with documented findings; not a personal rating.
- One or more daily insulin injections, a restricted diet, AND regulation of activities; ketoacidosis or hypoglycemic reactions requiring one or two hospitalizations per year OR twice-monthly diabetic-care visits; AND complications that would not be compensable if evaluated separately.60%Compare the complete criterion with documented findings; not a personal rating.
- More than one daily insulin injection, a restricted diet, AND regulation of activities; ketoacidosis or hypoglycemic reactions requiring at least three hospitalizations per year OR weekly diabetic-care visits; AND either progressive loss of weight and strength OR complications that would be compensable if evaluated separately.100%Compare the complete criterion with documented findings; not a personal rating.
What may happen in the exam room
- Review of diabetes diagnosis, medication, dietary management, and medical activity restrictions.
- Review of ketoacidosis or hypoglycemic reactions, hospitalizations, care visits, and complications.
Measurements and findings to understand
- Number of daily insulin injections and required dietary treatment.
- Documented regulation of activities for diabetes.
- Dates and reasons for hospitalizations and diabetic-care visits.
- Progressive weight and strength loss or documented complications, where applicable.
Questions the examiner may cover
- What medication and dietary treatment are required?
- Has your clinician restricted strenuous activities because of diabetes?
- Which hospitalizations or visits were due to ketoacidosis or hypoglycemic reactions?
- What complications have clinicians diagnosed?
Functional-impact language to think through
Use plain, truthful wording that matches your records and daily limitations. These examples are prompts for accuracy, not scripts.
- Describe your actual treatment and its effect on daily life.
- Use records to identify the reason and dates for hospital visits.
- Do not describe ordinary fatigue or meal planning as prescribed regulation of activities.
Common mistakes to avoid
- Assigning 10% for an oral drug plus restricted diet; that is listed at 20%.
- Treating insulin alone or an activity restriction alone as meeting 40%.
- Assigning a percentage based on Vietnam service or an assumed complication.
Evidence to organize before the exam
- Diabetes treatment records and medication list.
- Documented dietary and activity instructions.
- Hospitalization and diabetic-care visit records.
- Clinical records of complications.
Preparation notes
- Do not change medication, food intake, or activity to influence an examination.
- Service connection, including any presumption, is separate from the severity percentage.
Important context
Complications: Compensable complications are evaluated separately unless used to support the 100% criteria. Noncompensable complications are part of the diabetic process. A symptom alone does not establish a complication or medical nexus.
Official rating source
38 CFR 4.119, DC 7913. Checked 2026-09-04. Educational preparation only; not a personal rating.
How secondary service connection works
A secondary condition is not automatic. The evidence must connect a current diagnosed disability to an already service-connected condition or its medically indicated treatment.
- Basic evidence: a current diagnosis, an already service-connected primary condition, and competent evidence linking the two.
- Two theories: the primary condition or its treatment caused the new disability under 38 CFR § 3.310(a), or aggravated a pre-existing non-service-connected disability under § 3.310(b). An opinion should address both when the record raises both; causation alone may be inadequate (El-Amin).
- Treatment pathway: service-connected condition → medically indicated medication or surgery → documented adverse effect → current diagnosis. Pharmacy records, start and stop dates, and a treating clinician’s reasoning matter; medication use alone does not establish the connection.
- Weight as an intermediate step: obesity or weight gain can be part of the causal chain under VAOPGCPREC 1-2017, but obesity itself is not a disability for a VA rating.
- Standard of proof: VA applies the “at least as likely as not” standard and reasonable-doubt rule under 38 CFR § 3.102. This guide identifies evidence questions; it does not tell you what to file.
- Avoid pyramiding: 38 CFR § 4.14 prohibits rating the same manifestation twice. Mental-health diagnoses generally use one § 4.130 evaluation for the same occupational and social impairment, and insomnia may be a symptom rather than a separate disability.
- Presumptives are different: qualifying service may make chronic rhinitis, chronic sinusitis, hypertension associated with herbicide exposure, or type 2 diabetes presumptive. OSA is not a PACT Act presumptive. Check current eligibility before seeking nexus evidence for a condition the law may already presume.
- DBQ is not a nexus: a DBQ documents diagnosis and severity; it does not necessarily establish service connection. A VA-accredited VSO can help with filing strategy at no charge.
Other medically indicated treatments for a service-connected condition may support a secondary theory when a clinician documents the adverse effect in this veteran.
Sources: 38 CFR § 3.310 · 38 CFR § 4.14 · VA-accredited representatives
Possible secondary conditions to discuss with a qualified reviewer
These are educational issue-spotting notes, not medical nexus opinions. VA decides service connection.
Documented diabetic neuropathy may be evaluated under affected nerve criteria for each distinct extremity, subject to pyramiding rules.
Eye examinations and retinal findings establish whether a diabetic eye complication is separately evaluable.
Renal labs and diagnosis establish whether diabetic nephropathy is separately evaluable.
Document location, depth, recurrence, infection, treatment, and whether a clinician identifies the wound as diabetic.
A diagnosed diabetic complication may be evaluated under applicable criteria; VA may also consider SMC when supported.
Review only when diagnosed and medically supported as caused or aggravated by diabetes.