Inside the exam room
1. You will be asked about medicine, insulin, diet, and activity limits prescribed by your clinician. Separate prescribed limits from activities you choose to avoid.
2. The examiner will review serious low-blood-sugar episodes, diabetes-related acid buildup, hospital stays, visits, and complications. Give dates, reasons for treatment, and supporting records.
3. You will be asked how treatment and symptoms affect your day. Explain meal schedules, treatment tasks, episodes, and limits your clinician prescribed.
How VA rates diabetes
List prescribed medicines, diet instructions, activity restrictions, and serious low- or high-blood-sugar episodes. Several requirements must be met together; do not stop at the insulin requirement. DC 7913 uses combined treatment and complication requirements. At 40% and above, insulin, restricted diet, and prescribed limits on strenuous activities (regulation of activities) are required together. These limits mean avoiding strenuous work and leisure activities on medical instructions. Meal timing or deciding on your own to do less does not meet that requirement.
What each rating percentage means
Match the whole description with your exam and records. A single symptom or illustration does not decide your rating.
| Rating | What the rule requires |
|---|---|
| 10% | Diabetes managed by a restricted diet only. |
| 20% | One or more daily insulin injections and a restricted diet, OR a blood-sugar medicine taken by mouth (oral hypoglycemic agent) and a restricted diet. |
| 40% | One or more daily insulin injections, a restricted diet, AND prescribed limits on strenuous activities (regulation of activities). |
| 60% | One or more daily insulin injections, a restricted diet, AND prescribed limits on strenuous activities (regulation of activities); diabetes-related acid buildup (ketoacidosis) or low-blood-sugar reactions (hypoglycemia) requiring one or two hospitalizations per year OR twice-monthly diabetic-care visits; AND other health problems that would not receive a paid rating on their own. |
| 100% | More than one daily insulin injection, a restricted diet, AND prescribed limits on strenuous activities (regulation of activities); diabetes-related acid buildup (ketoacidosis) or low-blood-sugar reactions (hypoglycemia) requiring at least three hospitalizations per year OR weekly diabetic-care visits; AND either progressive loss of weight and strength OR other health problems that would receive a paid rating on their own. |
Check these details in your records
The examiner uses a condition form called a Disability Benefits Questionnaire (DBQ). Compare these items with your own records and explain what actually happens in daily life.
- Diabetes managed by a restricted diet only.10%Compare the whole description with your medical records. Choosing it here does not decide your VA rating.
- One or more daily insulin injections and a restricted diet, OR a blood-sugar medicine taken by mouth (oral hypoglycemic agent) and a restricted diet.20%Compare the whole description with your medical records. Choosing it here does not decide your VA rating.
- One or more daily insulin injections, a restricted diet, AND prescribed limits on strenuous activities (regulation of activities).40%Compare the whole description with your medical records. Choosing it here does not decide your VA rating.
- One or more daily insulin injections, a restricted diet, AND prescribed limits on strenuous activities (regulation of activities); diabetes-related acid buildup (ketoacidosis) or low-blood-sugar reactions (hypoglycemia) requiring one or two hospitalizations per year OR twice-monthly diabetic-care visits; AND other health problems that would not receive a paid rating on their own.60%Compare the whole description with your medical records. Choosing it here does not decide your VA rating.
- More than one daily insulin injection, a restricted diet, AND prescribed limits on strenuous activities (regulation of activities); diabetes-related acid buildup (ketoacidosis) or low-blood-sugar reactions (hypoglycemia) requiring at least three hospitalizations per year OR weekly diabetic-care visits; AND either progressive loss of weight and strength OR other health problems that would receive a paid rating on their own.100%Compare the whole description with your medical records. Choosing it here does not decide your VA rating.
What may happen in the exam room
- The examiner reviews the diabetes diagnosis, medicines, meal plan, and activities your health care professional told you to limit.
- Review serious acid buildup from diabetes (ketoacidosis), low-blood-sugar reactions (hypoglycemia), hospital stays, appointments, and other health problems caused by diabetes.
What the measurements tell you
- How many insulin injections you need each day and what meal plan you were told to follow.
- Activity limits your health care provider prescribed because of diabetes.
- Dates and reasons for hospitalizations and diabetic-care visits.
- Whether you keep losing weight and strength, and which other health problems diabetes has caused, if any.
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 diabetes-related acid buildup (ketoacidosis) or low-blood-sugar reactions (hypoglycemia)?
- What complications have clinicians diagnosed?
Questions to expect
What treatment and activity restrictions has your clinician prescribed?
Explain: List medicine or insulin, diet and specific instructions to avoid strenuous activity because of diabetes. Separate these from limits you chose yourself.
Rating connection: DC 7913 requires the whole combination in a row. Regulation of activities means medically prescribed restrictions, not fatigue or a personal decision to exercise less.
What serious episodes, visits and complications occurred?
Explain: Use dates and records for ketoacidosis or low-blood-sugar hospitalizations, care frequency and complications.
Rating connection: Higher rows require specified treatment plus episode, visit and complication requirements. Other compensable complications may be rated separately under the stated exception.
Your answer outline
My current prescribed treatment is [medicine and meal plan]. I follow it by [actual routine]. My clinician has [specific activity instructions, or none that you know of]. [Treatment-related visits or difficulties, with dates or records when available].
Mark approximate dates and counts as estimates.
My notes: ________________________
Service connection records
1. How is this connected to your service?
For a direct claim, identify your current disability, what happened in service, and evidence linking them. Being on active duty or orders alone does not prove that link.
- Write the 5 Ws and how: who was there; what happened; when; where; why you were there; how the problem began. Add duty status, treatment, witnesses, and records. Mark uncertain dates as estimates.
- Guard or Reserve: find your orders, dates, duty type, and any line-of-duty records. Active duty, training, and drills have different rules.
- Secondary condition: it may start after service. Identify the service-connected condition and evidence that it caused or worsened this problem. A medical opinion may help explain the link.
- Started before service? Record what changed during service. Presumptive condition? Check the required diagnosis and service history; qualifying claims do not require separate proof of a link.
- Already service connected and seeking an increase? Focus on what has worsened and the records showing it.
If you do not know the cause, say so. Do not guess a medical connection.
Explain what changes in daily life
Describe both what you can do and what becomes difficult. Include how often it happens and how long it lasts.
- 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 prescribed limits on strenuous activities (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.
Records to get ready before the exam
- Diabetes treatment records and medication list.
- Recorded dietary and activity instructions.
- Hospitalization and diabetic-care visit records.
- Records of other health problems your provider says diabetes caused.
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
Other health problems caused by diabetes: A problem that qualifies for a paid rating is rated separately unless it was used to support the 100% diabetes rule. A problem that does not qualify for a paid rating stays part of the diabetes rating. Symptoms alone do not prove a separate diagnosis or its link to diabetes.
Official rating rule and code numbers
Use this source to check the full rule and its medical terms: 38 CFR 4.119, DC 7913. Source review recorded 2026-09-04.
Could one health problem have caused another?
A condition VA has already linked to your service may cause another health problem or make it worse. VA calls this secondary service connection. Having both conditions does not prove the link. Your records need to show a current diagnosis and explain how the first condition or its treatment affected the second.
- Start with your records. Find the current diagnosis, the condition VA already linked to service, and evidence from someone qualified to explain the connection.
- Ask about cause and worsening. Did the first condition or its treatment cause the new disability, or make an existing disability worse? These are different questions. The rules call them causation under 38 CFR § 3.310(a) and aggravation under § 3.310(b). If both are raised by your records, the medical opinion should address both; answering only the cause question may not be enough (El-Amin).
- If treatment may be involved, collect the dates. List the medicine or surgery prescribed for the condition VA linked to service, the side effect, and the new diagnosis. Bring pharmacy records and dates when treatment started or stopped. A provider must explain the connection in your case; taking a medicine alone does not prove it.
- If weight gain may be involved, ask how it fits. Weight gain or obesity can be a step between the first condition and another diagnosed disability under VAOPGCPREC 1-2017. Obesity itself does not receive a VA disability rating.
- You do not need absolute certainty. VA uses the “at least as likely as not” standard and the reasonable-doubt rule under 38 CFR § 3.102. Ask a VA-accredited representative how the evidence applies to your claim.
- The same symptom cannot be counted twice. This is the rule against pyramiding in 38 CFR § 4.14. Mental-health diagnoses generally share one § 4.130 rating when they affect the same work and social abilities. Trouble sleeping may be a symptom rather than a separate disability.
- Check whether VA already assumes a link to service. Some conditions qualify based on where or when you served. These are called presumptive conditions. Examples can include chronic rhinitis, chronic sinusitis, hypertension after qualifying herbicide exposure, and type 2 diabetes. Sleep apnea (OSA) is not a PACT Act presumptive. Check eligibility before seeking a medical opinion about the link.
- An exam form and a medical opinion do different jobs. A Disability Benefits Questionnaire (DBQ) records the diagnosis and how severe it is. It may not explain why it is linked to service, often called a nexus. A VA-accredited veterans service organization (VSO) can help you file at no charge.
If another prescribed treatment may have caused a problem, ask your health care provider to record what happened and explain the connection in your case.
Sources: 38 CFR § 3.310 · 38 CFR § 4.14 · VA-accredited representatives
Other health problems to ask about
Use these notes to ask your provider about problems you already have. Your records must explain the connection. VA decides whether the condition is linked to service.
If diabetes has caused nerve damage, records should identify each affected arm or leg and nerve. VA can apply the rule for each nerve without counting the same symptoms twice.
Bring eye-exam results showing damage from diabetes. VA uses them to decide whether the eye problem can receive a separate rating.
Bring kidney test results and the diagnosis. VA uses them to decide whether kidney disease from diabetes can receive a separate rating.
Record where sores appear, how deep they are, how often they return, any infection, and treatment. Ask the provider to record whether diabetes caused them.
A diagnosed problem caused by diabetes may receive a rating under its own rule. VA may also consider extra monthly compensation (SMC) when the records support it.
If either is diagnosed, ask your provider whether diabetes caused it or made it worse.
Choose the related health problems you want to discuss. Your preparation packet will include the notes you select and the full condition guides available for them.