How to file a VA type 2 diabetes claim — the Agent Orange presumption, direct and secondary routes, and how DC 7913 rates it
Type 2 diabetes mellitus is on VA's list of Agent Orange presumptive conditions: a veteran with presumed herbicide exposure needs only the diagnosis. Presumed exposure covers service in the Republic of Vietnam, its inland waterways or within 12 nautical miles of its coast between January 9, 1962 and May 7, 1975; the PACT Act locations (any U.S. or Royal Thai base in Thailand 1962–1976, Laos 1965–1969, Mimot or Krek, Cambodia in April 1969, Guam, American Samoa and their waters 1962–1980, Johnston Atoll 1972–1977); the Korean DMZ between September 1, 1967 and August 31, 1971; Air Force units with contaminated C-123 aircraft; and herbicide transport, testing or storage duties. Without presumed exposure, diabetes can still be service-connected directly or as secondary to another service-connected condition. VA rates it under 38 CFR 4.119, diagnostic code 7913, from 10% to 100% by how it is managed — diet, oral medication, insulin, regulation of activities, and hospitalizations.
What you'll need
- VA Form 21-526EZ
- Medical records showing the type 2 diabetes diagnosis, your treatment (diet, oral medication, insulin), any regulation of activities ordered by your provider, and any hospitalizations
- Service records showing service in a presumptive location and period, or a C-123 unit assignment (USAF Forms 2096, 5 or 781)
- For a secondary claim: the rating decision for the primary condition and a medical opinion linking the two
- A free accredited representative (CVSO or VSO)
Step-by-step
Step 1: Confirm presumed exposure or another route
Presumed Agent Orange exposure: service for any length of time in the Republic of Vietnam, aboard a vessel in its inland waterways, or on a vessel not more than 12 nautical miles seaward of the Vietnam–Cambodia demarcation line, between January 9, 1962 and May 7, 1975; any U.S. or Royal Thai base in Thailand from January 9, 1962 through June 30, 1976; Laos December 1, 1965 – September 30, 1969; Mimot or Krek, Kampong Cham Province, Cambodia, April 16–30, 1969; Guam, American Samoa or their territorial waters January 9, 1962 – July 31, 1980; Johnston Atoll or a ship that called there January 1, 1972 – September 30, 1977; the Korean DMZ September 1, 1967 – August 31, 1971; an Air Force unit where a C-123 with Agent Orange residue was assigned, with repeated contact through flight, ground or medical duties; or transporting, testing or storing Agent Orange. Otherwise, a diagnosis in service, or a medical opinion linking diabetes to a service-connected condition (38 CFR 3.310), supports the claim.
Reference: https://www.va.gov/disability/eligibility/hazardous-materials-exposure/agent-orange/
Step 2: Document the diagnosis and treatment
Gather the records that show a type 2 diabetes mellitus diagnosis and how it is managed: restricted diet, oral hypoglycemic agents, insulin (and how many injections a day), any instruction from your provider to avoid strenuous occupational or recreational activities, visits to a diabetic care provider, and any hospitalizations for ketoacidosis or hypoglycemic reactions. DC 7913 rates on these facts. Once diabetes is conclusively diagnosed VA will not require a glucose tolerance test just for rating purposes (Note 2).
Step 3: File VA Form 21-526EZ
File online, by mail to the Claims Intake Center (PO Box 4444, Janesville, WI 53547-4444), in person or through a free accredited representative, naming "type 2 diabetes mellitus" and the route (Agent Orange presumptive, direct, or secondary to a named condition). List complications you already have — peripheral neuropathy, eye disease, kidney disease, erectile dysfunction, heart disease — as separate conditions so they are rated. If VA denied the claim before your location or vessel became presumptive (for example Blue Water Navy service, or the PACT Act locations), file a Supplemental Claim (VA Form 20-0995) based on the change in law.
Reference: https://www.va.gov/disability/file-disability-claim-form-21-526ez/
Step 4: The claim exam
VA usually schedules an exam that records your treatment regimen, whether your provider has ordered regulation of activities, the frequency of care visits, episodes of ketoacidosis or hypoglycemia and any hospitalizations, and complications. Bring your medication list and any written activity restrictions; the examiner's findings on these points map directly onto the DC 7913 levels.
Step 5: How DC 7913 rates diabetes
10% — manageable by restricted diet only; 20% — requiring one or more daily injection of insulin and restricted diet, or an oral hypoglycemic agent and restricted diet; 40% — requiring one or more daily injection of insulin, restricted diet and regulation of activities; 60% — insulin, restricted diet and regulation of activities with episodes of ketoacidosis or hypoglycemic reactions requiring one or two hospitalizations a year or twice-monthly visits to a diabetic care provider, plus complications that would not be compensable if separately evaluated; 100% — more than one daily insulin injection, restricted diet and regulation of activities with episodes requiring at least three hospitalizations a year or weekly visits, plus progressive loss of weight and strength or complications that would be compensable if separately evaluated. Compensable complications are rated separately unless they are part of the 100% criteria; noncompensable ones are considered part of the diabetic process (Note 1).
Critical tips
- "Regulation of activities" means your provider has told you to avoid strenuous occupational and recreational activities because of the diabetes — ask that it be written in your record if it applies.
- Diabetic complications (neuropathy, retinopathy, nephropathy, erectile dysfunction, heart disease) are claimed as secondary conditions with medical evidence and rated under their own codes.
- Veterans with presumed exposure can also ask their VA environmental health coordinator for a free Agent Orange Registry health exam; it is not a claim exam.
- Questions about Agent Orange claims: VA help line 800-827-1000 (TTY 711).
- A county veterans service officer can file the claim for free: warriorsfund.org/find-cvso.
- In crisis: dial 988 then press 1, or text 838255.
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