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How does the VA rate diabetes?

Makarov

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PEB Forum Veteran
Registered Member
Good Afternoon Everyone!

I have a buddy that is trying to properly submit a claim for issues he has from Diabetes. The DAV was less than helpful for original claim and the VA denied his claim as “not service connected” without even doing a C&P exam. Basically this is his situation. He was diagnosed with a thyroid disease during his time in active duty service. The disease should be service connected because it is a result of a vaccine that the military no longer uses due to adverse thyroid effects. He received the vaccine in order to deploy to the Middle East in the 90’s. Anyway, the thyroid condition went relatively untreated and developed into full blown diabetes mellitus after he was honorably discharged from the Air Force. Because he cannot afford treatment, his diabetes has been terrible. He’s developed Osteomyelitis and had multiple diabetic lesions. These has eventually gotten so severe that he’s had several ER trips throughout the last 2 years and had 4 different amputation surgeries. He now only has 4 toes on one foot and has had all toes and half his foot removed from the other side. All of this could have been avoided if his claim was approved the first time. Anyway, how should he go about putting in a new claim? Basically would he have to ask for compensation for amputations secondary to diabetes secondary to the thyroid disease? And how would that be rated? Any help would be greatly appreciated. Thanks y’all!
 

RonG

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Hello @Makarov

Although I have service-connected diabetes, it is unrelated to the case you describe.

Here is a somewhat related case that was denied on appeal.

Citation Nr: 0914848
Decision Date: 04/21/09 Archive Date: 04/29/09

DOCKET NO. 07-15 584


On appeal from the
Department of Veterans Affairs Regional Office in San Juan,
the Commonwealth of Puerto Rico

The Veteran contends that he has hypothyroidism due to
service. He specifically asserts that his hypothyroidism was
caused by administration of the anthrax vaccination during
service.

When seeking VA disability compensation, a veteran generally
seeks to establish that a current disability results from
disease or injury incurred in or aggravated by service. 38
U.S.C.A. з 1110.

https://www.va.gov/vetapp09/files2/0914848.txt <--LINK

Ron
 

chaplaincharlie

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Diabetes is a disease of the pancreas. Tying diabetes to a thyroid disease will be a long haul.
 

Makarov

Well-Known Member
PEB Forum Veteran
Registered Member
Hello @Makarov

Although I have service-connected diabetes, it is unrelated to the case you describe.

Here is a somewhat related case that was denied on appeal.

Citation Nr: 0914848
Decision Date: 04/21/09 Archive Date: 04/29/09

DOCKET NO. 07-15 584


On appeal from the
Department of Veterans Affairs Regional Office in San Juan,
the Commonwealth of Puerto Rico

The Veteran contends that he has hypothyroidism due to
service. He specifically asserts that his hypothyroidism was
caused by administration of the anthrax vaccination during
service.

When seeking VA disability compensation, a veteran generally
seeks to establish that a current disability results from
disease or injury incurred in or aggravated by service. 38
U.S.C.A. з 1110.

https://www.va.gov/vetapp09/files2/0914848.txt <--LINK

Ron
Thanks for the quick response! Yes, I have seen this case. Although, the finding for the vaccine is relevant, I wonder if the reason for this finding is that the veteran was not diagnosed with Hypothyroidism until almost 3 years after he left active duty. My buddy received his diagnoses and treatment while on active duty. Do you know if that would change the outcome of a service connection finding or would it still be “not service connected” since the nexus between anthrax vaccine and hypothyroidism has already been debunked through previous case law?
 

Makarov

Well-Known Member
PEB Forum Veteran
Registered Member
Diabetes is a disease of the pancreas. Tying diabetes to a thyroid disease will be a long haul.
While I under your point about two different metabolic organs, the science behind it is already acknowledged by medical practice. I am a hyperbaric chamber operator who treats diabetic lesions and osteomyelitis along with other diving and aviation syndromes. It’s very common in our line of work to see pt’s with type 2 diabetes who have a history of thyroid disease...And vice versa.
 

Makarov

Well-Known Member
PEB Forum Veteran
Registered Member
Diabetes is a disease of the pancreas. Tying diabetes to a thyroid disease will be a long haul.
Here’s a study published in 2019 in the educational Journal of Medicine showing the risk factors of each one that leads to the other.

 

chaplaincharlie

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Here’s a study published in 2019 in the educational Journal of Medicine showing the risk factors of each one that leads to the other.


I admire that you are trying to help a buddy. It will be an uphill battle. The journal article you reference found a correlation between thyroid disease and diabetes. A correlation is not causation. I am not against you, just think you will have an uphill battle.
 

Makarov

Well-Known Member
PEB Forum Veteran
Registered Member
It just pisses me off because he could have gotten medical care if they didn’t take so long to do his claim. Now the dude has only 4 toes left on one side and half a foot on the other side. He deserves just compensation.
 

RonG

PEB Forum Regular Member
PEB Forum Veteran
Lifetime Supporter
Registered Member
Hello Makarov,

Re: "I admire that you are trying to help a buddy. It will be an uphill battle. The journal article you reference found a correlation between thyroid disease and diabetes. A correlation is not causation. I am not against you, just think you will have an uphill battle."--Chaplaincharlie

I echo Chaplaincharlie's comments including the uphill battle part.

On another site, I have seen discussions about journal articles and a potential nexus between one's service and certain disabilities. The primary contributors wren former and active VA raters.

The consensus was that journal articles and similar publication not yet adopted by the VA hold no weight.

I'll send the URL to you in case you want to bring up the issue there. Many are Vietnam Vets and it has a more static audience. Not better than the PEB Forum, just different demographics.

Ron
 

chaplaincharlie

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QUOTE FROM VA

5. Determining Secondary SC, Including by Aggravation​


Introduction​

This topic contains information on determining secondary SC, including by aggravation, including

provisions for SC under 38 CFR 3.310(a) and (b)
medical evidence required to show a non-service-connected (NSC) disability was aggravated by an SC disability
developing claims based on aggravation of an NSC disability by an SC disability
information that must be included in the examiner’s report for secondary SC based on aggravation, and
determining the extent to which an NSC disability was aggravated by an SC disability.

Change Date​

January 20, 2016

a. Provisions for SC Under 38 CFR 3.310(a) and (b)​

Award SC for the following under the provisions of 38 CFR 3.310(a) and 38 CFR 3.310(b).

disabilities that are proximately due to, or the result of, an SC condition, or
the increase in severity of a non-service-connected (NSC) disability that is attributable to aggravation by an SC disability, and not to the natural progression of the NSC disability.

Reference: For more information on SC for aggravation of NSC disabilities by SC disabilities, see
38 CFR 3.310(b), and
Allen v. Brown, 7 Vet.App. 439 (1995).

b. Medical Evidence Required to Show an NSC Disability Was Aggravated by an SC Disability​

Do not concede an NSC disability is aggravated by an SC disability unless the baseline level of severity of the NSC disease or injury is established by

medical evidence created before the onset of aggravation, or
the earliest medical evidence created between the
onset of aggravation, and
receipt of medical evidence establishing the current level of severity of the NSC disability.

c. Developing Claims​

Based on Aggravation of an NSC Disability by an SC Disability​

When developing a claim for secondary SC based on aggravation of an NSC disability by an SC disability, ask the Veteran to furnish medical evidence showing the

current level of severity of the NSC disability, and
its level of severity
before aggravation by the SC disability, or
as soon as possible after aggravation.

Important: Enclose VA Form 21-4142, Authorization to Disclose Information to the Department of Veterans Affairs, and VA Form 21-4142a, General Release for Medical Provider Information to the Department of Veterans Affairs, in the request letter.

Upon receipt of this evidence, request a medical examination and opinion, to include a review of the claims folder by the examiner, to establish whether increased manifestations of the NSC disability are proximately due to an SC disability.

Notes:
Do not request an examination if the Veteran has failed to furnish medical evidence establishing a baseline level of the severity of the NSC disability.
The examiner must have all available evidence for review when providing an opinion on the issue of aggravation.
Identify the evidence of particular relevance in the claims folder for the examiner.

d. Information That Must Be Included in the Examiner’s Report for Secondary SC Based on Aggravation​

The examiner’s report must separately address all of the following medical issues in order to be considered adequate for rating a claim for secondary SC based on aggravation

the current level of severity of the NSC disease or injury
an opinion as to whether an SC disability proximately caused the NSC disability to increase in severity, and
an adequate analysis with medical considerations supporting the opinion.

e. Determining the Extent to Which an NSC Disability Was Aggravated by an SC Disability​

To determine the extent to which, if any, an NSC disability was aggravated by an SC disability

determine the baseline and current levels of severity of the NSC disability under 38 CFR Part 4, Schedule for Rating Disabilities, and
deduct the baseline level of severity of the NSC disability, as well as any increase of the disability due to natural progression, from the current level.

Note: This policy applies even when the current level of severity of the NSC disability is 100 percent.

Important: Whenever there is competent and credible evidence of an increase in severity of the disability from the baseline, satisfying the guidance in this topic, but the current and baseline disability would be assigned the same level of evaluation under 38 CFR Part 4, Schedule for Rating Disabilities, grant SC and assign a noncompensable evaluation. To justify SC, the degree of disability after aggravation does not have to be at least one level of evaluation higher than the baseline.

Example: The medical examiner clearly states that the NSC disability was aggravated by the SC disability. The medical evidence shows that the baseline level of disability corresponds to 0 percent and the current level of severity after aggravation corresponds to 0 percent under 38 CFR Part 4, Schedule for Rating Disabilities. It is appropriate to find that there was aggravation. Grant SC and assign a noncompensable evaluation.
 
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