The most frequent type of diabetes that we see in our practices involves type II diabetes or adult onset diabetes. Sometimes it is called diabetes mellitus. The reason for this is because this disease is associated with Agent Orange exposure. Therefore, if you can establish your presence on the ground in Vietnam during the Vietnam War, your entitlement to service-connection for diabetes will be automatic. So frequently, litigation involving type II diabetes in individuals who believe they were exposed to Agent Orange, involves proving that they were in fact exposed to Agent Orange. The majority of these cases involve individuals who cannot prove that they were on the ground in Vietnam but were otherwise exposed either in other capacities or in other parts of the world. In those cases, the determinative issue in the case involves proving exposure rather than proving the connection between the herbicides and the type II diabetes. The VA has already conceded the medical science that establishes a link between type II diabetes and exposure to herbicides.
However, there are other cases involving diabetes that are unrelated to Agent Orange exposure. These cases typically involve individuals who served long after the end of Vietnam era and who otherwise were not in a location known to be contaminated with Agent Orange. These cases will usually involve situations were the Veteran believes that the early onset of his diabetes occurred during active duty but was not officially diagnosed until many years later. In these cases, strong forensic medical evaluations are required in order to carefully assess notations in the service treatment records that could be interpreted as the early symptoms of type II diabetes. There are numerous pre-diabetic conditions and symptoms that may frequently be missed by the average member of the Medical Corp during active duty. In addition, there is scientific research to indicate that the average type II diabetic case goes undiagnosed for a number of years before it is actually diagnosed by the medical profession. So, if you are officially diagnosed with type II diabetes within a short time frame following active duty, and assuming it is beyond the one year period following active duty, then a fair question would be whether or not this condition was undiagnosed beginning from the time period of active duty.
In other cases, there may not be overt signs of diabetic symptoms during service, but there may be other medical factors that would suggest the presence of metabolic syndrome during service, which is something that would lead to the type II diabetes. In our experience, we would typically look for significant weight gain during service, elevated cholesterol and elevated blood pressure during service. These factors would allow a forensic evaluator to determine that there was an existence at the time of active duty of some form of metabolic syndrome. Although this is a cutting edge area of litigation right now, it is our professional opinion that significant weight gain is a pre-disposing risk factor for the development of type II diabetes. Therefore, many individuals who were in the weight reduction program during service and were later diagnosed with type II diabetes may be able to pinpoint their type II diabetes to the weight gain that occurred during active duty. Keep in mind that this is an uncharted area of litigation and the VA has historically rejected claims that appeared as claims for service-connection for obesity. The VA will not grant service-connection for obesity not withstanding the fact that the American Medical Association recently characterized obesity as a medical disorder. The point is that with non-Agent Orange type cases involving type II diabetes, a careful analysis must be undertaken to determine the exact time period when the type II diabetes had its onset.
The other concerns with diabetes involve increased rating claims. In order to get into the upper range of the rating scale for service-connected diabetes, it is important that a Veteran be able to demonstrate that he is on insulin and that a doctor has prescribed regulation of activities. Otherwise, it is advisable that the Veteran look to determine what additional secondary problems he is experiencing as a result of the diabetes and then try to get separate ratings for those separate conditions on a secondary basis. For instance, we recently had a case in the office involving a Veteran who died as a result of pancreatic cancer. Although he was in Vietnam, pancreatic cancer is not on the list of things associated with Agent Orange exposure. However, research indicates that there is a link between the diabetes and pancreatic cancer. So under these circumstances, a Veteran, rather than seeking a hirer rating for diabetes, would want to obtain a separate rating for the residuals of pancreatic cancer secondary to the diabetes. Other diabetic problems include peripheral neuropathy, and diabetic retinopathy. Diabetes can also cause a host of cardiovascular problems which can result in heart disease and stroke. Erectile dysfunction is also a factor in type II diabetic cases. In short, if you are seeking an increased rating for your service-connected diabetes, you will want to ascertain any and all additional disabilities that can be linked to the diabetes. Recently, we are seeing some cases involving kidney cancer secondary to diabetes and some novel research that tends to show at least a correlation between those two factors.
No matter your situation, if you have recently been denied for an increased rating for your diabetes or for service-connection for diabetes or any of the conditions related to diabetes, then you are invited to contact our office to discuss the possibility of an appeal.