- Diagnostic Code
- 7913
- CFR Section
- §4.119 — Endocrine
Rating Tiers
Requiring more than one daily injection of insulin, restricted diet, and regulation of activities (avoidance of strenuous occupational and recreational activities) with episodes of ketoacidosis or hypoglycemic reactions requiring at least three hospitalizations per year or weekly visits to a diabetic care provider, plus either progressive loss of weight and strength or complications that would be compensable if separately evaluated
Requiring one or more daily injection of insulin, restricted diet, and regulation of activities with episodes of ketoacidosis or hypoglycemic reactions requiring one or two hospitalizations per year or twice a month visits to a diabetic care provider, plus complications that would not be compensable if separately evaluated
Requiring one or more daily injection of insulin, restricted diet, and regulation of activities
Requiring one or more daily injection of insulin and restricted diet, or; oral hypoglycemic agent and restricted diet
Manageable by restricted diet only
What Raters Look For
Based on M21-1 adjudication criteria for Endocrine conditions. These are the factors a VA rater evaluates when assigning a rating percentage.
M21-1 III.iv.4.I- •Lab values: HbA1c and fasting glucose for diabetes; TSH/T4 for thyroid conditions
- •Medication requirements: whether insulin is required vs. oral agents only
- •Regulation of the condition: whether it is well-controlled or labile
- •Complications present: neuropathy, retinopathy, nephropathy, vascular disease
- •Frequency of hypoglycemic episodes and whether they require medical assistance
- •Dietary restrictions required for management