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Dml Restricted Activities


chiefhouse00

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Greetings

Just got the statement below added to my VA medical records by my VA Primary Care Provider because I'm still having major problems maintaining my uncontrolled Diabetes which has already landed me in the ER more than three times over the last two years. I'm currently rated at 20% for DMl (overall 90% for other aliments) and taking over 180 units of insulin daily. Can I submit this statement to request an increase to at lease 40% for my Diabetes?

08/14/2014 ADDENDUM STATUS: COMPLETED

"Per discussion with Mr. X, I recommended promoting life habits that would improve his diabetes in form of daily cardio exercise and good diet and if possible, to avoid work and home activities that would adversely increase his stress level as this would cause his Blood Sugar to remain in hyperglycemic episodes. He agrees and we will continue to work on this as well as the pain in the knees, back, feet and lower/upper extremities. Signed: PRIMARY CARE PHYSICIAN"

Best Regards
Chiefhouse

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Diabetes Mellitus is rated thus:

"7913 Diabetes mellitus
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 100
Requiring 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 60
Requiring insulin, restricted diet, and regulation of activities 40
Requiring insulin and restricted diet, or; oral hypoglycemic agent and restricted diet 20
Manageable by restricted diet only 10
Note (1): Evaluate compensable complications of diabetes separately unless they are part of the criteria used to support a 100 percent evaluation. Noncompensable complications are considered part of the diabetic process under diagnostic code 7913. "

(Source VASRD)


Also now is a good time to review the VA Diabetes Training Letter here:


I hope you don't have any complications of the DMII but if you do they should be claimed as secondary to the DMII.You will need also a medical statem,ent supporting the nexus to the diabetes..

The 1997 version of this training letter helped me prove to VA that my husband had DMII from AO and that they had malpracticed on it, by never diagnosing or treating it at all. His VA employment physical, his VA dental records, and his drivers license were part of my proof, along with a crossed out entry in his med recs and his blood chem reports, brain MRI , autopsy etc etc. and 2 IMOs from Dr. Bash and a freeby from a former VA neuro who treated him, helped as well.

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Greetings Berta

I was rated with DM Type l and take insulin daily and on a restricted diet, and recently received the "regulation of activities" statement in my VA medical records. I also spent time in the ER and hospitized three times for episodes of ketoacidosis and hypoglycemic reactions over the past two years. I'm also rated for PN.

Best Regards

Chiefhouse

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Chiefhouse, DM1 especially if you are taking a large amount of insulin you should be rated at 40%- when taking insulin activities, need to be regulated (and most MDs agree on this, especially endocrinologists ) or you end up passed out occasionally. Injected insulin works when it gets absorbed and everyone absorbs at different rate. DM1 has a different scale because of the lack of endogenous insulin, if you look at a DM1s blood glucose readings over the course of a day, it looks like a mountain range ups and downs, so testing needs to be frequent anywhere from 6-10 times a day depending how out of control you are. The problem is the VA does not like to give out test strips, I used the VA system for the 1st 22 years of getting DM1, in 1995 they were telling me no more than 100 strips a month, this after passing out waiting for my appt. at a clinic, I went private after that.

Basically what I'm saying is if your injecting insulin you need to regulate your activities because you cannot regulate the exact way the insulin will get absorbed, if it was like other medications we would all have A1Cs of 5 or below.

Edited by Greg88 (see edit history)
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Greetings Greg88

I test five times a day and my reading are sporadic most of the time. I plan to submit for an increase because my claim is less than a year old. My DM1 was back dated to 2008 with a 20% rating. Thanks for the advice about the test strips and your experience with DM1.

Best Regards

Chiefhouse

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Greetings

Just a quick follow up on my Diabetes One (DM1) status.  I'm still shooting an average 85-95 units on insulin today plus 1000 mg Metformin twice daily.  So, I'm not making the greatest progress in reducing the amount of my dosage.  My NOD for DM is still in the DRO review pod since June 2015.   

Best Regards

Chiefhouse

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Chief house, did you receive confirmation that VA has letter from your Primary Doctor? One way to check and ensure they have it is to go onto ebenefits, track appeal status, click on all uploaded documents, you should see a line appear stating "Unsolicited Documents" a little further down the page. Click on that and you should see a list of all the evidence you have submitted. You absolutely want to ensure the rater sees that statement. Of course, if you elected a DRO hearing you can bring the evidence with you to the hearing. If i submit evidence i believe is crucial to my claim, i not only attach a statement of support (stating which claim evidence is in support of), i call peggy(the 1-800#) and ensure the medical exams from that date are pulled as evidence for my claim. Good Luck

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Chief house, did you receive confirmation that VA has letter from your Primary Doctor? One way to check and ensure they have it is to go onto ebenefits, track appeal status, click on all uploaded documents, you should see a line appear stating "Unsolicited Documents" a little further down the page. Click on that and you should see a list of all the evidence you have submitted. You absolutely want to ensure the rater sees that statement. Of course, if you elected a DRO hearing you can bring the evidence with you to the hearing. If i submit evidence i believe is crucial to my claim, i not only attach a statement of support (stating which claim evidence is in support of), i call peggy(the 1-800#) and ensure the medical exams from that date are pulled as evidence for my claim. Good Luck

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