diabetes Rating Code 7913

[Brandy]

Does anyone have a copy of the original Diabetes Mellitus code 7913? I found that they made changes to this code only once. I wanted to see exactly what the diffinition of "large" or "moderate" insulin dosage was vs the percent levels assigned back then.

This is the current 7913.

7913 Diabetes mellitus

Requiring more than one daily injection of insulin, restricted 100

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 insulin, restricted diet, and regulation of 60

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 insulin, restricted diet, and regulation of 40

activities...................................................

Requiring insulin and restricted diet, or; oral hypoglycemic 20

agent and restricted diet....................................

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.

Note (2): When diabetes mellitus has been conclusively

diagnosed, do not request a glucose tolerance test solely for

rating purposes.

This is all I could find about the change they made.

We revised the evaluation criteria for diabetes mellitus (DC 7913) to make them more objective and base them on how well the diabetes is controlled. The frequency of insulin injection and medical treatment are valid measures of the severity of diabetes, and we have stipulated a requirement for more than one daily injection of insulin for the 100-percent evaluation level. We also specified the number of hospitalizations per year required because of episodes of ketoacidosis or hypoglycemic reactions and the frequency of visits to a diabetic care provider that warrant a 60- or 100-percent evaluation. We eliminated the requirement for a "large" or "moderate" insulin dosage at the 40- and 20-percent levels respectively because the severity of diabetes is better determined by the degree of control in response to treatment than by the amount of medication required for control.

We deleted from the criteria for the 10- and 20-percent evaluation levels under DC 7913 the requirement "without impairment of health or vigor or limitation of activity" because they do not affirmatively denote required criteria for those evaluation levels. A requirement for regulation of activities was formerly one of the criteria for the 40- and 100-percent levels but not for the 60-percent level. For the sake of consistency, we have made "regulation of activities" one of the required criteria for the 40-. 60-, and 100-percent levels. We clarified the meaning of "severe" complications of diabetes and how to evaluate complications by means of a note and by including a reference to complications that would and would not be separately compensable under the 100- and 60-percent criteria respectively.

[Berta]

The earliest mention of the 7913 criteria I found at the BVA is:

The veteran has insulin dependent diabetes mellitus, rated under

Diagnostic Code 7913 of VA's rating schedule. A 100 percent rating

is warranted when the veteran has pronounced diabetes that is

uncontrolled, with repeated episodes of ketoacidosis or

hypoglycemic reactions, restricted diet and regulation of

activities; with progressive loss of weight and strength, or severe

complications. A 60 percent scheduler raring is warranted when the

veteran has severe diabetes, with episodes of ketoacidosis or

hypoglycemic reactions, but with considerable loss of weight and

strength and with mild complications, such as pruritus ani, mild

vascular deficiencies, or beginning diabetic ocular disturbances.

The rating schedule suggests a 40 percent raring for symptoms

comparable with moderately severe diabetes, requiring large insulin

dosage, restricted diet, and careful regulation of activities,

i.e., avoidance of strenuous occupational and recreational

activities. Although the record does not contain an assessment of

the frequency of the veteran's episodes of ketoacidosis or

hypoglycemia, the evidence reflects that as of early 1993 the

veteran had one below the knee amputation, and had three toes

amputated on the remaining leg. The Board finds that the veteran

suffers severe complications of his diabetes mellitus.

Accordingly, a 100 percent scheduler rating is warranted. 38 C.F.R.

4.119, Diagnostic Code 7913 (1993).

This is from:

http://www.va.gov/vetapp94/files3/9421553.txt

It is significant to note also-that in 1997 the ADA criteria for glucose levels was lowered-when determining a diabetic condition.

FPG (Fasting Glucose Levels)levels prior to the 1997 change were considered 140 and over indicating diabetes-

the newer criteria of the ADA is FPG at 126 or over.

The VA howevere in the 1990s used anything over 110 as an abnormal glucose value.(at some VAMCs they used 105)

Also diabetes claims often involve many other diagnostic codes and ratings to account for complications to a ratable degree- suchas cataracts, atherosclerosis, stroke, and heart disease.

Edited November 16, 2006 by Berta

[Brandy]

Berta,

Thanks so much for the reference. I am looking to prove that my husband's SC diabetes was out of control (severe) at the time they made the decision (1980). His BG levels usually run very high or very very low. They only rated him at 20%. He was seeing a VA doctor for his diabetes about every two weeks during the time he was on TDRL and during the following year after discharge. They were continually changing his insulin dosage because he got diabetes at such a young age it was uncontrollable and the doctors said so. The TDRL doctor also said so but rated him at 20% also. We have a letter from the doctor that cared for his diabetes before he was placed on TDRL and his fasting blood sugars were all over 200.

On another post I listed all of the problems he has now. He had his leg amputated in 1998.

[Berta]

If the 1980 decision is final-(I assume it sure would be by now)-

you could attempt to file a CUE claim on it. There is much info here at hadit on CUE.

The amputation is more surely a result of his diabetes- is this in his claim?

He presents a very disabled picture due to this and I hope he filed for TDIU too.

[Brandy]

Berta,

Yes, I have filed the amputation and TDIU on his claim. Looking at his clinic appointment notes from years ago, they did not diagnose his hypertension. They referenced that he had hypertension but did not treat him for it.

Diabetes + Hypertension leads to many other medical problems such as what he has today. I cannot believe that they did not even put him on some medication to lower his BP. He finally stopped going to them, for all medical issues, after about 9 years and started seeing a private doctor. The private doctor put him on BP medication after seeing him a few times.

[Brandy]

Berta,

Would this be a CUE and/or should I file 1151 because of failure to treat him for hypertension?

I think there are a few issues in which I will have to file a NOD and CUE's on. The problem is right now we need for them to give us ratings for his amputation, heart and kidney problems because of our financial situation. I don't want anything to hold that up right now.

He is going for exams on Nov.27th for GM, and Dec.13th for eyes. I am hoping this means they are really moving along on our case. My problem is since I am claiming the hypertension for him but do not want to stir them up right now, should I just make a statement about his hypertension being diagnosed back in the 80's by the VA clinic and attach records. This is just so they will know (they should have these records already) that I know the situation?

hope this makes sense??

[Guest jangrin]

Brandy,

It seems like things are moving now on your husbands claims. Depending on how long it takes the C&P professional to get his report of findings back to VA, your husband's file should move into the rating phase right after he has the exams.

Once he is rated for the eyes and TDIU, which with his severe diabetes he should be awarded TDIU 100% at the minimum. Then file for addtional claims. Many of the veterans here at Hadit have said that adding another claim will surely slow the process down.

My husband just had his C&P exam in September and we are told his claim is with the raters. But we still wait, so I figure at leat 3 t0 4 months at raters. I have other claims to file also, but I will wait on them until my husband gets a rating on the current claim.

Good Luck , Jangrin B)