A diagnosis of diabetes mellitus cannot be made from glycosuria alone, as this may result from Diabetes mellitus is not seriously disabling if, on a diet …
Section F Endocrine Conditions
Overview
|In this |This section contains the following topics: |
|Section | |
|Topic |Topic Name |See Page |
|22 |Diabetes Mellitus |4-F-2 |
|23 |Thyroid Conditions |4-F-6 |
|24 |Exhibit 1: Examples of Rating |4-F-8 |
| |Decisions Involving the Complications | |
| |of Diabetes Mellitus | |
22 Diabetes Mellitus
|Introduction |This topic contains information about diabetes mellitus, |
| |including |
| | |
| |the symptoms of diabetes mellitus |
| |evaluating the extent of disability caused by diabetes |
| |mellitus |
| |the complications of diabetes mellitus |
|
|rating complications of diabetes mellitus, and |
| |consideration of hypertension as secondary to diabetes |
| |mellitus |
|Change Date |December 29, 2007 |
|a Symptoms |The cardinal symptoms of uncontrolled diabetes are |
|of Diabetes | |
|Mellitus |polyuria excessive urination |
| |polydipsia excessive thirst |
| |polyphagia excessive hunger |
| |weakness, and |
| |loss of weight |
| | |
| |The presence of sugar in the urine is characteristic of, |
| |but not essential to, a diagnosis of diabetes mellitus |
| | |
| |Notes:
|
| |A diagnosis of diabetes mellitus cannot be made from |
| |glycosuria alone, as this may result from |
| |a low renal threshold for sugar, or |
| |excessive ingestion of sugar |
| |Persistent hyperglycemia, a blood sugar of 170 mg per 100 |
| |cc blood after 12-hour fast, and glycosuria may be |
| |secondary to |
| |hyperthyroidism |
| |dyspituitarism |
| |pregnancy |
| |apoplexy |
| |cerebral trauma, or |
| |severe infections |
Continued on next page
22 Diabetes Mellitus, Continued
|b |Diabetes mellitus is not seriously disabling
if, on a diet |
|Evaluating |sufficient to maintain the weight and strength of the |
|the Extent of|claimant, the |
|Disability | |
|Caused by |blood sugar can be kept within normal limits, and |
|Diabetes |urine is sugar free |
|Mellitus | |
| |As diabetes mellitus progresses |
| | |
| |it become more difficult to control, even with insulin |
| |complications develop which increase the degree of |
| |disability, and |
| |increasing limitation of activity due to unstable blood |
| |sugar levels limits employability |
|c |The complications of diabetes mellitus may include, but are|
|Complications|not limited to |
|of Diabetes |
|
|Mellitus |arteriosclerosis, including peripheral or cardiac |
| |complications |
| |cataracts, and |
| |secondary hypertension |
| | |
| |Notes: |
| |Most hypertension that develops in diabetics is essential, |
| |primary hypertension and not due to diabetes |
| |Even in the incipient stage, diabetic nephropathy is |
| |associated with renal hypertension, which is the most |
| |common cause of the hypertension that results from diabetes|
| |nephropathy, and is manifested by |
| |persistent microalbuminuria, which is characterized by |
| |urinary excretion of 150-500 mg of protein/24 hours, and |
| |overt proteinuria, which is characterized by urinary |
|
|excretion of greater than 05 mg protein/24 hours |
| |Renovascular hypertension, a type of secondary |
| |hypertension, is responsible for less than two percent of |
| |all cases of hypertension and is sometimes but not always|
| |due to arteriosclerosis that may be caused by diabetes |
| | |
| |Reference: For more information on considering |
| |hypertension as secondary to diabetes mellitus, see |
| |M21-1MR, Part III, Subpart iv, 4F22e |
Continued on next page
22 Diabetes Mellitus, Continued
|d Rating |Evaluate compensable complications of diabetes separately |
|Complications|unless they are a part of the criteria used to support a |
|of Diabetes |100 percent evaluation Noncompensable complications are |
|Mellitus |considered part of the diabetic process under diagnostic |
| |code DC 7913 |
| |
|
| |Reference: For examples of rating decisions for the |
| |complications of diabetes mellitus, see M21-1MR, Part III, |
| |Subpart iv, 4F24 |
|e |Infer the issue of service connection for hypertension as |
|Consideration|secondary to diabetes mellitus whenever |
|of | |
|Hypertension |service connection is established for |
|as Secondary |diabetes mellitus, and |
|to Diabetes |diabetic nephropathy, and |
|Mellitus |the veteran has a diagnosis of hypertension |
| | |
| |Use the table below to determine what action to take on the|
| |inferred claim for secondary service connection for |
| |hypertension |
|If the medical evidence |Then |
|shows
| |
|hypertension was diagnosed |grant service connection for|
|after diabetic nephropathy |hypertension as secondary to|
|was diagnosed |diabetes mellitus |
|hypertension was diagnosed |deny service connection for |
|before diabetic nephropathy |hypertension as not |
|was diagnosed, and |secondary to diabetes |
|there has been no change in |mellitus |
|the treatment of | |
|hypertension or increase in | |
|blood pressure readings | |
|since diabetic nephropathy | |
|was diagnosed | |
Continued on next page
22 Diabetes Mellitus, Continued
|e Consideration of Hypertension as Secondary to Diabetes Mellitus |
|continued |
|If the medical evidence |Then |
|shows | |
|hypertension was diagnosed |obtain a medical opinion
to |
|before diabetic nephropathy |determine if hypertension |
|was diagnosed, but |was aggravated by the |
|there has been a change in |service-connected SC |
|the treatment of |diabetic nephropathy |
|hypertension and/or an | |
|increase in blood pressure | |
|readings since diabetic | |
|nephropathy was diagnosed | |
|no clear indication as to |obtain a medical opinion to |
| |determine if hypertension |
|when hypertension was |developed or was aggravated |
|diagnosed, or |by the SC diabetic |
|whether hypertension has |nephropathy |
|worsened since diabetic | |
|nephropathy was diagnosed | |
23 Thyroid Conditions
|Introduction |This topic contains information about thyroid conditions, |
| |including |
| | |
| |the
definition of the term hyperthyroidism |
| |rating conditions combined with hyperthyroidism, and |
| |rating nontoxic adenoma |
|Change Date |December 13, 2005 |
|a |Hyperthyroidism with diffuse goiter is a condition caused |
|Definition: |by excessive functioning of the thyroid gland |
|Hyperthyroidi| |
|sm | |
|b Rating |Use the table below to rate different conditions determined|
|Conditions |to be combined with hyperthyroidism |
|Combined with| |
|Hyperthyroidi| |
|sm | |
|If hyperthyroidism is |Then |
|combined with | |
|predominant heart disease |rate the condition as |
|
|hyperthyroid heart disease |
| |under DC 7008, if doing so |
| |would result in a higher |
| |evaluation than using the |
| |criteria for hyperthyroidism |
| |under DC 7900 |
|psychiatric manifestations |consider the psychiatric |
| |condition in the overall |
| |evaluation under DC 7900 |
| | |
| |Rationale: There is a |
| |tendency for psychiatric |
| |manifestations to occur where|
| |hyperthyroidism is present |
Continued on next page
23 Thyroid Conditions, Continued
|c Rating |A nontoxic adenoma or tumor of the thyroid may be rated |
|Nontoxic |zero percent, 20 percent, or higher, if other organs are |
|Adenoma |affected |
|
| |
| |Note: Since the thyroid influences the general rate of |
| |metabolism, growth, and development, disease of the thyroid|
| |may affect other vital organs and interfere with their |
| |functions, resulting in higher evaluations which should be |
| |evaluated under the diagnostic code for the particular |
| |organ involved |
24 Exhibit 1: Examples of Rating Decisions Involving the Complications
of Diabetes Mellitus
|Introduction |This exhibit contains three examples of rating decisions |
| |involving the complications of diabetes mellitus |
|Change Date |December 13, 2005 |
|a Example 1|Situation: The veteran has noncompensable complications of|
| |diabetes mellitus but does not have ketoacidosis or |
| |hypoglycemic reactions |
| |
|
| |Result: Do not evaluate the diabetes mellitus at 60 |
| |percent simply because noncompensable complications are |
| |present Assign a 40 percent evaluation if there is a |
| |requirement of insulin, restricted diet, and regulation of |
| |activities Include the noncompensable complications under|
| |DC 7913 |
|b Example 2|Situation: The veterans diabetes mellitus is controlled |
| |by insulin, restricted diet and careful regulation of |
| |activities In addition, there is diabetic peripheral |
| |neuropathy ratable at 10 percent |
| | |
| |Result: Rate the diabetes mellitus at 40 percent, and |
| |separately evaluate the compensable complication in |
| |accordance with the note under DC 7913 |
Continued on next page
24 Exhibit 1: Examples of Rating Decisions
Involving the Complications
of Diabetes Mellitus, Continued
|c Example 3|Situation: The veteran underwent a below-the-knee |
| |amputation due to complications of diabetes mellitus In |
| |addition |
| |his basic diabetes mellitus requires |
| |more than one daily injection of insulin |
| |restricted diet, and |
| |regulation of activities |
| |his episodes of ketoacidosis require weekly visits to the |
| |diabetic care provider, but |
| |there is no progressive loss of weight and strength |
| | |
| |Result: Evaluate the diabetes mellitus at 100 percent and |
| |grant Special Monthly Compensation SMC k for anatomical|
| |loss of a foot Since the below the knee amputation is |
| |secondary to diabetes mellitus, and is considered a
|
| |compensable complication in lieu of progressive loss of |
| |weight and strength to warrant the 100 percent evaluation,|
| |it would be pyramiding to assign a separate 40 percent |
| |evaluation for the amputation |
| | |
| |Note: If compensable complications are not considered in |
| |reaching the 100 percent evaluation, they may be separately|
| |evaluated |
Source:wide.msu.edu
