Diabetes Mellitus

Your doctor will complete VA Form 21-0960E-1 (Diabetes Mellitus DBQ) after examining you. This walkthrough helps you prepare them. The DBQ is a standardized questionnaire; your doctor's answers directly determine your VA rating. Brief them on these specific points before the exam so nothing important is missed or underdocumented.

Common mistakes

• ×Asking your doctor to just "fill out the VA form" without briefing them - an uninformed completion is often generic and leads to lower ratings.
• ×Bringing the DBQ to a provider who has never seen you before - your treating physician who knows your history will write the most credible documentation.
• ×Going to the exam and waiting for the doctor to ask questions - come prepared with specific examples of your worst days and functional limitations.

These are the key clinical questions from the Diabetes Mellitus DBQ. Help your doctor understand what each question is asking and give them concrete examples for your situation. Print this section and bring it to the appointment. 1. Does the Veteran require insulin, oral medication, or both? WHY IT MATTERS: Treatment requirements are a primary factor in rating level TIPS: Insulin requirement supports a minimum 20% rating; Oral medication alone supports a 10-20% rating; Document all diabetes medications and dosages 2. Is regulation of activities required due to diabetes? WHY IT MATTERS: Medically required regulation of activities is needed for 40%+ ratings TIPS: This means a doctor has TOLD you to restrict strenuous activities; Get a written statement from your doctor about activity restrictions; "Regulation of activities" is a specific medical directive, not voluntary lifestyle change 3. How many episodes of ketoacidosis or hypoglycemic reactions requiring hospitalization? WHY IT MATTERS: Frequency of hospitalizations for diabetic crises determines higher ratings TIPS: Document every ER visit or hospitalization for blood sugar emergencies; 1-2 per year with 1-2 doctor visits per month supports 60% 4. Are there diabetic complications (nephropathy, retinopathy, peripheral neuropathy)? WHY IT MATTERS: Complications are rated SEPARATELY as secondary conditions TIPS: Each complication can receive its own disability rating; Common secondary conditions: peripheral neuropathy, kidney disease, eye disease; File secondary claims for each complication

Common mistakes

• ×Not understanding that "regulation of activities" must be medically prescribed
• ×Failing to file separate secondary claims for diabetic complications
• ×Not documenting all ER visits and hospitalizations for blood sugar emergencies

VA raters use the Diabetes Mellitus DBQ to determine your disability rating. The most important rating factors for this condition are: 1. 10%: Manageable by restricted diet only 2. 20%: Requires insulin and restricted diet, OR oral medication and restricted diet 3. 40%: Requires insulin, restricted diet, AND regulation of activities 4. 60%: Requires insulin, restricted diet, regulation of activities, AND 1-2 hospitalizations per year 5. 100%: Requires more than one daily insulin injection, restricted diet, regulation of activities, AND 3+ hospitalizations per year or weekly doctor visits 6. Complications (neuropathy, nephropathy, retinopathy) rated separately For each factor, give your doctor specific examples from your daily life so they can document accurately (not generically).

Common mistakes

• ×Assuming oral medication alone qualifies for higher ratings without other criteria

Authority

• 38 CFR 4.1 - Functional impairment as the basis for rating.

Preparation checklist for the Diabetes Mellitus DBQ exam: 1. Get a written statement from your doctor about activity restrictions if applicable 2. Document all ER visits and hospitalizations for diabetic crises 3. List all diabetic complications and file secondary claims for each 4. Bring HbA1c results showing blood sugar control history 5. Have your medication list with dosage changes over time Remember: Describe your WORST days, not your average days. VA raters evaluate the full range of your disability including its worst manifestations.

Common mistakes

• ×Describing your best days or average functioning instead of your worst - VA rates the full range of disability.
• ×Minimizing symptoms out of stoicism or pride - accurate documentation is not exaggeration; it is honesty.
• ×Not mentioning secondary symptoms, side effects, or additional conditions the doctor may not ask about.