{"page":"https://casescribe.ai/explorer/secondary/diabetes-mellitus-secondary-to-ptsd","generated_at":"2026-10-03T18:34:30.879Z","data_as_of":{"decisions":944125,"first_year":2017,"last_year":2026,"latest_decision":"2026-04-30","cfr":"2026-10-01","m21":"2026-09-29"},"about":{"publisher":"CaseScribe AI (VA Law Explorer)","source":"Public Board of Veterans' Appeals decisions (appeals of VA decisions, not VA's first decisions), M21-1 Adjudication Procedures Manual, 38 CFR Parts 3 and 4.","method":"Outcomes are issue-level: each condition the Board decided in a decision counts once. Decision data is extracted by AI and can contain errors. Rates describe past appeals and do not predict any claim.","disclaimer":"For research only. CaseScribe AI is not a law firm and this is not legal advice. Verify figures against the source decisions and regulations.","attribution":"Cite as: VA Law Explorer, CaseScribe AI, with the page URL."},"data":{"claim":"Diabetes mellitus secondary to PTSD","secondary_condition":"Diabetes mellitus","service_connected_disability":"PTSD","decisions":551,"years":"2017-2026","granted_pct":20.3,"denied_pct":17.2,"remanded_pct":61.3,"granted_on_merits_pct":54.1,"by_year":[{"year":2017,"issues":25,"granted_pct":12,"denied_pct":44,"remanded_pct":40},{"year":2018,"issues":23,"granted_pct":8.7,"denied_pct":21.7,"remanded_pct":65.2},{"year":2019,"issues":42,"granted_pct":4.8,"denied_pct":31,"remanded_pct":61.9},{"year":2020,"issues":56,"granted_pct":17.9,"denied_pct":17.9,"remanded_pct":64.3},{"year":2021,"issues":45,"granted_pct":8.9,"denied_pct":15.6,"remanded_pct":75.6},{"year":2022,"issues":47,"granted_pct":19.1,"denied_pct":19.1,"remanded_pct":61.7},{"year":2023,"issues":88,"granted_pct":19.3,"denied_pct":10.2,"remanded_pct":70.5},{"year":2024,"issues":83,"granted_pct":32.5,"denied_pct":7.2,"remanded_pct":59},{"year":2025,"issues":104,"granted_pct":27.9,"denied_pct":17.3,"remanded_pct":52.9},{"year":2026,"issues":38,"granted_pct":23.7,"denied_pct":18.4,"remanded_pct":57.9}],"benefit_of_doubt_in_grants_pct":82.1,"evidence_on_merits":[{"evidence":"va_exam_favorable","decisions_with":65,"granted_pct_with":77.3,"granted_pct_without":47.9},{"evidence":"va_exam_unfavorable","decisions_with":431,"granted_pct_with":50.3,"granted_pct_without":76.7},{"evidence":"nexus_positive","decisions_with":141,"granted_pct_with":85.9,"granted_pct_without":25},{"evidence":"nexus_negative","decisions_with":360,"granted_pct_with":49.3,"granted_pct_without":67.3},{"evidence":"private_opinion","decisions_with":188,"granted_pct_with":72.4,"granted_pct_without":35.3},{"evidence":"lay_statement","decisions_with":409,"granted_pct_with":46.7,"granted_pct_without":86.8}],"top_reasons":{"granted":[{"reason":"current diagnosis established","decisions":14},{"reason":"service connection established","decisions":11},{"reason":"aggravated by the service-connected disability","decisions":4},{"reason":"private medical opinion found probative","decisions":3},{"reason":"va examiner: less likely than not related to service","decisions":3},{"reason":"conflicting medical opinions on nexus","decisions":2}],"denied":[{"reason":"va examiner: less likely than not related to service","decisions":19},{"reason":"service records negative or silent","decisions":12},{"reason":"no in-service complaints, treatment or diagnosis","decisions":9},{"reason":"preponderance of the evidence against the claim","decisions":9},{"reason":"no current diagnosis","decisions":7},{"reason":"no continuity of symptomatology","decisions":3}]},"recent_examples":{"granted":[{"case_id":"A26040471","year":2026,"judge":"M. C. GRAHAM","rationale":"Private opinion found PTSD contributed to metabolic dysfunction.; Conflicting opinions between VA and private examiners.; Benefit of the doubt resolved in Veteran's favor."},{"case_id":"A26036815","year":2026,"judge":"TANYA SMITH","rationale":"DM is secondary to service-connected acquired psychiatric disorder via intermediate step of obesity.; VA examiners' opinions found persuasive for secondary nexus.; Reasonable doubt resolved in Veteran's favor."},{"case_id":"A26036320","year":2026,"judge":"J. T. HUTCHESON","rationale":"Private evaluation found diabetes at least as likely as not caused/aggravated by PTSD; PTSD causes neuroendocrine dysregulation and impaired glucose metabolism; Temporal relationship between PTSD and diabetes onset supports PTSD as etiological factor; Evidence in equipoise, doubt resolved in Veteran… [truncated, 8 chars omitted]"}],"denied":[{"case_id":"26004295","year":2026,"judge":"THOMAS H. O'SHAY","rationale":"Congenital genetic disorder predating service.; Service treatment records silent for symptoms.; VA opinions found condition not related to service exposures or PTSD.; No evidence of alcohol abuse aggravating the condition."},{"case_id":"A26029029","year":2026,"judge":"JOHN J. CROWLEY","rationale":"Service-connected PTSD acknowledged; Obesity not a ratable condition; Obesity not proven as intermediate step causing DM2"},{"case_id":"A26028185","year":2026,"judge":"J. B. FREEMAN","rationale":"No current diagnosis of diabetes found in service treatment records or post-service records.; VA examination found no diagnostic evidence of diabetes.; Veteran's assertions of diabetes are not competent medical evidence."}]},"how_argued":{"note":"From keyword matches in each issue's AI summary and rationale, not the full decision. Only issues whose text names a medical link are counted under pathways; one issue can name several. A link named in a denial was often the argument the Board rejected.","issues":551,"aggravation_discussed":{"issues":249,"granted_pct":12.4},"causation_only":{"issues":302,"granted_pct":26.8},"issues_naming_a_pathway_pct":45.2,"pathways":[{"pathway":"Weight gain or obesity","issues":225,"granted_pct":28.9,"examples":[{"case_id":"26002007","year":2026,"outcome":"GRANTED","quote":"Obesity contributes to other service-connected conditions"},{"case_id":"A26015343","year":2026,"outcome":"DENIED","quote":"Obesity symptoms subsumed under PTSD diagnosis"}]},{"pathway":"Reduced activity or mobility","issues":15,"granted_pct":33.3,"examples":[{"case_id":"25011266","year":2025,"outcome":"GRANTED","quote":"Service-connected PTSD, low back disability, and asthma impacted mobility and lifestyle, leading to morbid obesity."},{"case_id":"A25111110","year":2025,"outcome":"DENIED","quote":"The Board denied service connection, finding the VA examiner's opinion persuasive that the diabetes was likely due to risk factors like family history, being overweight, and a sedentary lifestyle, rather than service or toxic exposures."}]},{"pathway":"Stress","issues":14,"granted_pct":21.4,"examples":[{"case_id":"24024781","year":2024,"outcome":"GRANTED","quote":"The Veteran claimed the diabetes was caused by in-service stress and PTSD."},{"case_id":"23017996","year":2023,"outcome":"DENIED","quote":"The veteran was diagnosed with type II diabetes in January 2017 and claimed it was secondary to his service-connected PTSD, insomnia, shin splints, and related medications, exacerbated by weight gain due to inactivity and stress."}]},{"pathway":"Sleep disruption","issues":13,"granted_pct":23.1,"examples":[{"case_id":"25004992","year":2025,"outcome":"GRANTED","quote":"Medical treatises cited linking PTSD/sleep impairment to diabetes."},{"case_id":"23017996","year":2023,"outcome":"DENIED","quote":"The veteran was diagnosed with type II diabetes in January 2017 and claimed it was secondary to his service-connected PTSD, insomnia, shin splints, and related medications, exacerbated by weight gain due to inactivity and stress."}]}]},"how_va_rates":{"citation":"38 CFR 4.119","diagnostic_code":"7913","name":"Diabetes mellitus","url":"https://www.ecfr.gov/current/title-38/section-4.119","levels":[{"criteria":"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","rating":100},{"criteria":"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","rating":60},{"criteria":"Requiring one or more daily injection of insulin, restricted diet, and regulation of activities","rating":40},{"criteria":"Requiring one or more daily injection of insulin and restricted diet, or; oral hypoglycemic agent and restricted diet","rating":20},{"criteria":"Manageable by restricted diet only","rating":10}],"notes":["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 DC 7913.","Note (2): When diabetes mellitus has been conclusively diagnosed, do not request a glucose tolerance test solely for rating purposes."]},"requirements":"38 CFR 3.310: a current diagnosis, a service-connected disability, and medical evidence that it caused (3.310(a)) or aggravated (3.310(b)) the condition."}}