Secondary service connection
Diabetes mellitus secondary to PTSD: BVA grant rates and what wins
From 2017 to 2026, the Board of Veterans' Appeals decided diabetes claimed as secondary to PTSD in 551 decisions. It granted the issue in 20.3% of them, close to the 20.2% grant rate for all diabetes issues, denied it in 17.2%, and remanded it in 61.3%. Counting only decisions on the merits, 54.1% were granted.
Decisions
551
2017–2026
Granted
20.3%
All diabetes: 20.2%
Granted on the merits
54.1%
Granted ÷ (granted + denied)
Remanded
61.3%
Denied: 17.2%
How VA rates diabetes
Once service connection is granted, VA assigns a disability rating from the rating schedule: 38 CFR 4.119, diagnostic code 7913 (Diabetes mellitus). The rating is the same whether the condition is service connected directly or as secondary to another disability.
| Rating | Criteria |
|---|---|
| 100% | 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 |
| 60% | 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 |
| 40% | Requiring one or more daily injection of insulin, restricted diet, and regulation of activities |
| 20% | Requiring one or more daily injection of insulin and restricted diet, or; oral hypoglycemic agent and restricted diet |
| 10% | Manageable by restricted diet only |
- 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.
Text of 38 CFR 4.119 as of Feb 27, 2026. Confirm the current text at the source before relying on it.
See all diabetes decisions, direct and secondary.
Diabetes mellitus secondary to PTSD: outcomes by year
| Year | Issues decided | Granted | Denied | Remanded | Other |
|---|---|---|---|---|---|
| 2017 | 25 | 12.0% | 44.0% | 40.0% | 4.0% |
| 2018 | 23 | 8.7% | 21.7% | 65.2% | 4.3% |
| 2019 | 42 | 4.8% | 31.0% | 61.9% | 2.4% |
| 2020 | 56 | 17.9% | 17.9% | 64.3% | 0.0% |
| 2021 | 45 | 8.9% | 15.6% | 75.6% | 0.0% |
| 2022 | 47 | 19.1% | 19.1% | 61.7% | 0.0% |
| 2023 | 88 | 19.3% | 10.2% | 70.5% | 0.0% |
| 2024 | 83 | 32.5% | 7.2% | 59.0% | 1.2% |
| 2025 | 104 | 27.9% | 17.3% | 52.9% | 1.9% |
| 2026 | 38 | 23.7% | 18.4% | 57.9% | 0.0% |
Each row counts issues (each condition the Board decided), so the shares add up to 100%. Other: dismissed, withdrawn or no clear outcome. Years with fewer than 20 issues are left out.
Evidence in granted and denied diabetes decisions
For each kind of supporting evidence: how often the Board granted the diabetes issue on the merits when the decision mentioned it, compared with decisions that did not. These are associations, not causes, and evidence is recorded per decision, not per issue.
| In the record | Decisions | Granted when present | When absent | Difference |
|---|---|---|---|---|
| Positive nexus opinion | 141 | 85.9% | 25.0% | +60.9 pts |
| Private medical opinion | 188 | 72.4% | 35.3% | +37.1 pts |
| Favorable VA exam | 65 | 77.3% | 47.9% | +29.4 pts |
| Lay statement | 409 | 46.7% | 86.8% | −40.1 pts |
- The Board applied the benefit-of-the-doubt rule (38 CFR 3.102) in 82.1% of the decisions that granted diabetes.
- The Board found the veteran's statements credible in 16.1% of grants and 8.4% of denials.
Negative evidence in the record
An unfavorable exam or a negative nexus opinion often sits in the same record as favorable evidence, and the Board weighs them against each other. So these rows show how often diabetes was still granted when the record contained the negative item, not that the item helped.
| In the record | Decisions | Granted when present | When absent | Difference |
|---|---|---|---|---|
| Negative nexus opinion | 360 | 49.3% | 67.3% | −17.9 pts |
| Unfavorable VA exam | 431 | 50.3% | 76.7% | −26.4 pts |
How these claims are argued
A secondary claim says PTSD caused diabetes or made it worse, and names how. Below: whether the Board's decision discussed aggravation, and the medical link each decision names, with how often those issues were granted.
Aggravation discussed
made worse by the disability, 3.310(b)
12.4%
granted, of 249 issues (45.2% of all)
Causation only
caused by the disability, 3.310(a)
26.8%
granted, of 302 issues (54.8% of all)
| Medical link named | Issues | Granted |
|---|---|---|
Weight gain or obesity Granted “Obesity contributes to other service-connected conditions” 26002007 (2026) Denied “Obesity symptoms subsumed under PTSD diagnosis” A26015343 (2026) | 225 | 28.9% |
Reduced activity or mobility Granted “Service-connected PTSD, low back disability, and asthma impacted mobility and lifestyle, leading to morbid obesity.” 25011266 (2025) Denied “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.” A25111110 (2025) | 15 | 33.3% |
Stress Granted “The Veteran claimed the diabetes was caused by in-service stress and PTSD.” 24024781 (2024) Denied “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.” 23017996 (2023) | 14 | 21.4% |
Sleep disruption Granted “Medical treatises cited linking PTSD/sleep impairment to diabetes.” 25004992 (2025) Denied “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.” 23017996 (2023) | 13 | 23.1% |
Based on words in the AI-written summary and reasons for each issue, not a reading of the full decision. 45.2% of the 551 issues name at least one medical link; the rest only say “secondary to” the disability. One issue can name several links. Granted is the share of those issues granted (remands count as not granted). A link named in a denial was often the argument the Board rejected.
Why the Board granted or denied diabetes
Most common reasons in grants
- Current diagnosis established14
- Service connection established11
- Aggravated by the service-connected disability4
- Private medical opinion found probative3
- VA examiner: less likely than not related to service3
- Conflicting medical opinions on nexus2
- Caused by the service-connected disability2
- Service connection granted as secondary to PTSD2
Most common reasons in denials
- VA examiner: less likely than not related to service19
- Service records negative or silent12
- No in-service complaints, treatment or diagnosis9
- Preponderance of the evidence against the claim9
- No current diagnosis7
- No continuity of symptomatology3
- Evidence persuasively weighs against service connection2
- Service connection established2
Numbers are decisions that gave the reason. Reasons are short phrases extracted by AI from each decision; common wordings of the same reason are grouped. Benefit of the doubt is reported above.
Recent diabetes decisions
Granted
Private opinion found PTSD contributed to metabolic dysfunction.; Conflicting opinions between VA and private examiners.; Benefit of the doubt resolved in Veteran's favor.
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.
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's favor
Denied
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.
Service-connected PTSD acknowledged; Obesity not a ratable condition; Obesity not proven as intermediate step causing DM2
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.
What VA needs to grant a secondary claim
Secondary service connection means VA disability benefits for a condition caused or made worse by a disability that is already service connected (38 CFR 3.310). The claim needs three things:
- A current diagnosis of diabetes.
- PTSD is already service connected.
- Medical evidence linking them (a nexus opinion): diabetes was caused by PTSD (3.310(a)), or was made worse beyond its natural progress by it (aggravation, 3.310(b)).
VA's procedures for these claims are in M21-1 V.ii.2.D. When the evidence for and against is about even, VA must decide in the veteran's favor (38 CFR 3.102).
Other conditions secondary to PTSD
- Major depressive disorder secondary to PTSD305 decisions · 62.0% granted
- Migraine secondary to PTSD1,732 decisions · 37.1% granted
- Sleep apnea secondary to PTSD11,479 decisions · 31.7% granted
- Erectile dysfunction secondary to PTSD1,645 decisions · 30.3% granted
- Gastroesophageal reflux disease (GERD) secondary to PTSD1,237 decisions · 25.3% granted
- Irritable colon syndrome (spastic colitis mucous colitis) secondary to PTSD380 decisions · 24.2% granted
- Hypertension secondary to PTSD3,194 decisions · 16.5% granted
Diabetes mellitus secondary to other conditions
See all conditions secondary to PTSD or diabetes as a primary or secondary condition.
Rules that apply to secondary diabetes claims
- 38 CFR 3.310
Secondary service connection and aggravation
Read it in VA Law Explorer - M21-1 V.ii.2.D
Secondary service connection and aggravation of non-service-connected disabilities
Read it in VA Law Explorer - 38 CFR 3.102
Reasonable doubt (benefit of the doubt)
Read it in VA Law Explorer - 38 CFR 4.119 · DC 7913
Schedule of ratings: endocrine system
Read it in VA Law Explorer - 38 CFR 3.309(e)
Presumptive service connection (herbicide exposure)
Read it in VA Law Explorer - M21-1 V.iii.11.1
Diabetes: evaluation, scope of the claim, effective dates
Read it in VA Law Explorer - M21-1 V.iii.11.2
Complications of diabetes and when to rate them separately
Read it in VA Law Explorer
Research your diabetes case
Narrow by year, judge, evidence or secondary condition, read the decisions, and export a research memo.
How these numbers are calculated
- Counts decisions in which the Board decided a diabetes issue claimed as secondary to PTSD, by the outcome of that issue.
- The primary disability is read from the decision text ("secondary to …") and grouped by name, so spellings such as "PTSD" and "posttraumatic stress disorder" count together.
- Secondary claims also include aggravation of a non-service-connected condition by a service-connected one (38 CFR 3.310(b)).
- The data comes from CaseScribe's AI extraction of public BVA decisions (2017–2026) and can contain errors. It is updated automatically as new decisions are added.