Secondary service connection
Conditions secondary to diabetes
Veterans with service-connected diabetes often claim other conditions as caused or worsened by it. This page lists those conditions, what VA needs to grant them, and how they fared when veterans appealed to the Board of Veterans' Appeals.
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 the secondary condition.
- Diabetes is already service connected.
- Medical evidence linking them (a nexus opinion): the secondary condition was caused by diabetes (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).
Conditions claimed secondary to diabetes
Conditions the Board decided at least 300 times as secondary to this disability, highest appeal grant rate first. Open one for the evidence and reasons behind the decisions.
- Peripheral arterial occlusive disease (buerger's disease) secondary to diabetes335 decisions · 37.3% granted
- Retinal dystrophy (including retinitis pigmentosa macular degeneration) secondary to diabetes416 decisions · 37.0% granted
- Peripheral nerve disorders secondary to diabetes3,602 decisions · 33.6% granted
- Kidney disease secondary to diabetes906 decisions · 26.5% granted
- Erectile dysfunction secondary to diabetes1,811 decisions · 25.8% granted
- Sleep apnea secondary to diabetes994 decisions · 23.0% granted
- Cataract extraction secondary to diabetes372 decisions · 22.6% granted
- Hypertension secondary to diabetes2,809 decisions · 15.2% granted
- Glaucoma secondary to diabetes482 decisions · 10.6% granted
Diabetes claimed secondary to other conditions
The other direction: diabetes claimed as caused or worsened by a different service-connected disability.
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.
All Board decisions on diabetes, direct and secondary: Diabetes mellitus grant rates.
Rules that apply to secondary 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 secondary case
Narrow by year, judge, evidence or secondary condition, read the decisions, and export a research memo.