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.
Positive nexus opinions track with higher diabetes grant rates
In 30,088 Board decisions on diabetes, claims with a positive nexus opinion were granted on the merits 58.4% of the time, against 30.1% without one.
Direct service connection and medical nexus
The top denial reasons point at the service record. The Board cited no in-service complaints, treatment or diagnosis in 1,183 decisions and silent service records in 806. A positive nexus opinion appeared in 4,046 decisions. A negative one appeared in 11,510, and those claims were granted 25.6% of the time versus 41.0% without it. Claims with a treating physician opinion were granted 46.9% of the time versus 33.9%. The data does not show why these gaps exist.
Positive nexus opinion
Negative nexus opinion
Favorable VA exam
Unfavorable VA exam
Treating physician opinion
Board decisions decided on the merits. Association only; the data does not show why outcomes differ.
C&P exams and DBQ forms
The data tracks VA exam opinions, not the DBQ forms themselves. An unfavorable VA exam appeared in 17,709 decisions, far more than the 3,050 with a favorable one. With an unfavorable exam the grant rate was 25.0%, against 53.3% without one. A favorable exam went with 50.9%. The Board named an examiner's less likely than not opinion as a denial reason in 559 decisions.
Agent Orange presumptive service connection
The Board cited Thailand service during the Vietnam era in 206 diabetes grants. Presumed herbicide exposure was cited in 96 grants and an applied presumption in 59. These are counts of grant reasons, not grant rates, so the data cannot say how presumptive claims fare overall.
Diabetes secondary to PTSD
Diabetes claimed secondary to PTSD reached the Board in 551 decisions, with 20.3% granted. That is close to the 20.2% rate for diabetes overall. Claims tied to a psychiatric disorder were granted 21.3% of the time, while claims tied to hypertension lagged at 14.6%. The data does not break out medication weight gain as a theory.
Secondary to PTSD
Secondary to a psychiatric disorder
Secondary to hypertension
Diabetes overall
Share of all Board decisions granted, including remands in the denominator.
Figures from the research data as of Oct 26, 2026. Every number is computed from the data, which is extracted by AI from public decisions and can contain errors.
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.
Where this data comes from
- Claim
- Regional office decides
- Veteran appeals
- Board decides
- Granted · Denied · Remanded: back to the regional office
Board of Veterans' Appeals decisions show how VA's highest review body applies 38 CFR and weighs evidence on contested claims.
Each one is an appeal: a regional office decided the claim first, and the veteran appealed. So these rates describe the Board, not a veteran's odds at the regional office, where most claims are decided and whose decisions are not public.
More on what Board decisions can and cannot tell you