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%
See all diabetes decisions, direct and secondary.
Diabetes mellitus secondary to PTSD: outcomes by year
| Year | Decisions | Granted | Denied | Remanded |
|---|---|---|---|---|
| 2017 | 25 | 12.0% | 44.0% | 40.0% |
| 2018 | 23 | 8.7% | 21.7% | 65.2% |
| 2019 | 42 | 4.8% | 31.0% | 61.9% |
| 2020 | 56 | 17.9% | 17.9% | 64.3% |
| 2021 | 45 | 8.9% | 15.6% | 75.6% |
| 2022 | 47 | 19.1% | 19.1% | 61.7% |
| 2023 | 88 | 19.3% | 10.2% | 70.5% |
| 2024 | 83 | 32.5% | 7.2% | 59.0% |
| 2025 | 104 | 27.9% | 17.3% | 52.9% |
| 2026 | 38 | 23.7% | 18.4% | 57.9% |
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 |
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.
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.