VA Help Needed

Type 2
#1

Hey all,

As you may or may not remember, my stepfather has had A1cs in the 6.3-6.5 range, with random bgs in the neighborhood of 170-180, along with elevated cholesterol levels and bp readings. His private doctor has diagnosed him as having type 2 diabetes, "treated" with diet and exercise (not that he actually eats the way he should, but that's another story).

He finally decided to have the VA re-evaluate his disability claim, and he's been going to see many doctors for this evaluation, as he's got a number of problems beyond the diabetes. Believe me, so far, it's been a long, involved process that is testing all of our patience.

Now, the good news is that after researching his term of service in VietNam, the VA has agreed that he has been exposed to Agent Orange. However, he was told yesterday that if the A1c he had taken yesterday is not greater than 6.5, the VA will not say he has diabetes, but pre-diabetes and will not include that in his re-evaluation.

My question is: Can anyone confirm that the VA requires an A1c over 6.5 as diagnostic of diabetes? What about having a private physician saying, over and over again in his practice notes, that this person has diabetes? Does that not count? I looked at the VA website, and it seems to imply that if a private physician has diagnosed the vet as having diabetes and it has been confirmed that the vet was exposed to Agent Orange while deployed in VietNam, that the VA would accept that as having diabetes caused by his service. I'd really appreciate any information, as I'm pretty confused!

#2

The VA Clinical Practice Diabetes Guidelines are online and they say:

The criteria for the diagnosis of DM include any of the following:

  1. Fasting plasma glucose (FPG) is ≥126 mg/dL on at least two occasions; or,
  2. A single HbA1c reading of ≥ 6.5% confirmed with a FPG ≥126 mg/dL. These tests can be done on the same or different days; or,
  3. HbA1c reading of ≥ 7% on two occasions using a clinical laboratory methodology standardized to the National Glycohemoglobin Standardization Program (NGSP) not a Point of Care; or ,
  4. Patient with symptoms of hyperglycemia, and a random glucose is ≥ 200 mg/dL on two occasions. However, random plasma glucose is not recommended as a routine screening test.

So from this definition, even an A1c > 6.5% isn't enough. If your dad has an elevated fasting blood sugar (measured twice) then that will be a confirmed diagnosis. And finally, if he can eat a krispy kreme donut and have his blood sugar > 200 mg/dl and simply complains about symptoms (polyuria, polydipsia, or polyphagia) then he can be diagnosed with diabetes according to the VA DM clinical practice guidelines.

ps. polyuria - peeing frequently, polydispia - excessive thirst and polyphagia is excessive hunger.

#3

Brian,

Thanks for the info. It was helpful in getting the air cleared about what was really said at the evaluation at the VA. As you point out, the VA clinics have no problem saying that someone with a 6.5 OR greater A1c has diabetes. The problem lies in who is eligible for compensation for their diabetes. Apparently, it's not enough for a vet with confirmed Agent Orange exposure and confirmed diabetes to receive compensation; according to the doctor he saw, he needs to have an A1c greater than 6.5 if he is going to receive compensation. It's kind of weird, but I haven't found anything to either confirm or refute that statement. I suppose I will have to wait and see!