How the Board ruled on diabetes claims, 2021–2025

Diabetes (direct service connection)

Direct (began in or was caused by service), or theory not stated in the Board order

47.5% granted of 3,040 decided cases (margin of error 45.7–49.2%). 1,443 granted, 1,597 denied, 2,685 sent back to VA (remanded, not decided), 563 dismissed.

What convinced the Board in granted cases

• Most usable grants turned on the veteran's credible statements or buddy statements showing service where herbicide exposure is recognized, such as near Thai air base perimeters or the Korean DMZ, so the diabetes presumption applied. (4 of 6 decisions read; e.g. 21014961, A23025168, 21032341)
• In the few secondary claims, the Board granted when medical evidence linked diabetes to a service-connected condition and the VA examiner failed to address whether that condition worsened the diabetes. (2 of 6 decisions read, few decisions; e.g. A24042088, 24021192)

Common reasons in denied cases

• The Board denied when a VA opinion based on the record and medical literature went unrebutted, or when private opinions rested on an incorrect history or were not reliable. (4 of 9 decisions read; e.g. 22017543, 21077479, 22048463)
• Claims failed when the record did not show herbicide or toxic exposure, and diabetes did not begin in service or within one year after. (4 of 9 decisions read; e.g. A23027321, A24012734, 23031656)
• The veteran's own belief that service, an exposure, or another condition caused the diabetes was not treated as competent medical evidence. (3 of 9 decisions read; e.g. 21003822, A23027321, 21053597)

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Diabetes (exposure claims)

Exposure (e.g. Agent Orange, Camp Lejeune, burn pits)

49.3% granted of 722 decided cases (margin of error 45.7–52.9%). 356 granted, 366 denied, 615 sent back to VA (remanded, not decided), 30 dismissed.

What convinced the Board in granted cases

• The Board accepted the veteran's credible, consistent account of duties near a Thailand air base perimeter or the Korean DMZ as proof of herbicide exposure, even without official records. (6 of 9 decisions read; e.g. 21074891, 22055515, 21011834)
• Once exposure was conceded and type 2 diabetes was diagnosed, the presumption applied and no medical nexus opinion was needed. (6 of 9 decisions read; e.g. 21018453, 21011834, 22016969)
• When evidence about exposure was evenly balanced, the Board resolved the doubt in the veteran's favor. (5 of 9 decisions read; e.g. 21018453, 21011240, A21014762)

Common reasons in denied cases

• Exposure was not established: ship deck logs or unit records outweighed the veteran's account, or the account was speculative or secondhand. (8 of 12 decisions read; e.g. 22040237, A24003123, 21011377)
• Without the presumption, no competent medical opinion linked diabetes to service; the veteran's own belief was not competent, and VA opinions citing other causes went unrebutted. (5 of 12 decisions read; e.g. 23053200, A21000345, 21036810)
• Service records were silent and diabetes was first diagnosed decades after service, outside any presumptive period. (3 of 12 decisions read; e.g. 23053200, A25035454, A23021663)

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Diabetes secondary to any service-connected condition

Secondary (caused or worsened by a service-connected condition)

57.8% granted of 583 decided cases (margin of error 53.8–61.7%). 337 granted, 246 denied, 686 sent back to VA (remanded, not decided), 40 dismissed.

What convinced the Board in granted cases

• The Board credited opinions that explained a mechanism, such as the service-connected condition causing weight gain or inactivity, or PTSD raising metabolic and blood-sugar risks. (5 of 7 decisions read; e.g. 21031888, A24061627, 22030571)
• Opinions that cited medical literature and applied it to the veteran's own records and history were found highly probative; some came from treating doctors, one from a VA examiner. (3 of 7 decisions read; e.g. A21011196, A24061627, 21031888)
• A negative VA opinion that ignored whether the service-connected condition worsened the diabetes lost weight, and balanced evidence was resolved for the veteran. (2 of 7 decisions read, few decisions; e.g. A21011196, 23015385)

Common reasons in denied cases

• Thorough VA opinions that reviewed the file, often citing literature or medication timing, found diabetes was not caused or worsened by the service-connected condition and went unrebutted. (8 of 10 decisions read; e.g. 21053440, 21037271, 21022175)
• The Board found another cause more likely, such as genetics or diet. (3 of 10 decisions read; e.g. 21011421, 21056837, 23005578)
• The veteran's or family member's own belief about the cause was not competent; one private opinion stating a probable link with no rationale got no weight. (4 of 10 decisions read; e.g. 21037271, 23005578, A25035051)

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Diabetes secondary to hypertension

Secondary (caused or worsened by a service-connected condition)

50% granted of 44 decided cases (margin of error 35.8–64.2%). 22 granted, 22 denied, 58 sent back to VA (remanded, not decided), 1 dismissed.

What convinced the Board in granted cases

• The Board granted when a private opinion reviewed the veteran's medical history and was backed by medical literature. Such opinions outweighed, or matched, VA examinations the Board found inadequate or no stronger. (4 of 9 decisions read; e.g. A24068149, A24027801, A24058135)
• The Board granted when a VA opinion itself supported the link, such as one citing research that people with hypertension often have insulin resistance and a higher risk of diabetes. (2 of 9 decisions read, few decisions; e.g. 23031136, 23026029)
• The Board granted when the evidence was in approximate balance, for example when submitted medical literature carried real weight against a VA opinion, or when hypertension medication was named as a factor. (3 of 9 decisions read; e.g. A25034747, 21019603, A24027801)

Common reasons in denied cases

• The Board denied when thorough VA opinions found that other risk factors, such as obesity or family history, explained the diabetes, or that the blood pressure medication did not affect blood sugar. (5 of 13 decisions read; e.g. 21037271, 24020368, 21040510)
• Private opinions lost weight when they were general and not specific to the veteran, gave a conclusory statement with no rationale, or relied on articles that were not peer-reviewed. (4 of 13 decisions read; e.g. A22005047, 22023891, 21040510)
• The Board denied when no medical evidence supported the link and only the veteran believed it. Direct claims also failed when diabetes was diagnosed years after service with no in-service signs. (6 of 13 decisions read; e.g. 22015050, 24007730, 21007053)

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Diabetes secondary to PTSD

Secondary (caused or worsened by a service-connected condition)

48.5% granted of 33 decided cases (margin of error 32.5–64.8%). 16 granted, 17 denied, 51 sent back to VA (remanded, not decided), 4 dismissed.

What convinced the Board in granted cases

• The Board gave high weight to private opinions that reviewed the full record, examined the veteran, and cited medical studies showing a link between PTSD and diabetes. (4 of 11 decisions read; e.g. 23018251, 23050040, A25005350)
• Negative VA opinions lost weight when they simply called the conditions unrelated, ignored the literature in the private opinion, or speculated about whether PTSD caused weight gain. (3 of 11 decisions read; e.g. A25005350, A24060717, A23025439)
• Several grants ran through weight gain or obesity caused by PTSD symptoms, with obesity then leading to diabetes; one rested on a VA examiner's favorable opinion citing literature. (4 of 11 decisions read; e.g. A24055396, A23025439, A24030475)

Common reasons in denied cases

• VA opinions found no recognized medical link between PTSD and diabetes, and the Board found nothing that outweighed them. (4 of 13 decisions read; e.g. 22023891, A24070201, A24067325)
• There was no probative opinion supporting a link, or the private opinion was conclusory and named no specific medical literature. (3 of 13 decisions read; e.g. 22023891, A25017207, 22022412)
• The veteran's own belief that PTSD caused diabetes was not competent medical evidence. (3 of 13 decisions read; e.g. 22051185, 21052642, A24070201)

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Diabetes secondary to sleep apnea

Secondary (caused or worsened by a service-connected condition)

Small sample: 25 decided cases, too few for a reliable percentage. 20 granted, 5 denied, 35 sent back to VA (remanded, not decided), 1 dismissed.

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Diabetes secondary to depression / psychiatric disorder

Secondary (caused or worsened by a service-connected condition)

Small sample: 20 decided cases, too few for a reliable percentage. 11 granted, 9 denied, 63 sent back to VA (remanded, not decided), 2 dismissed.

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Diabetes secondary to low back (lumbar spine)

Secondary (caused or worsened by a service-connected condition)

Small sample: 15 decided cases, too few for a reliable percentage. 9 granted, 6 denied, 36 sent back to VA (remanded, not decided), 2 dismissed.

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Diabetes secondary to knee

Secondary (caused or worsened by a service-connected condition)

Small sample: 10 decided cases, too few for a reliable percentage. 8 granted, 2 denied, 19 sent back to VA (remanded, not decided), 1 dismissed.

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