Nurses have told us that DMII is a chronic condition; that once you have it, you always have it. And to never go off the restricted diet or risk suffering terrible side effects.
When we lived in a senior apartment complex in MN, we saw some of those side effects including foot amputation of an attractive slender woman in her sixties. Just do a Google images using the search term “diabetes amputated leg” to see this particular horrific consequence in graphic detail.
But the VA has a different belief/standard, one that doesn’t see DMII as chronic. If a veteran’s DMII is under control, his chart may be coded “prediabetic” and that is not accurate.
One afflicted Vietnam vet decided to stop taking his DMII medications because three ROs: San Diego, WRJ (VT) and Detroit all claimed he did not meet the VA’s criteria. Why? Because his medications successfully managed his diabetes mellitus, type II. So he decided put himself at risk and fight on.
BVA Veterans Law Judge BARBARA B. COPELAND set this case right
(Citation Nr: 1422344)
and possibility saved this vet from further physical disability when he rebelled at the idiocy and injustice and went off his meds (link). She wrote:
At a February 2010 hearing before a DRO, the Veteran testified that he was treated with Metformin for his diabetes mellitus but had recently stopped taking the medication because of VA’s continued denial of his claim for diabetes. He stated that he had been medically treated for diabetes for two years. He testified that his peripheral neuropathy was related to his diabetes mellitus.
His private doc went to bat for his patient:
Dr. Hanson noted that the VA examiner has disputed that the Veteran has diabetes mellitus at all based on the ADA’s outmoded standard definition of diabetes which requires two fasting blood sugars 146 or above on two separate occasions; a two hour post 75 gram glucose load come back above 200 mg/dl on two occasions; and random blood sugar 200 on two occasions. Dr. Hanson noted that the Veteran had a hemoglobin A1C of 6.4 percent in 2007 despite running vigorously and regularly and having a lean body mass that exceeds most Americans’ fitness.
Thank you Dr. Hanson and Judge Copeland for caring.
The DIABETES MELLITUS DISABILITY BENEFITS QUESTIONNAIRE (LINK) uses the outmoded standard (See page 3) of diagnostic testing to deny benefits (exception of 146 versus 126.) In this case, a non-VA provider is essential to writing a good nexus letter or to fill out this form.
According to the NIH, the A1C and the blood glucose are the two most important tools; but like political polls–there is a margin of error. VA Doc David Aron provided these charts to the NIH (link) to illustrate.
Oddly, the VA QUESTIONNAIRE does not ask about heredity. Why? Because special, more accurate tests, are needed if a hemoglobin variant is present.(LINK)
People of African, Mediterranean, or Southeast Asian descent, or people with family members with sickle cell anemia or a thalassemia are particularly at risk of interference. People in these groups may have a less common type of hemoglobin, known as a hemoglobin variant, that can interfere with some A1C tests.
That’s a whole lot of vets...and many are unaware of their DNA roots. I didn’t find out about my thalassemia until I was 50. We confirmed Mediterranean heredity via DNA private testing (ancestory.com) origins, and other genes, and should probably request the most accurate tests now.
False A1C results may also occur in people with other problems that affect their blood or hemoglobin. For example, a falsely low A1C result can occur in people with
- heavy bleeding
A falsely elevated A1C result can occur in people who
- are very low in iron, for example, those with iron deficiency anemia
Other causes of false A1C results include
- kidney failure
- liver disease
So if one suspects diabetes, it behooves us all to find out if you have a hemoglobin variant and if so, request the right lab tests.