Published for VA's
WASHINGTON -- Vietnam veterans with "Type 2"
diabetes came closer today to receiving disability
compensation from the Department of Veterans Affairs
(VA) with the formal publication of the rules that
will allow VA to provide benefits to those veterans.
"The hazards of the battlefield include more than
bullets and shells," said Secretary of Veterans
Affairs Anthony J. Principi. "As our
understanding of the health risks faced by our
military personnel increases, VA will adjust its
programs and benefits to fit the needs of
Principi's announcement came as the Federal
Register today published VA's final rules for
benefits for Vietnam veterans with "Type 2"
diabetes. Under federal law, those rules don't take
effect for 60 days. However, VA offices are already
accepting claims from eligible Vietnam veterans.
Veterans affected by the new rules will receive a
priority for VA health care, and, depending upon the
severity of their illnesses, disability compensation
that ranges from $101 to $2,107 monthly.
Today's announcement follows a report in November by
the National Academy of Sciences' prestigious
Institute of Medicine (IOM) that found "limited /
suggestive" evidence of a link between
adult-onset, or Type 2, diabetes, and Agent
and other herbicides used in Vietnam.
VA estimates that about 9 percent of the 2.3 million
Vietnam veterans still alive have Type 2 diabetes. The
illness is characterized by high blood sugar levels
caused by the body's inability to process the hormone
insulin. Approximately 16 percent of veterans
currently receiving care in VA medical facilities have
been diagnosed with diabetes.
of the new benefit during the next five years is
projected to be $3.3 billion, with about 220,000
veterans receiving benefits.
number of diseases recognized by VA as associated with
has steadily increased since the early 1990s.
following conditions are now considered
service–connected for veterans who served in
(a skin disorder);
(a liver disorder);
or subacute peripheral neuropathy
(a nerve disorder);
certain cancers, including non-Hodgkin's
tissue sarcoma, Hodgkin's disease, multiple yeloma,
(including cancers of the lung, larynx, trachea and
Mellitus is a serious national problem that has
reached epidemic proportions. Nearly 16 million
Americans (5.9 percent) have diabetes but about 5.5
million Americans are undiagnosed, based upon data
from the Centers for Disease Control and Prevention.
VA’s patients with diabetes account for about 16
percent of the total it cares for. That number is
based upon a combination of physician coding and
prescriptions for diabetes medications.
the objective of standardizing diabetes care by
clinicians, VA distributed treatment guidelines for
veterans with diabetes in March 1997. These guidelines
were developed by more than 70 scientists and
clinicians from VA and other federal agencies, many of
whom hold leadership positions in the American
Diabetes Association (ADA) and the National Diabetes
Education Program. They were revised in partnership
with the Department of Defense in February 2000.
1994, VA initiated a diabetes database with voluntary
participation by VA facilities. The information
documents the prevalence, costs and complications of
diabetes. It also demonstrates links between
intermediate health outcomes -- such as blood sugar,
hypertension and cholesterol -- and medication usage.
1999, the database has included a census of all VA
diabetic patients. Based on the information available,
VA’s Healthcare Analysis and Information Group has
made meeting presentations and published numerous
reports and journal articles. VA publishes annual
reports on demographics, use of pharmaceuticals and
intermediate health outcomes and complications,
specifically lower-extremity amputations.
1996, VA established performance measures, which are
updated yearly, to evaluate the quality of care given
for diabetes. The VA Office of Quality and Performance
uses these measures to document the rates of screening
for eye, kidney and foot problems and the rates of
testing for and lowering blood sugar values and
"bad cholesterol" (low density lipoprotein
cholesterol or LDL-C).
latest data show that 93 percent of veterans with
diabetes receive an annual HbA1c test for blood sugar.
Of this group, 15 percent are above the 9.5 percent
level, which is poor control, and 63 percent are below
eight percent, the target value the ADA recommends for
intervention. Over 75 percent of veterans with
diabetes receiving cholesterol testing have
"bad" cholesterol lower than the target of
annual foot exam was performed on 93 percent of VA’s
most recently tracked diabetic patients. An annual
retinal exam was given to 67 percent, even though
patients with target-level HbA1c levels not receiving
insulin only require biennial eye exams. And 54
percent of diabetic patients had lab tests for renal
addition to multiple investigator research studies, VA
has partnered with the Juvenile Diabetes Foundation to
establish six VA Diabetes Research Centers of
Excellence. VA signed an agreement with the ADA in
March 1998 to collaborate in such areas as education
and quality of care.
has established the Diabetes Quality Enhancement
Research Initiative (QUERI) to translate research
findings into better care for patients with diabetes.
In 2000, VA funded a five-year, multi-site
study to determine if tight control of blood sugar
will decrease the
of macrovascular complications, such as heart disease
and stroke, that are the major cause of
hospitalization and death for persons with diabetes.
of the last three presidents of the ADA Health Care
and Education Track have been VA clinicians nationally
recognized in the fields of podiatry and patient
education. The ADA journal Diabetes Care will
publish a special supplement on diabetes care in VA in
the next few months. VA accomplishments in diabetes
quality of care were presented in a plenary session at
the ADA June 2000 national scientific sessions.
March 1999 and May 2000, VA hosted national symposiums
to enhance the education of VA clinicians about
diagnosis and treatment of patients with diabetes.
VA diabetes informational web site (http://www.va.gov/health/diabetes/default.htm)
has cataloged VA initiatives in diabetes and has
linkages to other federal agencies.
will continue to expand its partnerships and
implementation of its diabetes projects. VA
participates in several federally led coalitions,
including the National Diabetes Education Program, the
Diabetes Quality Improvement Project and the Diabetes
Mellitus Interagency Coordinating Committee
Health Administration Diabetes Program
& Diabetes Information Page