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 veterans."
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
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 Agent
steadily increased since the early 1990s.
following conditions are now considered service–connected for
veterans who served in Vietnam:
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
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 130 mg/dl.
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 status.
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
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
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
In 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
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
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