Type 2 Diabetes VA Rating: Why Most Get 20%, and How 40% Works

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Type 2 diabetes is one of the most common VA ratings, and most veterans who have it are rated at 20%. That is not a mistake on VA’s part. The rating code is built around what treatment you need, and the jump from 20% to 40% depends on one phrase that trips up almost everyone: regulation of activities.

The bigger money in a diabetes claim is often not the diabetes rating itself. It is the complications, which VA rates separately and which many veterans never claim.

The rating criteria

Each level is an “and” list. If one piece is missing, VA drops you to the level below.

Why most veterans stop at 20%

Read the 20% and 40% rows side by side. The only difference is insulin plus regulation of activities.

The rating code defines it in a parenthesis: “avoidance of strenuous occupational and recreational activities.” In 2007 the Court of Appeals for Veterans Claims, in Camacho v. Nicholson, held that this has to be shown by medical evidence. The Board of Veterans’ Appeals applies that strictly. Two things follow:

1. Your own decision to take it easy does not count. If you stopped running or lifting because you felt shaky, that is self-limitation. The Board treats it differently from a doctor’s order.
2. “Exercise more” works against you. Most doctors tell diabetic patients to be more active. When the records say “encouraged daily walking” or “increase physical activity,” the Board often reads that as the opposite of regulation of activities and denies 40%.

What a 40% record actually looks like

The doctor’s note has to say, in some form, that you should avoid strenuous activity because of your diabetes. For example, a note that reads something like:

That sentence covers both halves (work and recreation) and gives a medical reason. A note that only says “be careful when exercising” usually does not.

This is not something to ask a doctor to write if it is not true. But many insulin-dependent veterans have been told to avoid heavy exertion, for example because of low blood sugar episodes, and it simply never got written down. If that is you, ask your provider to record the restriction and the reason in your treatment notes.

Three worked examples

Veteran A: metformin and diet advice. Takes metformin twice a day. Her VA dietitian note says “carb-controlled diet.” No insulin. Rating: 20%. She cannot reach 40% without insulin, no matter how well documented anything else is.

Veteran B: insulin, told to exercise. Uses long-acting insulin once a day and follows a restricted diet. His primary care notes say “continue walking 30 minutes daily.” Rating: 20%. He is on insulin, but there is no medical regulation of activities, and the notes point the other way.

Veteran C: insulin, documented restriction. Uses insulin twice a day. After two low blood sugar episodes at work, her endocrinologist wrote that she should avoid strenuous occupational and recreational activity. Rating: 40%. All three 40% elements are in the record.

Complications: where the extra ratings are

Note (1) to the diabetes code sets a simple rule:

• A complication that would be rated 10% or more on its own is rated separately, unless it is being used to support a 100% diabetes rating.
• A complication that would be rated 0% on its own is treated as part of the diabetes and not rated separately.

Common complications that can carry their own ratings:

What separate ratings can do to your total

Veteran A’s diabetes is rated 20%. She also has nerve damage in both feet, rated 10% on each side.

• The two 10% leg ratings combine to 19, and because both legs are affected, VA adds the bilateral factor: 10% of 19, which brings it to 21.
• 21 combined with the 20% diabetes rating gives 37.
• 37 rounds to 40% combined.

The same veteran with only the diabetes rating stays at 20%. See how VA math works.

If ED is also service connected, SMC-K is paid on top of the 40% rate. It does not change the combined percentage.

Getting service connected

Presumptive: Agent Orange

Type 2 diabetes is on VA’s list of diseases presumed to be caused by herbicide exposure. It can appear at any time after service, as long as it reaches at least 10%. If you served in a location VA recognizes, you do not have to prove the diabetes came from service. Those locations include Vietnam (January 9, 1962, to May 7, 1975), any U.S. or Royal Thai base in Thailand (through June 30, 1976), the Korean DMZ area (September 1, 1967, to August 31, 1971), and the newer PACT Act locations, which include Laos, parts of Cambodia, Guam, American Samoa and Johnston Atoll. See Agent Orange presumptive conditions for the full list and dates.

Type 1 diabetes is not on the Agent Orange list.

Presumptive: within a year of discharge

Diabetes is one of VA’s chronic diseases. If it reached at least 10% within one year of separation, VA presumes it is service connected, for any veteran, whatever the cause.

Check your separation physical and any lab work from your last year in service, then the first year after. An A1C or fasting glucose result in that window can be the whole case.

Direct and secondary

• Direct: elevated blood sugar or a diabetes diagnosis in your service records.
• Secondary: a medical opinion that another service-connected condition, or the medicine for it, caused or worsened your diabetes. Long-term steroid treatment and some psychiatric medicines are examples that come up. These claims need a nexus letter with reasoning. See secondary conditions.

Evidence checklist

For the diabetes rating itself:

• Your current medication list showing oral medication or insulin, and how many injections a day
• A treatment note or dietitian note showing a restricted diet was prescribed (not just “eat healthy”)
• For 40% and higher: a note saying a provider told you to avoid strenuous work and recreational activity, and why
• For 60% and 100%: hospital records for low blood sugar or ketoacidosis, and a count of visits to your diabetes care provider
• For 100%: weight records over time if you have been losing weight and strength

For complications:

• Any nerve test (nerve conduction study) or foot exam showing loss of sensation
• Your most recent eye exam report
• Kidney labs (eGFR and urine albumin)
• Blood pressure readings, if you are claiming hypertension too

For service connection:

• Your DD-214 and any records placing you in a qualifying Agent Orange location
• Lab results from your last year in service and first year out

The free VA claim evidence checklist covers the paperwork that every claim needs.

At the C&P exam

The examiner fills out the diabetes questionnaire. It asks how your diabetes is managed and whether a provider has told you to regulate your activities. Be ready to answer:

• Exactly what you take, the dose, and how many insulin injections a day
• Who prescribed your diet and what it is
• Whether a provider told you to avoid strenuous activity, who, and when. If you have the note, bring it.
• How many times in the past year you were hospitalized or seen for low blood sugar
• Any numbness or tingling in your feet or hands, vision changes, or kidney problems

Do not describe yourself as “very active” if you are not, and do not undersell symptoms. See the C&P exam guide.

Reading your decision letter

A diabetes decision usually explains the rating by naming which pieces of the rule your records show, and which higher-level piece is missing. The exact wording varies, but the pattern looks like this:

At the Board, the same issue appears in plain terms. A 2018 Board decision applying Camacho found the veteran “does not require regulation of his activities for treatment,” and ended: “Entitlement to a rating in excess of 20 percent for diabetes mellitus, type II … is denied.”

The “not warranted unless” part tells you exactly what was missing. If you are on insulin and a provider did restrict your activities, the missing piece is usually a note in your records. That is new evidence for a supplemental claim. The decision letter decoder can help with other wording.

Also check that the letter addresses every complication you claimed. If nerve damage in your feet is in your records but missing from the decision, it may never have been claimed. You can file for it as a secondary condition.

Common mistakes

• Expecting 40% for insulin alone, without a doctor’s activity restriction
• Not claiming peripheral neuropathy, kidney disease, eye disease or ED as separate conditions
• Records that say “advised to exercise more” with nothing explaining any restriction
• Agent Orange veterans who were denied for diabetes years ago and never filed again under the expanded PACT Act locations
• Not looking at first-year-after-discharge lab results

Common questions

What is the most common VA rating for type 2 diabetes? 20%, for oral medication (or insulin) plus a restricted diet.

Does insulin get me 40%? Not by itself. You also need a restricted diet and medical evidence that you must avoid strenuous work and recreational activity.

Is diabetic neuropathy rated separately? Yes, if it would be rated at least 10% on its own. Each affected limb is rated separately, and the bilateral factor can apply.

Is type 2 diabetes presumptive for Agent Orange? Yes, at any time after service, for veterans with qualifying service. Type 1 is not.

I was diagnosed with prediabetes. Can I claim it? The rating code covers diabetes mellitus once it has been diagnosed. Prediabetes is not listed in it. Make sure the result is in your records anyway, so the timeline is clear if it progresses.

Last reviewed October 2026. This guide is general educational information, not legal or medical advice, and this site is not affiliated with the Department of Veterans Affairs. Rules and rates change. Confirm details on VA.gov or with an accredited representative. See our disclaimer and editorial policy.