Highlights
What GAO Found
The Department of Veterans Affairs (VA) considers Type 2
diabetes—which most often develops in adults due to several factors, including
genetics, physical inactivity, and environmental factors—to be associated with
exposure to herbicides used in the Vietnam War. VA does not assume the same
association exists with Type 1 diabetes, for which the exact causes are unknown
but most often develops in children and teens.
VA does not have comprehensive data on claims involving Type
1 diabetes. Specifically, data for Veterans Benefits Administration (VBA)
claims decisions are not available prior to 2003. Further, available VBA data
do not distinguish between Type 1 and Type 2 diabetes because VBA tracks both
conditions using the same medical diagnostic code. Thus, GAO cannot reliably
report the number of claims that VBA has granted or denied to Vietnam veterans
for Type 1 diabetes. VBA officials stated they do not systematically track
claims for Type 1 diabetes, but they can identify Type 1 diabetes claims by
performing customized text searches. Accordingly, VBA identified around 1,900
claims decisions as potentially involving Type 1 diabetes from fiscal year 2003
through July 2021, which represented less than 1 percent of all decisions for
diabetes during that time. Additionally, officials from VA and representatives
from veterans service organizations said they did not expect there would be
many claims for Type 1 diabetes, in part, because Type 1 diabetes most often
develops at a young age and prior to military service.
VA evaluates veterans' claims for Type 1 diabetes either
using evidence of a direct connection to service or by presuming a connection
if the condition developed within a year following service. As with claims for
any other condition, VBA claims processors may grant benefits if veterans
provide evidence that their Type 1 diabetes was caused or aggravated by their
military service. Such evidence could include development of Type 1 diabetes
symptoms during service (e.g., elevated blood sugar), according to VBA
officials. Additionally, claims processors may presume a connection to service
if veterans' Type 1 diabetes developed to a certain degree within a year
following their service.
Among 30 VBA claims decisions that GAO reviewed potentially
involving Type 1 diabetes, claims processors granted or denied benefits for
various reasons, and generally explained whether the claim contained evidence
to support a connection with the veteran's service. For example, in two of 11
decisions to grant benefits, VBA claims processors identified evidence of
veterans being diagnosed with Type 1 diabetes during or within a year of
completing service, and a disability medical examiner stated that the veteran's
condition was "at least as likely as not" due to military service. In
contrast, claims processors noted in eight of 19 decisions to deny benefits
that the veteran's treatment records did not include complaints, treatments, or
a diagnoses of Type 1 diabetes during service.
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