May 8, 2001

Rules Published for VA's Diabetes-Agent Orange Benefits

            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 Orange 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.

Cost of the new benefit during the next five years is projected to be $3.3 billion, with about 220,000 veterans receiving benefits.

The number of diseases recognized by VA as associated with Agent Orange has steadily increased since the early 1990s.

VA and Diabetes

Background

Diabetes 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.

With 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.

Data Base

In 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.

Since 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.

Performance Measures

In 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).

The 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.

An 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.

Partnerships

In 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.

VA 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

number of macrovascular complications, such as heart disease and stroke, that are the major cause of hospitalization and death for persons with diabetes.

Two 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.

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.

The 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.

VA 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

Veterans Health Administration Diabetes Program

http://www.va.gov/diabetes/

The VA Agent Orange & Diabetes Information Page

http://www.va.gov/opa/fact/diabetes/index.htm