Citation NR: 9731302 Decision Date: 09/12/97 Archive Date: 09/17/97 DOCKET NO. 96-24 368 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Wichita, Kansas THE ISSUE Entitlement to service connection for diabetes mellitus (DM) resulting from the use of prednisone therapy at a VA medical center, pursuant to the provisions of 38 U.S.C.A. § 1151 (West 1991). REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Appellant and his spouse ATTORNEY FOR THE BOARD Michelle L. Nelsen, Associate Counsel INTRODUCTION The veteran had active duty from October 1961 to August 1962. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 1996 rating decision of the Department of Veterans Affairs (VA) Medical & Regional Office Center (MROC) in Wichita, Kansas. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that the RO erred in denying service connection for DM pursuant to 38 U.S.C.A. § 1151. He argues that he did not have diabetes prior to treatment at a VA facility consisting of prednisone. In particular, the veteran states that VA physicians conceded that the prednisone caused the onset of diabetes. He claims to have loss of vision in the left eye as a result of treatment. Therefore, a favorable disposition is requested. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991 & Supp. 1997), has reviewed and considered all of the evidence and material of record in the veteran's claims files. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the veteran has not met the initial burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that his claim for entitlement to service connection for diabetes mellitus (DM) resulting from the use of prednisone therapy at a VA medical center, pursuant to the provisions of 38 U.S.C.A. § 1151 (West 1991), is well grounded. FINDING OF FACT There is no medical evidence showing additional disability resulting from September 1993 prednisone therapy at a VA facility. CONCLUSION OF LAW The veteran’s claim of entitlement to VA disability benefits for DM is not well grounded. 38 U.S.C.A. §§ 1151, 5107 (West 1991); 38 U.S.C.A. §§ 3.102, 3.358 (1996). REASONS AND BASES FOR FINDING AND CONCLUSION Factual Background A review of the claims folder found VA medical center (MC) laboratory reports from October 1987. Over a 5-day period, these reports showed the veteran’s glucose levels ranged from 92 milligrams per deciliter (mg/dl) to 215 mg/dl. On August 31, 1993, the veteran was admitted to a VA facility for treatment of polymyalgia rheumatica. He was treated with prednisone, first at low doses; increased doses resulted in marked relief of the veteran’s symptoms. It was noted on the discharge summary that the veteran carried a diagnosis of non-insulin dependent diabetes mellitus (NIDDM) at admission. The veteran’s serum glucose level at admission was 137 mg/dl. The following day, the glucose level was 136 mg/dl. He was discharged on September 9, 1993 in good and stable condition on a tapering dose of prednisone. On September 30, 1993, the veteran was readmitted to the facility complaining of going blind. A biopsy of the right temporal artery was negative for temporal arteritis. The veteran complained of decreased visual acuity of the left eye; the right eye is blind from a previous accident. On examination, visual acuity of the left eye was 20/200. Serum glucose level at admission was 851 mg/dl. A subsequent check revealed a glucose level of 713 mg/dl. The veteran was given insulin. An hour later, the glucose level was 450 mg/dl. He was then put on a sliding scale insulin dose. The next morning, the glucose level was 210 mg/dl. The veteran’s vision did not correct immediately; he was informed that it may take days to weeks. He was placed on a diabetes regimen including a restricted diet, self-testing, and medication with oral and intravenous hypoglycemic drugs. He was to continue the taper dosage of prednisone. Discharge diagnoses included steroid-induced hyperglycemia. Additional VA laboratory reports dated from January 1994 to May 1996 showed serum glucose levels ranging from 145 mg/dl to 278 mg/dl. The May 1996 reading showed a level of 226 mg/dl. Following the veteran’s application for benefits, the VAMROC requested that the VAMC Chief of Staff determine whether the prednisone caused the veteran additional disability. Edward J. Huycke, M.D., responded that the diabetic signs and symptoms occurred naturally and may have been accentuated by the prednisone therapy. He stated that the prednisone did not cause the DM, and that the signs and symptoms of DM remained after the prednisone was stopped. The veteran and his spouse testified at a hearing in June 1996. He stated that he was tested for diabetes before he was given the prednisone and told that he did not have it. The veteran indicated that he had previously had high blood sugar when he was drinking a lot of soft drinks. He was told that he was not diabetic, but that controlling the diet would bring the blood sugar levels down. He thought this incident happened in 1985 or 1986 when a Dr. Bob Gibson was treating him. He testified that in the last 6 months or so his blood sugar levels ranged from 60 or 70 to 300. He indicated that the levels were higher at times of stress. He stated that he could not see well enough to do much and that his wife did all the driving now. The VAMROC requested the veteran’s treatment records from Dr. Gibson. No response was received. A July 1996 VA outpatient treatment record indicated that, regarding his vision, the veteran could not see fingers at one foot in the right eye due to trauma to the eye at age 5. Regarding the left eye, visual acuity was measured at 20/20. In November 1996, the VAMROC obtained an opinion from G.B. Wood, M.D., a VA physician, on the issue of whether the veteran’s DM was caused or aggravated by prednisone. Dr. Woods agreed with the previous statement by Dr. Huycke, and stated that the medical records supporting a finding of aggravation of preexisting DM with unintended additional disabilities including greater dietary control, home blood glucose testing, and daily insulin injections. Applicable Law and Analysis Disability benefits may be payable to a veteran for non- service connected disability in limited circumstances. If the prescribed requirements are met, disability payments are awarded in the same manner as if the disability was service connected. 38 U.S.C.A. § 1151 (West 1991). First, the veteran must incur an injury or aggravation of an injury as the result of hospitalization, medical or surgical treatment, submission to a VA examination, or the pursuit of a course of vocational rehabilitation. 38 U.S.C.A. § 1151; 38 C.F.R. § 3.358(c) (1996). In cases of medical care, proof of actual causation between the treatment and the injury is required; injury or aggravation which is coincidental with, or is the natural consequence of, the treatment in question is not compensable. 38 C.F.R. § 3.358(c)(2) and (3). The Board notes that § 1151 contains no requirement of fault on the part of the service providers to confer entitlement on the injured veteran. See Brown v. Gardner, 115 S.Ct. 552, 556 (1994). Second, the injury or aggravation cannot be the result of the veteran’s own willful misconduct. 38 U.S.C.A. § 1151; 38 C.F.R. § 3.358(c)(4). Finally, such injury or aggravation must result in additional disability. 38 U.S.C.A. § 1151; 38 C.F.R. § 3.385(b). The presence of additional injury is determined by comparing the state of the veteran’s physical condition immediately preceding the injury with the subsequent physical condition resulting from the injury. 38 C.F.R. § 3.358(b)(1). With respect to surgical treatment in particular, a before-and- after comparison is made of the condition the surgery was designed to relieve. 38 C.F.R. § 3.358(b)(1)(ii). Injury or aggravation that is merely the continuance or natural progression of the condition for which the treatment was authorized is not compensable additional disability. 38 C.F.R. § 3.358(b)(2). However, an individual claiming VA benefits must meet the initial burden of submitting evidence “sufficient to justify a belief in a fair and impartial individual that the claim is well grounded.” 38 U.S.C.A. § 5107(a); 38 C.F.R. §§ 3.102, 3.159; Murphy v. Derwinski, 1 Vet.App. 78, 91 (1990); Gilbert v. Derwinski, 1 Vet.App. 49, 55 (1990). A claim that is well grounded is plausible, meritorious on its own, or capable of substantiation. Murphy, 1 Vet.App. at 81; Moreau v. Brown, 9 Vet.App. 389, 393 (1996). For purposes of determining whether a claim is well grounded, the Board presumes the truthfulness of the supporting evidence. Robinette v. Brown, 8 Vet.App. 69, 77-78 (1995); King v. Brown, 5 Vet.App. 19, 21 (1993). In this case, the Board finds that the veteran’s claim for diabetes mellitus pursuant to 38 U.S.C.A. § 1151 is not well grounded as there is no evidence of additional disability. First, the medical evidence does not show any loss of vision of the left eye. The July 1996 consultation report showed visual acuity of the left eye as 20/20. The Board recognizes that there was decreased acuity of the left eye recorded at the September 30, 1993 admission. However, the evidence shows that the decreased vision was transitory and resolved as the veteran lowered the dosage of, and then discontinued the use of, prednisone. Thus, there is no additional disability in terms of loss of vision. Second, the evidence of record does not show increased disability in terms of the diabetes mellitus. Laboratory reports from 1987 showed glucose levels elevated beyond a normal range. A diagnosis of NIDDM was noted at the veteran’s initial admission in August 1993. Glucose levels at that time were elevated as well. It is clear that the veteran subsequently developed hyperglycemia associated with prednisone use. However, subsequent glucose levels taken after the veteran discontinued the prednisone do not reveal a marked change in the underlying disorder as it existed prior to beginning prednisone therapy. The fact that the veteran is now treating the DM does not itself constitute an additional disability for purposes of obtaining disability benefits pursuant to § 1151. Under these circumstances, the Board finds that the veteran has not met his initial burden of submitting evidence of a well grounded claim for entitlement to VA disability benefits for DM. 38 U.S.C.A. § 5107(a). As the duty to assist is not triggered here by a well grounded claim, the Board finds that the VA has no obligation to further develop the veteran’s claim. See Grivois v. Brown, 5 Vet.App. 136, 140 (1994). The Board recognizes that this appeal is being disposed of in a manner that differs from that used by the RO. The RO denied the veteran’s claim on the merits, while the Board has concluded that the claim is not well grounded. However, the Court has held that “when an RO does not specifically address the question whether a claim is well grounded but rather, as here, proceeds to adjudication on the merits, there is no prejudice to the veteran solely from the omission of the well-grounded analysis.” Meyer v. Brown, 9 Vet.App. 425, 432 (1996). ORDER Entitlement to service connection for diabetes mellitus (DM) resulting from the use of prednisone therapy at a VA medical center, pursuant to the provisions of 38 U.S.C.A. § 1151 (West 1991), is denied. RENÉE M. PELLETIER Member, Board of Veterans' Appeals 38 U.S.C.A. § 7102 (West Supp. 1997) permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991 & Supp. 1997), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402, 102 Stat. 4105, 4122 (1988). 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