Citation Nr: 9821817	
Decision Date: 07/17/98    Archive Date: 07/23/98

DOCKET NO.  97-33 388	)	DATE
	)
	)

On appeal from the
Department of Veterans Affairs Regional Office in Jackson, 
Mississippi


THE ISSUE

Entitlement to service connection for diabetes mellitus. 


REPRESENTATION

Veteran represented by:	Disabled American Veterans


ATTORNEY FOR THE BOARD

B. P. Tierney, Associate Counsel


INTRODUCTION

The veteran served on active duty from March 1948 to December 
1973.

This appeal arises from an adverse decision of the Department 
of Veterans Affairs (VA) Regional Office (RO) in Jackson, 
Mississippi, dated in August 1997.  That decision denied, in 
pertinent part, the veteran’s claims of entitlement to 
service connection for diabetes mellitus.  That denial of 
service connection was duly appealed.

The case has been forwarded to the Board of Veterans’ Appeals 
(Board) for appellate review.


CONTENTIONS OF VETERAN ON APPEAL

The veteran contends that the use of prednisone for treatment 
of his service-connected dyshidrosis has caused or aggravated 
diabetes mellitus.



DECISION OF THE BOARD

The Board, in accordance with the provisions of 38 U.S.C.A. 
§ 7104 (West 1991 & Supp. 1998), 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 evidence supports the 
grant of service connection for diabetes mellitus.



FINDING OF FACT

The use of prednisone for control of service-connected 
dyshidrosis caused diabetes mellitus.



CONCLUSION OF LAW

Diabetes mellitus is proximately due to a service-connected 
disease or disability.  38 U.S.C.A. §§ 1110, 5107 (West 
1991); 38 C.F.R. § 3.310 (1997).


REASONS AND BASES FOR FINDING AND CONCLUSION

At the outset, the Board finds that the veteran’s claims are 
well grounded, or plausible.  38 U.S.C.A. § 5107(a); Murphy 
v. Derwinski, 1 Vet. App. 78, 81-82 (1990).  The Department 
of Veterans Affairs (VA) therefore has a duty to assist the 
veteran in the development of facts pertinent to his claim.  
Id.  In this regard, the Board is satisfied that all relevant 
facts have been developed, that available pertinent evidence 
has been obtained, and that the case is properly in appellate 
status.

Service connection will be granted where the evidence shows 
that the disease or disorder was incurred in or aggravated by 
service .  See 38 U.S.C.A. § 1110, 1131; 38 C.F.R. § 3.303(d) 
(1997).

Service connection will be granted for disease or disability, 
which is diagnosed after discharge from military service, 
when all of the evidence establishes that such disease was 
incurred in service. Cosman v. Principi, 3 Vet. App. 303, 305 
(1992); 38 C.F.R. § 3.303(d) (1997).

Service connection is also provided for a disability, which 
is proximately due to, or the result of a service-connected 
disease or injury.  38 C.F.R. § 3.310(a) (1997).

Any additional impairment of earning capacity resulting from 
an already service-connected condition, regardless of whether 
or not the additional impairment is itself a separate disease 
or injury caused by the service-connected condition, shall be 
compensated.  [T]o the extent [that] such additional 
disability is literally a result of “personal injury 
suffered or disease contracted in line of duty,” under 38 
U.S.C.A. § 1110, service connection should be established.  
Id.  In such a case, the additional “disability” results 
from the original service-connected condition.  Thus, 
pursuant to §§ 1110, 1131 and 38 C.F.R. § 3.310(a), when 
aggravation of a veteran’s non-service-connected condition is 
proximately due to or the result of a service-connected 
condition, such veteran shall be compensated for the degree 
of disability (but only that degree) over and above the 
degree of disability existing prior to the aggravation.  
Allen v. Brown, 7 Vet App 439 (1995) (citations omitted).

Service connection was initially granted for dyshydrosis of 
the hands and feet in a rating decision dated in December 
1975.

VA outpatient treatment records show that in September 1979, 
the veteran was noted to have severe dyshidrosis, and was 
prescribed prednisone.

Other VA outpatient treatment records show that in March 
1993, while seeking treatment for his skin disorder, then in 
an uncontrolled flare-up, the veteran was noted to have 
expressed a strong desire for treatment with prednisone.  The 
assessment was widespread eczema.  Repeatedly in the 
subsequent treatment records, prednisone was found to be the 
only effective treatment.

Notes of a May 1993, VA dermatologic consultation listed 
increased sugar as a possible side effect of prednisone. 

A VA hospitalization report in April 1994 noted that the 
veteran’s course in the hospital was uncomplicated except he 
was noted to have elevated sugar.  It was reported that:
Initially, this did require a sliding 
scale of Insulin, but he ha[d] 
subsequently had this discontinued as the 
steroids were tapered to every other day.  
He is, however, continuing to acquire 50 
mg of prednisone every other day and is 
quite well aware of the potential 
complication of this.  We have discussed 
this on numerous occasions.

In July 1994, it was noted that the veteran was now diabetic 
and on an oral hypoglycemic. 

In January 1996, a VA treatment note again reported that 
prednisone could cause increased sugar.

The veteran was examined in August 1996 by VA for 
compensation purposes.  He was noted to be taking 50 mg of 
prednisone every other day.  The diagnosis was severe, 
disabling dyshidrosis.  It was noted that there had been 
considerable confusion as to the correct diagnosis and a 
review of skin biopsy reports would be helpful in arriving at 
a correct diagnosis.  The examiner commented that regardless 
of the correct diagnosis, the skin disease was a disabling 
condition.  The examiner concluded that the veteran’s use of 
prednisone for his skin lesion would complicate the control 
of his diabetes mellitus.  

In an addendum to the examination report received in June 
1997, the same examiner wrote that the use of prednisone for 
the skin problem complicated the management of diabetes and 
increased the requirement for insulin and/or oral agents. 

The report of a September 1997 VA treatment note reveals a 
five year history of taking prednisone for dermatitis causing 
problems with diabetes control.  The diagnosis was NIDDM (non 
insulin dependent diabetes mellitus).

Analysis

The VA medical examiner opined that prednisone complicated 
the management of diabetes mellitus and required increased 
amounts of insulin and/or oral agents to control the diabetes 
mellitus.  In addition, several treatment notes list the 
possibility of increased blood sugar as one of the potential 
side effects of prednisone treatment.  The Board also 
recognizes the veteran’s citation to The Physician’s Desk 
Reference, p. 2538 (1995), as supporting the proposition that 
prednisone may cause manifestation of latent diabetes 
mellitus. 

If the preponderance of the evidence is against the veteran’s 
claim, the claim is denied; if the evidence is in support of 
the claim or is in equal balance, the claim is allowed. See 
Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990).  The VA 
examiner’s opinion was that the diabetes mellitus was 
aggravated by the prednisone treatment for his service 
connected skin disability, while medical professionals 
elsewhere in the record have suggested that diabetes mellitus 
is a potential side effect of prednisone treatment.  The 
undisputed evidence is that the diabetes was either caused or 
aggravated by prednisone, provided as treatment for a service 
connected disability.  Resolving reasonable doubt in the 
veteran’s favor, the Board concludes that the veteran’s 
diabetes mellitus is proximately due to his service connected 
skin disorder.  Accordingly, the benefit sought on appeal is 
allowed and service connection for diabetes mellitus is 
granted.


ORDER

Service connection for diabetes mellitus is granted.






		
	Mark D. Hindin
	Member, Board of Veterans’ Appeals

NOTICE OF APPELLATE RIGHTS:  Under 38 U.S.C.A. § 7266 (West 
1991 &  Supp. 1998), 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).  The 
date which appears on the face of this decision constitutes 
the date of mailing and the copy of this decision which you 
have received is your notice of the action taken on your 
appeal by the Board of Veterans’ Appeals.

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