Citation Nr: 18148518 Decision Date: 11/07/18 Archive Date: 11/07/18 DOCKET NO. 18-17 824 DATE: November 7, 2018 ORDER Service connection for diabetes mellitus, type II, is granted. Service connection for hypertension is granted.   FINDINGS OF FACT 1. Resolving all doubt in the Veteran’s favor, diabetes mellitus, type II, is secondary to service-connected posttraumatic stress disorder with major depressive disorder and alcohol use disorder. 2. Resolving all doubt in the Veteran’s favor, hypertension is secondary to service-connected posttraumatic stress disorder with major depressive disorder and alcohol use disorder. CONCLUSIONS OF LAW 1. The criteria for service connection for diabetes mellitus, type II, have been met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2017). 2. The criteria for service connection for hypertension have been met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1982 to March 1989. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued in November 2015 by a Department of Veterans Affairs (VA) Regional Office. The Board observes that following the January 2018 statement of the case, additional evidence was associated with the record. However, as the Board herein grants service connection for the issues on appeal, which are fully favorable determinations, there is no prejudice to the Veteran in proceeding with a decision on such matters. SERVICE CONNECTION Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. § 1131; 38 C.F.R. § 3.303. “To establish a right to compensation for a present disability, a veteran must show: “(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service”-the so-called “nexus” requirement.” Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may also be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. See 38 C.F.R. § 3.310. 1. Service connection for diabetes mellitus, type II, to include as secondary to posttraumatic stress disorder with major depressive disorder and alcohol use disorder (psychiatric disability) The Veteran contends his diabetes mellitus, type II, is caused or aggravated by his service-connected psychiatric disability. Initially, the Board finds VA treatment records reflect a current diagnosis of diabetes mellitus, type II. Test results from February 2017 show an A1C level of 7.7 percent and results from August 2017 show an A1C level of 8.9 percent. Further, an October 2017 record indicates the Veteran receives treatment for diabetes mellitus, type II, and his past medical history lists diabetes. Concerning a nexus between the currently diagnosed diabetes mellitus, type II, the Veteran was afforded VA examination in November 2017. In such report, the examiner indicated the Veteran’s diabetes was at least as likely as not proximately due to or the result of his service-connected psychiatric disability. Specifically, she stated the severity of the psychiatric disability warrants, by proximity, association with the claimed diabetes condition. She noted the Veteran’s diabetes mellitus began subsequent to the psychiatric disability and found such was the direct result of the antecedent condition. She also reported medical literature supported her conclusion, citing several studies indicating a sustained activation of the hormonal stress axis due to chronic stress symptoms was most likely a major causing mechanism of diabetes mellitus. In January 2018, a VA physician found the Veteran’s diabetes was not related to his psychiatric disability. Although noting that an August 2010 VAMC intake diagnosis reflected diabetes mellitus, the physician then stated the record contained no medical onset or diagnosis for diabetes mellitus. In addition, there was no sequential timeline for the onset of the condition based on the record. Therefore, the physician found he was unable to provide a medical opinion regarding the causality for the Veteran’s diabetes without resorting to mere speculation and a nexus had not been established. In letter dated in February 2018, a physician opined the Veteran’s severe PTSD caused his diabetes to be aggravated. The physician reported that the Veteran’s binge-eating (and poor control of diabetes) increased during times of anxiety/stress. Evidence attached to the opinion includes a November 2016 VA treatment record indicating the Veteran binged on sugar and alcohol and August 2017 records showing reports of at least weekly binging on sugar to cope with anxiety and significant social avoidance. The Board notes the conflicting medical opinions of record. Upon review, the Board affords significant probative value to the opinions provided in November 2017 and February 2018. The positive nexus opinions reflect consideration of the relevant facts and medical history and are supported by well-reasoned rationales, relying on and citing to relevant medical literature. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008). Therefore, the evidence is at least in equipoise and, resolving all doubt in the Veteran’s favor, the Board finds his diabetes mellitus, type II, is secondary to his service-connected psychiatric disability. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Accordingly, service connection is warranted for diabetes mellitus, type II. 2. Service connection for hypertension, to include as secondary to service-connected psychiatric disability The Veteran contends he has hypertension secondary to his service-connected psychiatric disability. Initially, VA treatment records reflect a diagnosis of hypertension. The Board finds the record, to include an October 2011 reading of 163/72 and a September 2016 reading of 136/87, supports that the Veteran’s blood pressure was found to be elevated during the appeal period. In addition, August 2015 and April 2016 VA records also note treatment for and a history of hypertension. Thus, a current disability is established for purpose of service connection. With regard to a nexus, the Veteran was afforded a November 2017 VA examination. The report of such shows the examiner concluded the Veteran’s hypertension was at least as likely as not proximately due to or the result of his service-connected psychiatric disability. She stated the severity of the psychiatric disability warranted, by proximity, association with the claimed hypertension. She also indicated the Veteran’s hypertension began subsequent to the psychiatric disability and was the direct result of the antecedent condition. She noted the medical literature supported her conclusion. In addition, the examiner referenced several studies showing veterans with mental health diagnoses had a significantly higher frequency of hypertension and other cardiovascular disease risk factors. Alternatively, the January 2018 VA examiner indicated the Veteran’s hypertension was not related to his psychiatric disability. Despite the medical records cited above, the examiner stated the record contained no medical onset or diagnosis for hypertension, and as a result, he was unable to provide an opinion regarding causality without resorting to mere speculation; therefore, a nexus had not been established. In this case, while there are medical opinions in favor of and against entitlement to service connection, the Board determines the November 2017 VA examination report is the most probative evidence of record with regard to the etiology of the Veteran’s hypertension. In particular, it reflects consideration of the relevant facts and medical history and is supported by well-reasoned rationale, relying on and citing to relevant medical literature. See Nieves-Rodriguez, 22 Vet. App. at 302-304. Therefore, the Board finds the evidence is at least in equipoise and, resolving all doubt in the Veteran’s favor, hypertension is secondary to the Veteran’s service-connected psychiatric disability. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Accordingly, service connection for hypertension is warranted. M. M. Celli Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. Isaacs, Associate Counsel