Citation Nr: 18148761 Decision Date: 11/08/18 Archive Date: 11/08/18 DOCKET NO. 13-04 446 DATE: November 8, 2018 ORDER Entitlement to service connection for diabetes mellitus is granted. Entitlement to service connection for hypertension is granted. FINDINGS OF FACT 1. The evidence is at least in equipoise as to whether the Veteran’s currently diagnosed diabetes mellitus had its onset during service. 2. The evidence is at least in equipoise as to whether the Veteran’s currently diagnosed hypertension had its onset during service. CONCLUSIONS OF LAW 1. The criteria for diabetes mellitus have been met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2017). 2. The criteria for service connection for hypertension have been met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the Army from November 1984 to November 1987. He is a peacetime Veteran. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a September 2009 rating decision of the Department of Veterans Affairs (VA) Atlanta Regional Office (RO) denying the Veteran service connection for his hypertension and diabetes mellitus. The Veteran testified at a hearing at the RO before the undersigned Veterans Law Judge of the Board via video conference (video conference hearing) in May 2015. A transcript of that hearing has been associated with the claims file. In August 2017, the Board requested a medical expert opinion from the Veterans Health Administration (VHA) pursuant to 38 U.S.C. § 5107(a) (2012) and 38 C.F.R. § 20.901 (2017). That requested medical opinions were rendered in May 2018. The Board notes that the Veterans Law Judge who conducted the May 2015 hearing has retired and is no longer employed by the Board. The Veteran was informed that the Veterans Law Judge who conducted the May 2015 was no longer employed by the Board and offered the opportunity for a new hearing in a June 2018 letter. The Veteran was notified that he had 30 days to respond, if no response was received the Board would assume the Veteran declined a new hearing and requested that the Board consider his case on the evidence of record. Therefore, the Board may proceed with its decision. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff’d, 78 F.3d 604 (Fed. Cir. 1996). Service connection for diabetes mellitus and hypertension. The Veteran contends that his diabetes mellitus and hypertension had their onset during service. During his May 2015 Board hearing, the Veteran testified that he was diagnosed with hypertension in 1989 or 1990, that he experienced hypertension symptoms during service and that such symptoms included blurred vision, numbness, swelling, difficulty sleeping. Service treatment records do not indicate any abnormal blood readings or diabetes. Outpatient records show that the Veteran has had high blood pressure and is on medication. See Medical Treatment Record, May 31, 2012. In an October 2012 VA examination report, a VA examiner opined that it was less likely than not (less than 50 percent probability) that the Veteran’s hypertension and/or diabetes mellitus were proximately due to or the result of the Veteran’s service connected condition. The VA examiner reasoned that a cause and effect relationship between the onset of hypertension and/or diabetes mellitus and the prevention of regular mobility and the ability to exercise has not been established to date by the preponderance of the medical literature. An opinion as to direct service connection was not provided. However, this opinion did not address the Veteran’s contention that his diabetes mellitus and hypertension had their onset during service. In a December 2015 VA addendum opinion, a VA examiner opined that the claimed diabetes mellitus and/or hypertension were less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event or illness. The examiner reasoned that there was no confirmed diagnosis of hypertension during service and that there was insufficient evidence in the file to support the Veteran’s reports that he had headaches, thirst, fatigue, and blurred vision in service. The examiner noted that the service treatment records revealed 20/20 vision and no chronic constitutional symptoms and that a nexus has not been established. The examiner also opined that there was no physiological relationship between diabetes and/or hypertension and pes planus and that there can be no aggravation if no relationship exists. However, the examiner did not consider the Veteran’s reports that his symptoms began during service. See, e.g., Dalton v. Nicholson, 21 Vet. App. 23 (2007) (an examination was inadequate where the examiner did not comment on a Veteran’s reports of in-service injury and instead relied on the absence of evidence in a Veteran’s service treatment records to provide a negative opinion). This opinion is therefore afforded little, if any, probative weight. A May 2018 VHA examiner, an endocrinologist, noted that the classic symptoms of type 2 diabetes include thirst, excess urination, excess fluid intake, urinating more at night and infrequently weight loss. She also noted that some patients can have fatigue and blurry vision if the glucose levels are high, that headaches would not be a classic symptom of diabetes, that fatigue is common with a multitude of causes and that the Veteran had reported some symptoms suggestive of diabetes during service. She stated that she did not have any records of other medical conditions that this patient had at the time to be able to determine if his symptoms were caused by another condition or not, that overall his symptoms alone would not be enough to diagnose type 2 diabetes as such a diagnosis would need to be confirmed with blood testing showing elevated glucose levels or elevated HbA1c. She also noted that type 2 diabetes is a progressive disease, that it is often undiagnosed for years and that it was usually asymptomatic. She opined that given the fact that the Veteran was diagnosed with diabetes shortly after service ended, it is possible that he had early diabetes during service that was not diagnosed based on laboratory testing and that it was not unreasonable to assume that he had undiagnosed diabetes during his time in service. A second May 2018 VHA examiner, a nephrologist, noted that hypertension was a disease that is diagnosed by the level of blood pressure, that the diagnosis of hypertension has been changing over the years due to evidence that has proven that lower blood pressures are associated with improved outcomes over time, and that it was not clear whether the Veteran had blood pressure greater than 140/90 at the time he was discharged from service. The physician noted that symptoms of hypertension include headaches, transient weakness or blindness, blurry vision or loss of visual acuity, chest pain, dyspnea and/or claudication. She opined that based on the Veteran’s symptoms of headaches, fatigue and blurred vision during service, he could have had early hypertension during service and that he may not have been diagnosed with hypertension based on the guidelines at that time. She also noted that the Veteran’s symptoms alone without blood pressure readings would not be enough to actually diagnose hypertension. Although these May 2018 VHA opinions contains only a brief rationale, the Board notes that it is prohibited from developing additional evidence for the purpose of obtaining evidence against a claimant’s case. See Mariano v. Principi, 17 Vet. App. 305 (2003). There is no contrary probative opinion of record. The Board also finds that the Veteran has competently and credibly provided lay evidence regarding the onset of symptomatology later associated with his diabetes mellitus and hypertension. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (lay evidence can be competent and sufficient to establish a diagnosis of a condition when lay testimony describing symptoms at the time supports a later diagnosis by a medical professional). In summary, the Board finds that service connection is warranted as the evidence regarding the relationship between the Veteran’s diabetes mellitus, hypertension and service is at least in relative equipoise, and he has competently and credibly provided a lay account of the onset of symptoms associated with these conditions during service. Therefore, the Board resolves all doubt in the Veteran’s favor and finds that service connection for diabetes mellitus and hypertension are warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). KRISTY L. ZADORA Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Iglesias, Law Clerk