Citation Nr: 18161111 Decision Date: 12/28/18 Archive Date: 12/28/18 DOCKET NO. 15-14 502A DATE: December 28, 2018 ORDER Entitlement to service connection for diabetes, type I, is granted. Entitlement to service connection for status-post acute kidney injury, secondary to diabetic ketoacidosis, is granted. FINDINGS OF FACT 1. The Veteran’s diabetes, type I began during a period of active service. 2. The Veteran suffered an acute kidney injury secondary to diabetic ketoacidosis during a period of active service. Although the kidney injury had resolved by the time he was afforded a VA examination, the injury occurred within 2 months of his filing a claim for service connection, and will be considered a “current disability” despite resolution. CONCLUSIONS OF LAW 1. The criteria for service connection for diabetes, type I are met. 38 U.S.C. §§ 1110, 1131, 5107 (2014); 38 C.F.R. §§ 3.102, 3.303 (2018). 2. The criteria for service connection for status-post acute kidney injury secondary to diabetic ketoacidosis are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 2002 to February 2003, from January 2004 to April 2005, from December 2008 to January 2010, and from June to July 2013. He has various other periods of active duty for training and inactive duty for training through the Army National Guard. The Veteran’s awards include the Purple Heart, the Army Commendation Medal, and the Combat Infantry Badge. These matters come before the Board of Veterans’ Appeals (Board) on appeal from an August 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Los Angeles, California. Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). Establishing service connection generally requires competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009). Active military, naval, or air service includes any period of active duty for training (ACDUTRA) during which the individual concerned was disabled from a disease or injury incurred in line of duty. 38 U.S.C. § 101 (21) and (24); 38 C.F.R. § 3.6(a). Active military, naval, or air service also includes any period of inactive duty training (INACDUTRA) duty in which the individual concerned was disabled from injury incurred in the line of duty. Id. 1. Entitlement to service connection for diabetes, type I and status-post acute kidney injury secondary to diabetic ketoacidosis The Veteran has argued that he is entitled to service connection for diabetes because (a) it had onset during a period of active service, and (b) as secondary to his service-connected posttraumatic stress disorder (PTSD). His secondary service-connection claim is based on his belief that his diabetes onset was due to stress, alcohol use, and poor health choices and he stated he had read articles online relating diabetes mellitus to PTSD. The Board finds that the record indicates the Veteran’s diabetes, type I was diagnosed during a period of active duty. The Board, again, notes that the Veteran is not diagnosed with diabetes mellitus, the more common form of diabetes, which is referred to as diabetes, type II. The Veteran’s service treatment records for all periods of his service are currently missing. The United States Court of Appeals for Veteran's Claims (CAVC) has held that in cases where records once in the hands of the government are lost, the Board has a heightened obligation to explain its findings and conclusions and to consider carefully the benefit-of-the-doubt rule. See O'Hare v. Derwinski, 1 Vet. App. 365, 367 (1991). The Veteran filed his claims of entitlement to service connection on August 7, 2013. He also submitted a DD Form 220, Active Duty Report, which noted that his effective date of entry on active duty was June 29, 2013, and that the date he departed from his duty station home was July 19, 2013. His length of tour was recorded as 21 days long. The DD 220 is issued, instead of a DD 214, for short periods of active duty other than annual training. Here, the DD 220 was issued because the Veteran was a member of the National Guard who was mobilized under title 10, reported to a mobilization station, and was found unqualified for active duty. The DD 220 indicated that the Veteran was treated from July 6th to 9th for “Type 1 Diabetes, Acute Kidney Injury” at Fort Bliss SRRC (Soldier Resiliency and Readiness Center). The remarks section noted that the Veteran was identified as medically non-deployable, his travel day was July 19, 2013, and his effective date of REFRAD (temporary medical release from active duty) was July 19, 2013. The accompanying medical evidence included a physician discharge summary which included that the Veteran was hospitalized for two days (July 6th to 8th, 2013) for diabetic ketoacidosis. He was noted to have no known prior medical history and was recently mobilized to Fort Bliss on July 1, 2013 for planned deployment to Afghanistan in August 2013. For the past three weeks, he had endorsed feelings of generalized fatigue, excessive thirst with frequent urination, and unintentional weight-loss. He was recently in Little Rock, Arkansas for army training prior to mobilization at Fort Bliss, where he endorsed difficulty with completing physical tasks in a hot environment. He denied a family history of diabetes. He did not follow regularly with a primary care physician and had been in stable health. Testing revealed high blood glucose, and he was started on Lantus insulin. His sugar levels reached acceptable levels and his anion gap was closed. He was to begin insulin injections three times per day. The Veteran’s service personnel records include an official statement that the Veteran was released from active duty effective July 19, 2013. His available service personnel records do not include the start date of his training prior to mobilization, but do include a service school academic evaluation report that indicated he was in Squad Designated Marksman Course from June 16th to June 28th, 2013. In July 2014, the Veteran was afforded VA diabetes and kidney examinations. He was noted to have diabetes mellitus, type I. He reported his symptom onset, that was later diagnosed as diabetes, as beginning July 5, 2013. He was also noted to be status-post acute kidney injury due to diabetic ketoacidosis, resolved. During the kidney examination, the Veteran reported he was unsure if his kidney dysfunction detected in July 2013 had resolved or not because he had not seen a doctor yet. The examiner provided a positive nexus opinion linking the Veteran’s diabetes and acute kidney injury with his active service and cited the active duty report and the hospitalization report for William Beaumont Army Medical Center in Fort Bliss, Texas. The examiner noted that the Veteran was status-post acute kidney injury due to diabetic ketoacidosis, but that the condition had resolved. “When a patient has a new onset of diabetic ketoacidosis with anion gap metabolic acidosis, most often a patient is severely dehydrated and is found to have concomitant elevation of creatinine with diagnosis of acute kidney injury. Commonly, the acute elevation of creatinine resolves after treatment with IV fluids and insulin.” It was noted that his laboratory results from May 2014 showed normal bun and creatinine levels, which is why the examiner indicated his acute kidney condition had resolved. As shown by the evidence above, the Veteran began to experience symptoms of diabetes within three weeks of his hospitalization on July 6, 2013. He entered active duty on June 29, 2013, one week prior to his hospitalization. However, the hospitalization records noted that he had been in training for mobilization in Little Rock prior to mobilization in Fort Bliss, Texas. Available personnel records indicated he received 142 hours of marksman training from June 6th to June 28th, 2013. Therefore, the Veteran was either on active duty or in ACDUTRA at the time of initial onset of diabetes symptoms. Certainly, whether his symptoms began on active duty or during ACDUTRA, the Veteran had an aggravation of symptoms on July 6, 2013 such that he was hospitalized and initially diagnosed with type I diabetes, diabetic ketoacidosis, and acute kidney injury. Resolving reasonable doubt in the Veteran’s favor, his diabetes, type I began during a period of active duty, and entitlement to service connection is warranted. Regarding the Veteran’s status-post kidney injury, the Board notes that as of the May 2014 VA examination there did not appear to be any residuals of his July 2013 kidney injury. His BUN and creatinine levels had returned to within normal limits. However, the Veteran filed his claim in August 2013, and his acute kidney injury occurred in July 2013. As such, he meets the criteria for a “current disability” as he had the acute kidney injury during the period on appeal, although it has since resolved. A condition that resolved prior to the appeal period or laboratory results consistent with vaccination cannot be considered a disability without any indication that they cause impairment of earning capacity. See Saunders v. Wilkie, 886 F.3d 1356, 1363 (Fed. Cir. 2018). However, when a condition resolves during the appeal period, service connection may be warranted. See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007) (the requirement of having a current disability is met “when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim.”) As such, entitlement to service connection for status-post acute kidney injury is warranted. KRISTI L. GUNN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M.H. Stubbs, Counsel