Citation Nr: 18161330 Decision Date: 12/31/18 Archive Date: 12/31/18 DOCKET NO. 15-43 413 DATE: December 31, 2018 ORDER Entitlement to service connection for diabetes mellitus type II, to include as secondary to Agent Orange exposure is granted. FINDING OF FACT The Veterans diabetes mellitus is presumed to be the result of his exposure to herbicide agents during service. CONCLUSION OF LAW The criteria for entitlement to service connection for diabetes mellitus type II, to include as secondary to Agent Orange exposure have been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1968 to June 1970 and from August 1970 to July 1994. This includes service in the Republic of Vietnam during the Vietnam War, and as such the Veteran is presumed to have had exposure to herbicide agents during his military service. The Veteran filed a claim for service connection in November 2010, arguing that his diabetes mellitus type II is the result of herbicide exposure. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131. The nexus requirement, in pertinent part, can be established through objective medical evidence or the application of statutory presumptions. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.303, 3.307, 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). The Veteran asserts that his diabetes mellitus type II was present prior to pancreatic surgery, and therefore was not caused by the surgery. The Veteran has alternatively suggested that he was at the very least pre-diabetic for years prior to the surgery and his diabetes mellitus would have manifested eventually, regardless of the surgery. In support of this theory, the Veteran’s representative has pointed to several above normal glucose readings of 137 and 130 in June 2007 and February 2010. The Veteran appears to have been first diagnosed with diabetes mellitus in approximately September 2010, following a partial pancreatectomy, and VA medical opinions in December 2011 and March 2012 suggested that the surgery may have caused the diabetes mellitus. Prior to September 2010, the Veteran’s medical records were silent for diagnosis or treatment of diabetes mellitus type II. Medication and monitoring for diabetes mellitus type II did not start until after the Veteran’s 2010 pancreas surgery. In December 2011, a VA examiner stated that the Veteran’s pancreatic surgery was the beginning of his diabetes mellitus. In a March 2012 VA addendum opinion, the examiner opined that the Veteran’s diabetes mellitus type II is at least as likely as not the result of his September 2010 pancreatectomy and not the result of Agent Orange exposure. The examiner noted review of the Veteran’s medical records indicated no evidence that the Veteran had diabetes prior to his pancreas surgery. The examiner also noted that upon hospital admission in September 2010, an endocrinologist consult indicated a new onset of diabetes mellitus type II due to the pancreatectomy. However, the examiner did not specifically address the elevated glucose findings that predated the pancreatectomy. Based on the foregoing, the Board sought a VHA opinion to determine if the Veteran’s diabetes mellitus type II existed prior to, or would have manifested regardless of, the pancreatectomy. The December 2018 VHA clinician found that it was at least as likely as not that the herbicide exposure caused his diabetes. As rationale for the opinion, the clinician stated that it is possible Veteran already had pre-diabetes otherwise known as impaired fasting glucose or impaired glucose tolerance. The clinician found that based on the records available for review, Veteran had some morning mild hyperglycemia with blood glucose > 100 and less than 126 which is consistent with impaired fasting glucose. If the values of 137 measured on 6/26/07 12.05pm and 130 measured on 2/1/10 9.00am were fasting samples, these could be considered diabetes. The endocrinologist explained that to make a diagnosis of diabetes mellitus, elevated fasting blood sugar of 126 or more needs to be repeated and confirmed. Here, two values were drawn close to three years apart hence could not be considered a confirmation of previous elevated value. However, given that the Veteran had other morning labs which also showed impaired fasting glucose range, it was at least as likely that the Veteran had diabetes mellitus before the pancreatic surgery of September 2010. The clinician concluded that the Veteran appeared to already have pre-diabetes before September 2010 when he underwent pancreatic surgery which could have progressed to diabetes mellitus at any time during his lifetime especially in this individual who was obese. The VHA opinion is considered probative and afforded great weight. The opinion is grounded in the Veteran’s complete medical history and relevant medical literature. The opinion also provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). In this case, the preponderance of evidence supports a grant of service connection. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R. I. Sims, Associate Counsel