Citation Nr: 20046675 Decision Date: 07/13/20 Archive Date: 07/13/20 DOCKET NO. 11-30 649 DATE: July 13, 2020 ORDER Entitlement to service connection for diabetes mellitus, type II, is granted. FINDING OF FACT The preponderance of the evidence indicates that the Veteran’s diabetes mellitus, type II, was incurred in, or is otherwise related to, his active duty military service. CONCLUSION OF LAW The criteria for entitlement to service connection for diabetes mellitus, type II, have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from February 1973 to February 1975 and in the United States Navy from March 1977 to March 1979 and December 1981 to December 1983. Procedurally, this matter was previously before the Board of Veterans’ Appeals (Board) in June 2016, at which time the Board remanded the claim of entitlement to service connection for diabetes mellitus, type II, to the agency of original jurisdiction (AOJ) in order to further develop the claim by affording the Veteran a VA medical examination and by obtaining outstanding medical records. The case was returned to the Board in June 2018, at which time the Board denied entitlement to service connection for diabetes mellitus, type II. The Veteran appealed the decision to the United States Court of Appeals for Veterans Claims (Court). In January 2020, the Court found that the Board erred by failing to address the Veteran’s assertion of a continuity of symptomatology of diabetes mellitus since service, as well as whether the Veteran’s diabetes mellitus was caused or aggravated by his service-connected hypertension; and the Court has remanded the claim to the Board for readjudication with the provision of adequate reasons and bases. For the reasons stated below, the Board finds that the evidence of record warrants a grant of service connection for diabetes mellitus, type II. Entitlement to service connection for diabetes mellitus, type II Service connection is warranted if it is shown that a veteran has a disability resulting from an injury incurred or a disease contracted in active duty service or for aggravation of a pre-existing injury or disease in active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Establishing direct service connection generally requires competent evidence of: (1) a current disability; (2) an 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. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Alternatively, a veteran can receive compensation via secondary service connection, which can be established when a disability is shown to be proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310. To be awarded secondary service connection, there must be evidence sufficient to show: (1) that a current disability exists; and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. Id.; Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Here, the Veteran asserts that his diabetes mellitus, type II, had its onset in service, is otherwise related to his military service, and/or that the disorder was caused by or aggravated by his service-connected hypertension. As an initial matter, the Board notes that the Veteran has a current disability of diabetes mellitus, type II. See, e.g., medical treatment records dated February 21, 2000. The record reflects that the Veteran has submitted medical articles explaining the symptoms of diabetes mellitus and related conditions, how blood and urine glucose testing is performed and how the results of such testing are yielded, and the association between hypertension and diabetes mellitus. The Board expresses its gratitude to the Veteran for undertaking the effort to procure helpful information pertaining to the medical principles inherent in an informed understanding of his claim. Although the Veteran’s service treatment records do not document an in-service diagnosis of diabetes mellitus, there are multiple references to the Veteran’s having experienced various symptoms of diabetes mellitus and other medical complications related to diabetes mellitus, including information which suggests that the Veteran experienced increased blood and urine glucose levels as well as hypoglycemia. See, e.g., service treatment records dated August 19, 1983. Turning to the Veteran’s post-service medical treatment records, the Board notes that the record contains multiple medical opinions addressing whether it is at least as likely as not that the Veteran’s diabetes mellitus, type II, was incurred in service, is otherwise related to his military service, or was caused or aggravated by his service-connected hypertension. In an August 2016 opinion, a family medicine physician concluded that the Veteran’s diabetes mellitus “more likely [than not]” had its onset during his active duty service. See medical opinion dated August 17, 2016. She additionally determined that the Veteran’s diabetes was at least as likely as not permanently aggravated by his service-connected hypertension. See id. Notably, the physician had reviewed the Veteran’s current and past medical treatment records, including his medication lists, before rendering her opinion as to the origin of the Veteran’s disorder. The Veteran was afforded a VA examination for his diabetes mellitus, type II, in March 2017. Following a physical evaluation of the Veteran, a clinician opined that the Veteran’s diabetes mellitus was less likely than not incurred in or caused by an in-service injury, event, or illness, reasoning that a review of the Veteran’s service treatment records did not reveal multiple readings of high blood sugar levels and that the Veteran did not report other symptoms indicative of diabetes mellitus. See VA examination dated March 22, 2017. Furthermore, the clinician reported that none of the Veteran’s other medical conditions at least as likely as not caused or permanently aggravated his diabetes mellitus. See medical opinion dated March 22, 2107. The record also contains a May 2017 medical opinion from a VA physician, who determined that the Veteran’s diabetes at least as likely as not manifested in and/or resulted from his active duty military service. See medical opinion dated May 9, 2017. Finally, in a medical opinion from June 2020, a physician furnished an explanation as to how diabetes mellitus develops over a period of time, noting that the Veteran’s service treatment records indicated that he experienced pre-diabetes or impaired glucose tolerance during his military service and that the condition eventually led to his diabetes mellitus, type II. The opinion was well-reasoned and explained the underlying medical principles involved in the development of diabetes, and moreover, was based on a review of the Veteran’s claims file and supporting documentation. As such, the Board finds the opinion to be especially probative in the matter at hand. Thus, in light of the foregoing, the Board finds that the preponderance of the evidence demonstrates that the Veteran’s diabetes mellitus had its onset during, or is otherwise related to, his military service. Accordingly, entitlement to service connection for diabetes mellitus, type II, is warranted. ANTHONY C. SCIRÉ, JR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board G. Tolbert, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.