Citation Nr: 20046857 Decision Date: 07/13/20 Archive Date: 07/13/20 DOCKET NO. 14-31 424 DATE: July 13, 2020 ORDER Service connection for diabetes mellitus, type II is denied. FINDING OF FACT The preponderance of the evidence is against a finding that the Veteran’s diabetes had onset in service or within one year of discharge; and the Veteran’s diabetes is not shown to be causally or etiologically related to any disease, injury, or incident in service, or a service connected disability. CONCLUSION OF LAW The criteria for service connection for diabetes mellitus, type II, have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty with the United States Army from August 1989 to September 1992. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2011 rating decision of the Department of Veterans’ Affairs (VA) Regional Office (RO). This matter was previously remanded in a November 2018 Board decision. Service connection for diabetes mellitus, type II Factual Background The Veteran’s VAMC treatment records document a diagnosis for and ongoing treatment for diabetes mellitus, type II throughout the appeal period. In July and October 2013 correspondences the Veteran’s representative posited a link between psychiatric disorders and the development of diabetes with citation to a quote by the American Diabetes Association. In a November 2018 Board decision, a VA examination was mandated to determine the nature and cause of the Veteran’s diabetes mellitus, type II, to include a causal relationship with his service-connected psychiatric disability. An in-person VA examination was performed in September 2019. The Veteran reported being diagnosed with diabetes mellitus in 2004. With respect to whether the Veteran’s diabetes mellitus, type II is directly related to his service, the examiner opined that it is less likely than not (less than 50% probability) causally related to his service. The examiner explained that a review of the medical evidence of record was insufficient for a diagnosis during service or within 12 years of service. Further there was no evidence tending to support a medical nexus between diabetes mellitus, type II and the Veteran’s service. With respect to whether the Veteran’s diabetes mellitus, type II is proximately due to or the result of the Veteran’s service-connected psychiatric disability, the examiner opined that it was less likely than not (less than 50% probability). The examiner addressed the contention that there is not a correlation between psychiatric disabilities and an increased likelihood of contracting diabetes emphasizing that it is based on speculation only and “cannot be supported by a physiological relationship.” The examiner continued, “Diabetes is caused by an impaired exocrine function of the pancreas resulting in none-to-reduced release of the hormone, insulin. A mental illness does not have a direct cause-effect relationship with diabetes. A nexus has not been established. Therefore, it is less likely than not that the claimed condition has secondary service connection.” Regarding aggravation, the examiner found there to be insufficient evidence to establish a baseline level of severity for the Veteran’s diabetes mellitus, type II. The examiner also found it to be less likely than not that the Veteran’s diabetes mellitus, type II was aggravated beyond its natural progression by his service-connected psychiatric disability. The rationale being that “there has been no emergency room visits, hospital admissions, diabetic ulcer, amputation, etc. within the last 12 months to support aggravation. A nexus has not been established. Therefore, it is less likely than not that the claimed condition was aggravated by his service-connected PTSD.” Analysis At the outset, the Board finds that the medical evidence of record does not demonstrate that the Veteran’s diabetes mellitus, type II had its onset during service or within one year following discharge from service. Accordingly, service connection cannot be established for diabetes mellitus, type II on a presumptive basis. 38 U.S.C. § 1112; 38 C.F.R. §§ 3.307, 3.309. With respect to a direct service connection theory of entitlement, neither the Veteran or his representative have put forth arguments or contentions that the Veteran’s diabetes mellitus, type II is related to an in-service event, injury or illness. The Board finds the September 2019 VA examiner’s negative nexus opinion to be the most probative evidence of record regarding this theory of entitlement. Consequently, service connection is not warranted on a direct basis. Regarding whether the Veteran’s diabetes mellitus, type II is proximately due to or the result, or was aggravated beyond its natural progression by the Veteran’s service-connected psychiatric disability, the Board finds that the competent medical evidence of record weighs against granting service connection under these theories of entitlement. First, concerning the quotation from the American Diabetes Association cited to in the July 2013 statement, the U.S. Court of Appeals for Veterans Claims (Court) has held that “generally, an attempt to establish a medical nexus to a disease or injury solely by generic information in a medical journal or treatise is too general and inconclusive.” Mattern v. West, 12 Vet. App. 222, 228 (1999) (citing Sacks v. West, 11 Vet. App. 314, 317 (1998)). Medical treatise evidence may indicate enough of a basis of a generic relationship to establish “a plausible causality based on objective facts.” Mattern, 12 Vet. App. at 228 (citing Wallin v. West, 11 Vet. App. 509, 514 (1998)). However, in this case, the opinion of a competent medical professional who is providing an opinion concerning a specific Veteran based on the evidence of record outweighs any general findings in medical literature. Ultimately, the Board finds the opinion of the September 2019 VA examiner to be highly persuasive and probative. The examiners’ findings were based on a review of the evidence, including the service treatment records and examination, which did not substantiate a finding that the Veteran developed diabetes mellitus, type II directly caused by service or any incident of service, nor was this condition aggravated beyond its natural progression due to a service-connected psychiatric disability. The examiners considered the complete record and the Veteran’s contentions and provided an explanation as to why the evidence does not support a finding that his diabetes is due to service or a service-connected disability. Additionally, the VA examiners provided reasoning that is supported by the record. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302 -04 (2008) (holding that it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion). Accordingly, the opinions are of significant probative value. Although the Veteran believes that he developed diabetes mellitus, type II secondary to his service-connected psychiatric disability, and he is certainly competent to report as to the observable symptoms he experiences and their history, neither he or nor his representative are competent to provide a medical opinion in this case. The record does not reflect that either have the requisite training or expertise to offer a medical opinion linking a complex medical disability to another service-connected disability and therefore are not competent to provide an opinion in this case. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007) (lay persons not competent to diagnose cancer). The ultimate questions in this case are related to an internal medical process which extends beyond an immediately observable cause and effect relationship. Id. In summary, the most probative and persuasive evidence is against a finding that the Veteran’s diabetes mellitus, type II is due to service; or is proximately due to or aggravated by a service-connected psychiatric disability. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the claim. As such, that doctrine is not applicable in the instant appeal, and the claim must be denied. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 49, 55-56. Jennifer White Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Kyle McKone 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.