Citation Nr: 20051058 Decision Date: 07/31/20 Archive Date: 07/31/20 DOCKET NO. 15-14 055 DATE: July 31, 2020 ORDER Entitlement to service connection for diabetes mellitus, type II is denied. FINDING OF FACT The Veteran’s diabetes mellitus was not incurred in or caused by active service and was not otherwise etiologically related to active service. CONCLUSION OF LAW The criteria for service connection for diabetes mellitus have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 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 November 1985 to November 2005. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a September 2011 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). This matter was remanded by the Board in July 2018 for further development. Specifically, the Board found that the Veteran was entitled to a VA examination to determine the etiology of the Veteran’s diabetes. VA provided the Veteran with an adequate VA examination and thus the Board finds that there has been substantial compliance with the July 2018 remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). The case is now properly before the Board for adjudication. 1. Entitlement to service connection for diabetes mellitus, type II The law provides that service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.304. In addition, certain chronic diseases may be presumed to have been incurred during service if the disorder becomes manifest to a compensable degree within one year of separation from active duty. 38 U.S.C. §§ 1101, 1112, 1113, 1131; 38 C.F.R. §§ 3.307, 3.309. Service connection may be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Medical evidence is required to demonstrate a relationship between a current disability and the continuity of symptomatology demonstrated if the condition is not one where a lay person’s observations would be competent. Clyburn v. West, 12 Vet. App. 296 (1999). Continuity of symptomatology may be established if a claimant can demonstrate (1) that a condition was noted during service; (2) evidence of post-service continuity of the same symptomatology and (3) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology. Evidence of a chronic condition must be medical, unless it relates to a condition to which lay observation is competent. Savage v. Gober, 10 Vet. App. 488 (1997). The Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. Masors v. Derwinski, 2 Vet. App. 181 (1992); Wilson v. Derwinski, 2 Vet. App. 614 (1992); Hatlestad v. Derwinski, 1 Vet. App. 164 (1991); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value. The Veteran contends that his diabetes originated during service. Specifically, that he had multiple elevated blood sugar levels throughout service, and this was a sign that his diabetes began in service. The Veteran admitted that he was not diagnosed with diabetes until 2009. Service treatment records (STRs) are silent for any complaints, treatment, or diagnoses related to diabetes, including his separation examination. The Veteran had blood sugar readings various times and showed these results: in March 2005 the tests reflected 104 and in June 2005 at 100. Records reflected that a normal range for blood sugar level readings are between 70 to 110. Moreover, in June 2005, the Veteran’s records reflect that the glucose tests came out negative and that he reported that he did not have high or low blood sugar. Post-service medical treatment records note elevated blood sugar levels in 2006 and a diagnosis in September 2009. The record reflects that between October 2006 and July 2009, the examiner reported that the Veteran did not have a diabetes mellitus diagnosis history. The record further reflects that the Veteran was diagnosed with diabetes in September 2009 when he was admitted to the hospital. He was prescribed oral medication and has been able to keep his blood sugar levels under control. In the July 2019 VA examination, the examiner noted that the Veteran had controlled his diabetes with oral medication. The examiner further noted that the Veteran visits his diabetic care provider for episodes of ketoacidosis and hypoglycemia less than two times per month. The Veteran has had zero episodes of ketoacidosis and of hypoglycemia that required hospitalization in the past year. The Veteran did not exhibit progressive unintentional weight loss or loss of strength attributable to his diabetes. The examiner opined that the Veteran’s diabetes did not impact his ability to work. The examiner further opined that the Veteran’s diabetes was less likely than not incurred in or caused by service since after reviewing all available medical records, applicable medical literature, and conducted a thorough clinical examination there was no indication that the Veteran met the diagnostic criteria for diabetes until 2009, which was four years after he left service. After review of the evidence, the Board finds that the preponderance of the evidence is against a finding that diabetes mellitus was related to the Veteran’s period of active service. There is no evidence that diabetes was present during the Veteran’s period of active duty or manifested to a compensable degree within one year of separation. See 38 C.F.R. §§ 3.307, 3.309(a). The earliest medical evidence indicating the presence of diabetes is many years after the Veteran’s separation from service. The Board notes that, although not a dispositive factor, the passage of time between the Veteran’s discharge and an initial diagnosis for the claimed disorder is one factor that weighs against the claim. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). Moreover, the record does not contain any medical opinion indicating that the Veteran’s diabetes was incurred in or otherwise related to active service, and there is no competent medical or lay evidence demonstrating continuity of symptoms since service. (Continued on the next page)   The Board notes that while the Veteran is competent to report observable symptoms, neither is shown to possess the medical training necessary to establish a current disability or render competent opinions about the etiology of a disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F. 3d 1331 (Fed. Cir. 2006). Based on the foregoing, the Board finds that the preponderance of the competent and credible evidence is against a grant of service connection for diabetes mellitus. In reaching this conclusion, the Board has considered the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable, and service connection must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Thomas H. O'Shay Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Imam, 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.