Citation Nr: 21000046 Decision Date: 01/04/21 Archive Date: 01/04/21 DOCKET NO. 15-21 222 DATE: January 4, 2021 ORDER Service connection for diabetes mellitus, type II, is denied. FINDING OF FACT Diabetes mellitus, type II, is not shown to be causally or etiologically related to any disease, injury, or incident during service and did not manifest to a compensable degree within one year of separation from service. CONCLUSION OF LAW The criteria for service connection for diabetes mellitus, type II, have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1131, 1137, 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 July 1979 to July 2005. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued in October 2013 by a Department of Veterans Affairs (VA) Regional Office. In January 2018, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. In October 2018, the Board remanded the instant claim, as well as a claim for service connection for sleep apnea, for additional development. While on remand, a January 2020 rating decision awarded service connection for obstructive sleep apnea. As such claim has been granted in full, it is no longer before the Board. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997). The remaining claim now returns for further appellate review. The Board notes that, since the issuance of the supplemental statement of the case in January 2020, additional evidence consisting of updated VA treatment records has been associated with the record. While the Veteran has not waived Agency of Original Jurisdiction (AOJ) consideration of such evidence, there is no prejudice to him in the Board proceeding with a decision at the present time because such newly received evidence is irrelevant to the issue on appeal or contain findings duplicative to those previously considered by the AOJ. 38 C.F.R. § 20.1305(c). Entitlement to service connection for diabetes mellitus, type II. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff’d, 78 F.3d 604 (Fed. Cir. 1996) [(table)]. Where a veteran served for at least 90 days during a period of war or after December 31, 1946, and manifests certain chronic diseases, such as diabetes mellitus, to a degree of 10 percent within one year, from the date of termination of such service, such disease shall be presumed to have been incurred or aggravated in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1137; 38 C.F.R. §§ 3.307, 3.309. Alternatively, when a disease at 38 C.F.R. § 3.309(a) is not shown to be chronic during service or the one year presumptive period, service connection may also be established by showing continuity of symptomatology after service. 38 C.F.R. § 3.303(b). However, the use of continuity of symptoms to establish service connection is limited only to those diseases listed at 38 C.F.R. § 3.309(a) and does not apply to other disabilities which might be considered chronic from a medical standpoint. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). 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). The Veteran contends that he developed diabetes mellitus, type II, during service as evidenced by high glucose readings and symptoms of erectile dysfunction and groin itching, and/or as a result of exposure to pharmaceutical chemicals such as acetone, acids, and powders while serving as a pharmacy specialist. In this regard, while the Veteran’s service treatment records are negative for any complaints, treatment, or diagnosis referable to erectile dysfunction, such reflect treatment on numerous occasions for a rash that was assessed as tinea cruris and urticaria in 1989 and 1990, and treatment for jock itch in August 1992. Also, in September 1993, the Veteran’s glucose was elevated at 112 mg/dL. Additional testing done during service reflect that his glucose was negative and/or within the normal range, but on the higher end, to include 105 mg/dL at his December 2004 retirement examination. The Veteran’s service personnel records reflect his military occupational specialty as a pharmacy specialist. Further, post-service treatment records reflect a diagnosis of glucose intolerance in November 2006 and diabetes mellitus, type II, in December 2012. In light of the foregoing, the Board remanded the case in October 2018 in order to afford the Veteran a VA examination so as to determine the nature and etiology of his diabetes mellitus, type II. Thereafter, in October 2019, following a review of the record, interview with the Veteran, and physical examination, a VA examiner opined that his diabetes mellitus, type II, was less likely than not incurred in or caused by any instance of his military service, to include elevated glucose readings and/or exposure to pharmaceutical chemicals such as acetone, acids, and powders consistent with his duties as a pharmacy specialist, and did not manifest within a year of his separation from service. In this regard, she noted that, while the Veteran had glucose readings of 112 and 105 mg/dL in service, which were above normal range, such did not meet the diagnostic standard for diabetes, i.e., 126 mg/dL fasting. Furthermore, there was no established connection between acetones, acids, and powders and the development of diabetes mellitus, type II. The examiner also indicated that the Veteran’s in-service tinea cruris, urticaria, and jock itch were not conclusive signs of diabetes. In this regard, she stated that, while diabetics are more prone to fungal infections, such also occurs very frequency in healthy individuals and is certainly not a conclusive sign of diabetes. Finally, the examiner observed that the Veteran’s diagnosis of glucose intolerance, which is not strictly diabetes mellitus, type II, was in November 2006, approximately 16 months after separation. The Board affords great probative weight to the October 2019 VA examiner’s opinions as such considered all of the pertinent evidence of record, to include the statements of the Veteran and relevant medical history, and provided a complete rationale, relying on and citing to the records reviewed. Moreover, the examiner offered clear conclusions with supporting data as well as reasoned medical explanations connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (“[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions”). Notably, there is no medical opinion to the contrary. The Board also considered the Veteran’s assertions as to the etiology of his diabetes mellitus, type II; however, as a lay person, he does not have the requisite training and experience necessary to address such a complex medical matter. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). In this regard, the etiology of such disorder involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship and, thus, may not be competently addressed by lay statements. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (explaining that while the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). Moreover, whether the symptoms the Veteran reportedly experienced during or after service are in any way related to his currently diagnosed diabetes mellitus, type II, is a matter that also requires medical expertise to determine. See Clyburn v. West, 12 Vet. App. 296, 301 (1999) (“although the veteran is competent to testify to the pain he has experienced since his tour in the Persian Gulf, he is not competent to testify to the fact that what he experienced in service and since service is the same condition he is currently diagnosed with.”). Accordingly, the Veteran’s opinion as to the onset and etiology of his diabetes mellitus, type II, is not competent evidence and, consequently, is afforded no probative weight. Therefore, the Board finds diabetes mellitus, type II, is not shown to be causally or etiologically related to any disease, injury, or incident during service and did not manifest to a compensable degree within one year of separation from service. Thus, service connection for such disorder is not warranted. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not applicable and such claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra. A. JAEGER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. M. Kelly, 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.