Citation Nr: 21001140 Decision Date: 01/07/21 Archive Date: 01/07/21 DOCKET NO. 16-62 274 DATE: January 7, 2021 ORDER Entitlement to service connection for impaired glucose tolerance is denied. Entitlement to service connection for constipation is denied. REMANDED Entitlement to service connection for hypertension is remanded. Entitlement to service connection for a cognitive disorder is remanded. Entitlement to service connection for the cause of the Veteran’s death is remanded. Entitlement to special monthly compensation based on the need for aid and attendance or based on being housebound is remanded. FINDINGS OF FACT 1. The Veteran has not been diagnosed with diabetes mellitus, and impaired fasting glucose is not a disability for VA compensation purposes. 2. The preponderance of the evidence is against finding that constipation began during active service, or is otherwise related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for impaired glucose tolerance have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for constipation have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1952 to February 1954. He died in November 2014, and the appellant is his surviving spouse. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2015 rating decision issued by the Department of Veterans Affairs (VA) RO, which in pertinent part, denied the issues on appeal on an accrued basis only. In February 2019, the appellant testified at a hearing before the undersigned Veterans Law Judge (VLJ); a copy of the hearing transcript is of record. In August 2019, the RO recognized the appellant as a properly substituted party for the claims pending at the time of the Veteran’s death. The Board remanded the appeal for further development in September 2019 and June 2020. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). 1. Entitlement to service connection for impaired glucose tolerance is denied. The Veteran sought service connection for impaired glucose tolerance. See March 2014 VA 21-526EZ. The appellant asserts that the Veteran’s service-connected bilateral pes planus and mechanical low back pain with osteoarthritis, associated with bilateral pes planus impacted his mobility to such an extent that he became sedentary, and developed impaired glucose/diabetes mellitus. See February 2019 Board Hearing. The initial question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. Upon review of the evidence, the Board concludes that the Veteran does not have a current disability for VA purposes. Specifically, the Veteran does not have a diagnosis of diabetes mellitus or another disability manifested by impaired glucose tolerance during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Pursuant to the Board’s remand, VA obtained a medical opinion regarding the Veteran’s claims in July 2020. The VA examiner evaluated the Veteran’s treatments record and determined that the objective random glucose, fasting glucose, and hemoglobin A1c values do not support a diagnosis of diabetes. In addition, the Veteran’s VA treatment records from November 2009 outlined the criteria for a diagnosis of diabetes mellitus, as a hemoglobin A1C level of 6.5 percent and noted that the Veteran’s laboratory testing remained below that level. Subsequent VA treatment records also note that he had impaired glucose tolerance as opposed to early diabetes mellitus. See February 2012 VA treatment records. In a February 2014 letter from his VA clinician, the Veteran was noted to have impaired glucose tolerance as opposed to early diabetes mellitus. Collectively, their conclusions are supported by a clear rationale and an accurate review of the evidence of record. Ultimately, the VA examiner and clinicians concluded that the Veteran does not have diabetes mellitus, but instead has impaired glucose tolerance. The Board finds the opinions of the VA clinicians and the VA examiner probative. They are medical professionals with the requisite training and education to evaluate the Veteran’s claimed disability. The Board notes that impaired glucose tolerance is insufficient to establish a disability for the purposes of service connection. Under VA regulations, laboratory results are not a disease upon which VA disability benefits can be based. 61 Fed. Reg. 20440, 20445 (May 7, 1996) (Suppl. Information - Endocrine System). The Court of Appeals for Veterans Claims (Court) has also noted that a diagnosis of impaired glucose is not equivalent to a diagnosis of diabetes mellitus. Waugerman v. Shinseki, No. 08-2685, 2011 WL 337152, at 4 (Vet. App. Feb. 4, 2011) (citing Dorland’s Illustrated Medical Dictionary 1960 (31st ed. 2007) (defining “impaired glucose tolerance” as “a term denoting values of fasting plasma glucose or results of an oral glucose tolerance test that are abnormal but not high enough to be diagnostic of diabetes mellitus.” Therefore, impaired glucose tolerance does not constitute a diagnosis of diabetes mellitus. Instead, impaired glucose tolerance merely refers to abnormal results on laboratory testing. The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C. § 1110. In the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). In this case, the competent and probative evidence does not show a disability during or in proximity to the appeal period. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not for application, and the claim must be denied. See 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). 2. Entitlement to service connection for constipation is denied. The appellant seeks service connection for the Veteran’s constipation. See March 2014 VA 21-526EZ. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran was diagnosed with constipation during the pendency of his appeal, the preponderance of the evidence weighs against finding that a chronic underlying disability, manifested as chronic constipation, began during service or is otherwise related to an in-service injury, event, or disease. Service treatment records are silent for a diagnosis, treatment, or symptoms related to the Veteran’s constipation. In fact, the Veteran’s January 1954 separation examination noted no related abnormality. The examination noted normal abdomen and viscera, and genitourinary system. Post-service, in the May 1981 treatment records, the Veteran was noted to have a small axial esophageal hiatal hernia, without other abnormality seen in the stomach, duodenal cap, or duodenal loop. The Veteran also complained of constipation in October 1984 treatment records. VA treatment records noted constipation. See October 2005 VA treatment records. In the February 2014 letter from his treating VA clinician, the Veteran was noted to have constipation among his medical conditions. Service connection is not warranted in this case. To the extent the Veteran reported constipation symptoms, he was competent to do so. However, the service treatment records are negative for a chronic underlying disability, manifested as chronic constipation. The claims file otherwise contains no competent opinions that diagnose a chronic underlying disability, manifested as chronic constipation, and link such a disability to his military service. In sum, the preponderance of the probative evidence weighs against the claim. Accordingly, the benefit of the doubt doctrine does not apply. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). Service connection is not warranted. REASONS FOR REMAND 1. Entitlement to service connection for hypertension is remanded. The Board previously remanded the claims for VA to obtain a medical opinion. An opinion was obtained in July 2020. The examiner opined that the Veteran’s service-connected pes planus and mechanical low back pain with osteoarthritis disabilities less likely than not caused or aggravated his hypertension. Regarding proximate causation, the examiner reasoned that the Veteran did not suffer obesity-promoting impairment of activities until his 1988 work-related back injury. The examiner did not, however, provide a rationale for (or explain the clinical significance of the noted timeline) as it relates to whether there was aggravation by service-connected pes planus and back disabilities. [Obesity may be an intermediate step between a service-connected disability and a current disability that may be connected on a secondary basis. VAOPGCPREC 1-2017 (January 6, 2017). This not only applies when a service-connected disability causes obesity, but also when a service-connected disability aggravates obesity. When raised by the record, the Board must consider whether obesity was caused or aggravated by a service-connected disability, consistent with 38 C.F.R. § 3.310.] Moreover, the Board notes that part of the examiner’s rationale was that there was not clinical evidence of obesity until 2014, at which point the Veteran weighed 230 pounds. However, the treatment records reveal that the Veteran’s obesity likely predated 2014. As early as May 2006, the Veteran was noted to weigh 244 pounds. VA treatment records dated in June 2008 note obesity and records in July 2009 reflect a weight of 244 pounds; February 2012 a weight of 242.2 pounds. The rationale provided in the July 2020 opinion does not adequately allow the Board to make a fully informed decision on the question of aggravation and a further addendum opinion is needed. 2. Entitlement to service connection for a cognitive disorder is remanded. The July 2020 examiner also indicated that the Veteran’s cognitive disorder is less likely than not to have been caused by his military service or aggravated beyond its normal course by his service-connected disabilities of pes planus or mechanical low back pain with osteoarthritis. Regarding proximate causation, the examiner reasoned that the Veteran’s Alzheimer’s disorder is of unknown cause and his Korsakoff disorder is caused by alcohol use disorder. The rationale did not sufficiently explain the aggravation prong of secondary service connection. As such, a remand is warranted for an addendum opinion as to this portion of the claim. 3. Entitlement to service connection for the cause of the Veteran’s death is remanded. 4. Entitlement to special monthly compensation based on the need for aid and attendance or based on being housebound is remanded. The issue of service connection for the Veteran’s cause of death and special monthly compensation based on aid and attendance of another is inextricably intertwined with the pending claim of service connection for dementia that is being remanded. The matters are REMANDED for the following action: Obtain an opinion from an appropriate clinician regarding the nature and etiology of the Veteran’s claimed conditions of hypertension and cognitive disorder (dementia). The examiner should review the claims file and a copy of this Remand. a) The examiner should opine as to whether the Veteran’s claimed disability of cognitive disorder (dementia) was at least as likely as not (i.e., a 50 percent or greater probability) aggravated by (worsened beyond the condition’s natural progression) the Veteran’s service-connected bilateral pes planus and/or mechanical low back pain with osteoarthritis. b) The examiner should also opine as to whether the Veteran’s claimed disability of hypertension was at least as likely as not (i.e., a 50 percent or greater probability) aggravated by (worsened beyond the condition’s natural progression) his service-connected bilateral pes planus and/or mechanical low back pain with osteoarthritis. In doing so, the examiner should address the following: (i) Is it at least as likely as not that the service-connected disabilities of pes planus and mechanical low back pain with osteoarthritis, either alone or in combination, caused the Veteran to become obese or aggravated the Veteran’s obesity? (ii) If obesity was either caused or aggravated a result of either the service-connected pes planus and mechanical low back pain, is it at least as likely as not that the obesity or aggravation of obesity was a substantial factor in causing the Veteran’s hypertension? (iii) If obesity or aggravation of obesity was a result of either the service-connected pes planus and mechanical low back pain (alone or in combination), is it at least as likely as not that the Veteran’s hypertension would not have occurred but for such obesity? c) If the Veteran’s hypertension is found to be service-connected, the examiner should opine as to whether it was at least as likely as not caused or aggravated his cognitive disorder (dementia). A complete rationale for all of the requested opinions should be provided. If the examiner feels that the requested opinions cannot be rendered without resorting to speculation, he or she must explain why this is so. D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Vuong, 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.