Citation Nr: 21001203 Decision Date: 01/07/21 Archive Date: 01/07/21 DOCKET NO. 20-04 632 DATE: January 7, 2021 ORDER Entitlement to service connection for hypertension secondary to service-connected diabetes mellitus type II is granted. Entitlement to service connection for gastritis secondary to service-connected diabetes mellitus type II is granted. FINDINGS OF FACT 1. Resolving the benefit of the doubt in favor of the Veteran, his hypertension is caused by his service-connected diabetes mellitus type II. 2. Resolving the benefit of the doubt in favor of the Veteran, his gastritis is caused by his service-connected diabetes mellitus type II. CONCLUSIONS OF LAW 1. The criteria for service connection for hypertension, as caused by his service-connected diabetes mellitus type II, have been satisfied. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310. 2. The criteria for service connection for gastritis, as caused by his service-connected diabetes mellitus type II, have been satisfied. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran has verified service on active duty from September 1962 to May 1966 and on Active Duty for Training (ADT) from August 1972 to June 1973, including service in the Republic of Vietnam. As a result of his military service, the Veteran received the Combat Infantryman Badge, among other decorations. This matter comes before the Board of Veterans’ Appeals (Board) from a May 2017 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). Service Connection Generally, to establish service connection, a claimant must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the so-called “nexus” requirement. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). A disability that is proximately due to, the result of, or aggravated by a service-connected disease or injury shall be service connected. 38 C.F.R. § 3.310. Service connection may additionally be granted for disability resulting from injury incurred in or aggravated while performing ADT or inactive duty for training (IADT) or a disease incurred or aggravated while performing ADT. 38 U.S.C. §§ 101(24), 106. 1. Hypertension. The Veteran contends that his hypertension is secondary to his service-connected diabetes mellitus type II. In November 2016, the Veteran submitted a private medical opinion from Dr. T.A. The physician stated that there is a strong correlation between the development of high blood pressure in patients with diabetes mellitus type II. The physician was very confident that the Veteran’s hypertension had occurred due to his diabetes mellitus type II. The Veteran underwent a VA examination in February 2017 where the examiner opined that it was less likely than not that the Veteran’s hypertension is secondary to his diabetes mellitus type II. The examiner believes there is neither evidence in the medical literature, consensus in the medical community, or evidence in this specific case that supports a causal/aggravation relationship between these conditions unless there is abnormal kidney function, which is not present here. Finally, in June 2017, the Veteran submitted a second private medical opinion from Dr. T.A. The physician opined it is more likely than not that his diabetes mellitus type II has caused his hypertension. The physician explained that diabetes mellitus type II damages arteries causing atherosclerotic cardiovascular disease, which can cause hypertension and its concomitant morbidities. Resolving the benefit of the doubt in favor of the Veteran, the Board finds that the evidence demonstrates that his hypertension is caused by his diabetes mellitus type II. Although the VA examiner opined that there is no medical evidence to link the Veteran’s hypertension to his diabetes mellitus type II, the private examiner provided opinions that diabetes mellitus type II can cause hypertension. Specifically, in February 2017 Dr. T.A. explained that diabetes mellitus type II damages the arteries causing atherosclerotic cardiovascular disease which can cause hypertension. Overall, the evidence demonstrates that the Veteran’s diabetes mellitus type II has caused his hypertension, and as such, service connection is warranted. 2. Gastrointestinal disability. The Veteran contends that his gastrointestinal condition is secondary to his service-connected diabetes mellitus type II. In October 2012, Dr. L.M. opined that it is more likely than not that the Veteran’s diabetes mellitus type II caused his gastroparesis. However, no rationale was provided for this opinion. A VA examiner in February 2013 determined that based on recent diagnostic testing the Veteran did not actually have gastroparesis. Subsequently, a February 2016 esophagogastroduodenoscopy showed gastritis but did not mention gastroparesis. In June 2017, the Veteran submitted a private opinion from Dr. T.A. The physician opined that it is more likely than not that his diabetes mellitus type II has caused his gastritis. According to Dr. T.A., diabetes mellitus type II damages arteries causing atherosclerotic cardiovascular disease. This can cause hypertension and its concomitant morbidities, and if not appropriately treated this can lead to vascular damage, myocardial infarction, autonomic nerve disorders including gastroparesis and chronic renal insufficiency and failure. Finally, in December 2019, a VA examiner opined that the Veteran’s chronic gastritis is less likely as not due to his diabetes mellitus type II. According to the examiner, there is no nexus between having diabetes mellitus type II and the development of gastritis. Diabetes mellitus type II is not found as an etiology or risk factor in UP TO DATE (a medical website). Resolving the benefit of the doubt in favor of the Veteran, the Board finds that the evidence demonstrates that his gastritis was caused by his diabetes mellitus type II. The VA examiner and Dr. T.A. appear to have reviewed the pertinent evidence and come to opposite conclusions, with Dr. T.A. describing a process where the Veteran’s diabetes mellitus could cause gastritis and the VA examiner citing a lack of support for the general theory in medical literature. The Board has no reason to favor one interpretation over the other. As such, reasonable doubt is resolved in the Veteran’s favor. Overall, the evidence demonstrates that the Veteran’s diabetes mellitus type II has caused his gastrointestinal condition, and as such, service connection is warranted. Nathan Kroes Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Hofmeister, Attorney Advisor 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.