Citation Nr: 21004187 Decision Date: 01/26/21 Archive Date: 01/26/21 DOCKET NO. 14-39 890 DATE: January 26, 2021 ORDER Entitlement to service connection for diabetes is denied. Entitlement to service connection for erectile dysfunction, to include as secondary to diabetes mellitus, is denied. Entitlement to service connection for residuals of stroke, to include as secondary to diabetes mellitus, is denied. Entitlement to service connection for hypertension, to include as secondary to diabetes mellitus, is denied. Entitlement to service connection for cataracts, to include as secondary to diabetes mellitus and hypertension, is denied. FINDINGS OF FACT 1. The Veteran’s diabetes is not etiologically related to his service, to include caused or aggravated by residuals of cold injury. 2. The Veteran’s erectile dysfunction is not related to service, nor has it been shown to be secondary to a service-connected disability. 3. The Veteran’s residuals of stroke are not related to service, nor has it been shown to be secondary to a service-connected disability. 4. The Veteran’s hypertension is not related to service, nor has it been shown to be secondary to a service-connected disability. 5. The Veteran’s cataracts are not related to service, nor has it been shown to be secondary to a service-connected disability. CONCLUSIONS OF LAW 1. The criteria for service connection for diabetes have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307. 2. The criteria for service connection for erectile dysfunction have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 3. The criteria for service connection for residuals of stroke have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 4. The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 5. The criteria for service connection for cataracts have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from January 1951 to October 1952. These matters come before the Board of Veterans’ Appeals (Board) on appeal from February 2012 and December 2013 rating decisions by a Department of Veterans Affairs (VA) Regional Office (RO) in Little Rock, Arkansas. In April 2018, the Veteran testified before the undersigned Veteran’s Law Judge. A transcript of the hearing is associated with the claims file. In January 2020, the Board remanded the intertwined claims to obtain a VA examination with etiological opinion for diabetes. Service Connection Service connection is granted for any current disability that is the result of a disease contracted or an injury sustained while on active duty service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for a disease diagnosed after discharge, where all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38C.F.R. § 3.303(d). Service connection requires competent evidence showing: (1) the existence of a present disability; (2) 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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection is permissible, as well, on a secondary basis for disability that is proximately due to, the result of, or chronically aggravated by a service-connected condition. See 38 C.F.R. § 3.310 (a) and (b). See also Allen v. Brown, 7 Vet. App. 439, 448 (1995). In order to establish entitlement to service connection on this alternative secondary basis, there must be: (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a nexus (i.e., link) between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). 1. Entitlement to service connection for diabetes. The Veteran contends that his diabetes is related to service, to include as caused or aggravated by residuals of cold injury. The Veteran’s service treatment records (STRs) do not reveal evidence of high blood sugar or a diagnosis of diabetes. The first evidence of diabetes is shown in January 2011 private medical treatment record, which notes high blood pressure and a diagnosis of diabetes mellitus. Upon remand, the Veteran underwent a VA examination in October 2020, which showed a 2011 diagnosis of diabetes mellitus type II with onset in 2014. The examiner opined that is less likely than not (less than 50 percent probability) that the Veteran’s diabetes is related to his active military service. The examiner stated that he researched the National Institute of Health, VA.gov, and Mayo clinic data bases for relevant information of whether cold injuries would aggravate or cause diabetes in any population of individuals. The examiner found that there are multiple listings in the data bases, resulting in no significant data to support that a cold injury or residuals of cold injuries would predispose a population to diabetes; findings and medical opinion leads to the conclusion that diabetes is a separate disease process that is unrelated to residuals of cold injury. Furthermore, the examiner stated, the medical record fails to provide a link of residuals of cold injury and diabetes that occurred 59 years prior to the diabetes diagnosis. Regarding causation, the examiner opined that the diabetes is less likely than not (less than 50 percent probability) proximately due to or the result of Veteran’s residuals of cold injury. The examiner stated that the conditions of diabetes and residuals of cold injury are not medically related because the diabetes is a separate entity entirely from the residuals of cold injury and unrelated to it. Further, the examiner stated that the medical record fails to provide a link, VA.gov and National institute of Health data base fails to provide a link of cause and effect etiology. A nexus has not been established. Regarding aggravation, the examiner could not determine a baseline level of severity of diabetes based upon medical evidence available prior to aggravation or the earliest medical evidence following aggravation by residuals of cold injury. Regardless, the examiner opined that the Veteran’s diabetes is not at least as likely as not aggravated beyond its natural progression by residuals of cold injury. The examiner stated that medical literature, National Institute of Health, and National Library of Medicine data search fails to provide a link that would support an opinion that residuals of cold injury would aggravate diabetes 55 years after injury. After careful review of the claim, the Board concludes that the evidence of record weighs against finding that the Veteran’s diabetes is related to service, to include as caused by or aggravated by residuals of cold injury. The examiner opined that the Veteran’s diabetes is less likely than not caused by or incurred in service, or proximately due to or aggravated by his service. The examiner reviewed medical literature addressing the Veteran’s contentions that there may be a link between cold injuries and diabetes. Following review of the medical resources and the Veteran’s history, no such link was established. The examiner’s opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data based on the evidentiary record. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Veteran maintains that his diabetes is related to residuals of cold injury incurred in service. Although the Veteran is credible as to his testimony regarding date of onset, symptoms and the environmental conditions of his military service, there is no indication that he has the training or expertise to competently opine on the cause of his diabetes. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372, 1376-77 (Fed. Cir. 2007). Service connection is also not warranted for diabetes as a chronic disability under 38 C.F.R. § 3.307(a), as the competent medical evidence of record does not demonstrate that the Veteran’s diabetes was noted as chronic in service or manifested to a compensable degree in service or within the one year presumptive period. The record does not show a diagnosis of diabetes until 2011, approximately 60 years post service. See 38 C.F.R. §§ 3.307(a)(3), 3.309(a). Accordingly, as the preponderance of the evidence weighs against service connection, this claim must be denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 2. Entitlement to service connection for erectile dysfunction. The Veteran contends that his erectile dysfunction (ED) is secondary to diabetes. Specifically, he contends that his ED is associated with or a complication of his diabetes. Regarding service connection element (1), current disability, the Veteran has a 2011 diagnosis of erectile dysfunction and prostate hypertrophy. See February 2019 VA examination. Regarding element (2) for secondary service connection, evidence of a service-connected disability, service connection is not in effect for diabetes. Therefore, service-connection cannot be granted on this secondary basis. As service connection for diabetes is not warranted, this aspect of the claim is denied as a matter of law. Regarding element (2) for direct service connection, in-service incurrence or aggravation, the Veteran’s STRs do not show in service treatment or diagnosis of ED. The Veteran’s service treatment records do not reveal evidence of ED. Further, he has not asserted that an event, injury, or disease occurred in service, other than secondary to diabetes. Regarding element (3), causal relationship to service, the record does not otherwise show a positive nexus or relationship between the Veteran’s ED and his service. To that end, as there is insufficient evidence of any in-service incurrence or aggravation and diabetes is not service connected, a secondary opinion regarding ED is not required. A VA medical opinion on direct service connection was obtained in February 2019. The examiner opined that the Veteran’s ED was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The examiner reasoned that during service, his condition was acute only and there is no evidence of chronicity of care. The most probative evidence indicates that the Veteran’s ED did not occur in nor was it aggravated by service. Additionally, it has not been shown to be otherwise related to his service, to include caused or aggravated by a service-connected disability. Although related to diabetes, diabetes is not service connected. Thus, service connection is not warranted on either direct or secondary basis. The Board has considered the Veteran’s statements asserting that the symptoms of his disabilities are due to diabetes. The Veteran is competent to report to his own health symptoms and the medical evidence is consistent with his statements and establish a link between his ED and diabetes. However, the Board finds the lay statements to be less probative than the medical evidence, which importantly, does not establish a link between diabetes and service. Without a finding of direct service connection or a link to a service-connected disability, the elements for either theory of entitlement are not met. Accordingly, as the preponderance of the evidence weighs against the claim for service connection for ED, the claim must be denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 3. Entitlement to service connection for residuals of stroke. The Veteran contends that his residuals of stroke are secondary to diabetes. Specifically, he contends that his erectile dysfunction, residuals of stroke, and hypertension are associated with or a complication of his diabetes. Regarding service connection element (1), current disability, the Veteran suffered a cerebrovascular accident in 2012. See June 2019 VA examination. Regarding element (2) for secondary service connection, evidence of a service-connected disability, service connection is not in effect for diabetes. Therefore, service-connection cannot be granted on this secondary basis. Regarding element (2) for direct service connection, in-service incurrence or aggravation, the Veteran’s STRs do not show in service treatment or diagnosis of a stroke. The Veteran’s service treatment records do not reveal evidence of a stroke. Further, he has not asserted that an event, injury, or disease occurred in service, other than secondary to diabetes. Regarding element (3), causal relationship to service, the record does not otherwise show a positive nexus or relationship between the Veteran’s residuals of stroke and his service. To that end, as there is insufficient evidence of any in-service incurrence or aggravation and diabetes is not service connected, a secondary opinion regarding stroke is not required.. Pursuant to the Board remand, in a VA examination report, egarding direct service-connection, the examiner opined that the Veteran’s stoke was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The examiner stated that medical records indicate that the Veteran began having symptoms of stroke in 2012, and a nexus of health during military service and health problems now is not established. Additionally, the examiner stated that the exit exam indicates he was in good health. The examiner concluded that the stroke event was a progress of natural decline over a period of time and genetics. The most probative evidence indicates that the Veteran’s residuals of stroke did not occur in nor was it aggravated by service. Additionally, it has not been shown to be otherwise related to his service, to include caused or aggravated by a service-connected disability. Although residuals of stroke are related to diabetes, diabetes is not service connected. Thus, service connection is not warranted on either direct or secondary basis. The Board has considered the Veteran’s statements asserting that the symptoms of his disability is secondary to diabetes. The Veteran is competent to report to his own health symptoms and the medical evidence is consistent with his statements and establish a link between his residuals of stroke and diabetes. However, the Board finds the lay statements to be less probative than the medical evidence, which importantly, does not establish a link between diabetes and service or a link between stroke and service. Without a finding of direct service connection or a link to a service-connected disability, the elements for either theory of entitlement is not met. Accordingly, as the preponderance of the evidence weighs against the claim for service connection for residuals of stroke, the claim must be denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 4. Entitlement to service connection for hypertension. The Veteran contends that his hypertension is secondary to diabetes. Specifically, he contends that his hypertension is associated with or a complication of his diabetes. Regarding service connection element (1), current disability, January 2011 private medical treatment record showed a diagnosis of high blood pressure. Regarding element (2) for secondary service connection, evidence of a service-connected disability, service connection is not in effect for diabetes. Therefore, service-connection cannot be granted on this secondary basis. Regarding element (2) for direct service connection, in-service incurrence or aggravation, the Veteran’s STRs do not show in service treatment or diagnosis of hypertension. The Veteran’s service treatment records do not reveal evidence of high blood pressure. Further, he has not asserted that an event, injury, or disease occurred in service, other than secondary to diabetes. Regarding element (3), causal relationship to service, the record does not otherwise show a positive nexus or relationship between the hypertension and his service. To that end, as there is insufficient evidence of any in-service incurrence or aggravation and diabetes is not service connected, a secondary opinion regarding hypertension is not required. A VA medical opinion on direct service connection was obtained in June 2019. The examiner opined that the Veteran’s hypertension is less likely than not (less than 50 percent probability) incurred in or caused by the claimed in- service injury, event, or illness. The examiner reasoned that available records indicate that he was diagnosed with hypertension around 60 years after he left activity duty service. Therefore, the examiner stated, no nexus to service can be established. The most probative evidence indicates that the Veteran’s hypertension did not occur in nor was it aggravated by service. Additionally, it has not been shown to be otherwise related to his service, to include caused or aggravated by a service-connected disability. Although hypertension is related diabetes, diabetes is not a service-connected disability. Thus, service connection is not warranted on either direct or secondary basis. The Board has considered the Veteran’s statements asserting that the symptoms of his hypertension are due to diabetes. The Veteran is competent to report to his own health symptoms and the medical evidence is consistent with his statements and establish a link between his hypertension and service, to include diabetes. However, the Board finds the lay statements to be less probative than the medical evidence, which importantly, does not establish a link between hypertension and service or service or diabetes and service. Therefore, without a finding of nexus for direct service connection or a service-connected disability, the elements for any bases of entitlement have not been met. Accordingly, as the preponderance of the evidence weighs against the claim for service connection for hypertension, the claim must be denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 5. Entitlement to service connection for cataracts. The Veteran contends that his cataracts is secondary to diabetes. Alternatively, he has contended that his cataracts is secondary to hypertension. The Veteran contends that his cataracts is secondary to diabetes. Specifically, he contends that his cataracts is associated with or a complication of his diabetes. Regarding service connection element (1), current disability, the Veteran has a June 2018 diagnosis of Pseudophakia secondary to cataract surgery, bilateral, and July 2019 diagnosis of right eye diabetic retinopathy. See July 2019 VA examination. Regarding element (2) for secondary service connection, evidence of a service-connected disability, service connection is not in effect for diabetes nor hypertension. Therefore, service-connection cannot be granted on this secondary basis. Regarding element (2) for direct service connection, in-service incurrence or aggravation, the Veteran’s STRs do not show in service treatment or diagnosis of cataracts. Further, he has not asserted that an event, injury, or disease occurred in service, other than secondary diabetes and hypertension. Regarding element (3), causal relationship to service, the record does not otherwise show a positive nexus or relationship between the Veteran’s cataracts and his service. To that end, as there is insufficient evidence of any in-service incurrence or aggravation and diabetes and hypertension is not service connected, an opinion for cataracts on a secondary basis is not required. The most probative evidence indicates that the Veteran’s cataracts/retinopathy did not occur in nor was it aggravated by service. Additionally, it has not been shown to be otherwise related to his service or caused or aggravated by a service-connected disability. Although his cataracts/retinopathy is related to diabetes or hypertension, neither diabetes nor hypertension is service connected. Therefore, service connection cannot be established on secondary basis. The Board has considered the Veteran’s statements asserting that the symptoms of his cataracts/retinopathy is due to diabetes or hypertension. The Veteran is competent to report to his own health symptoms and the medical evidence are consistent with his statements and establish a link between his eye disease and diabetes. However, the Board finds the lay statements to be less probative than the medical evidence, which importantly, does not establish a link between diabetes/hypertension and service. Without a finding of direct relationship between cataracts and service or between cataracts and an established service-connected disability, the elements of both theories of entitlement are unsatisfied. Accordingly, as the preponderance of the evidence weighs against the claim for service connection for cataracts the claim must be denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Wilson, 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.