Citation Nr: 21067398 Decision Date: 11/04/21 Archive Date: 11/04/21 DOCKET NO. 17-03 542 DATE: November 4, 2021 ORDER Service connection for diabetes mellitus is granted. FINDING OF FACT The preponderance of the evidence weighs in favor of finding that the Veteran's diabetes mellitus is proximately due to or aggravated by a service-connected lumbar spine disability, to include obesity as an intermediate step. CONCLUSION OF LAW The criteria for service connection for diabetes mellitus have been met. 38 U.S.C. §§ 1110, 1112, 5107(b), 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Marine Corps from April 1978 to April 1984, and the United States Army from September 1984 to April 2001. For his meritorious service, the Veteran was awarded (among other decorations) the Meritorious Service Medal and the Army Commendation Medal. This matter is before the Board of Veterans' Appeal (Board) on appeal from a July 2016 rating decision issued by the Department of Veteran Affairs (VA) Regional Office (RO). In October 2021, the Veteran testified before the undersigned at a Board hearing. 1. Service Connection for diabetes mellitus. The Veteran contends that service connection for diabetes mellitus is warranted under a secondary service connection theory of entitlement as being proximately due to or aggravated by service-connected lumbar spine disability; or that service-connected lumbar spine disability caused his obesity which then caused or aggravated his diabetes mellitus. In seeking VA disability compensation, a veteran generally seeks to establish that a current disability results from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110. "Service connection" basically means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein. 38 C.F.R. § 3.303. Establishing service connection generally requires competent evidence showing: (1) the existence of a current 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 may also 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). Service connection may alternatively be established on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disability. 38 C.F.R. § 3.310(a). Secondary service connection may also be established for a disorder which is aggravated by a service-connected disability. See 38 C.F.R. § 3.310(b); Allen v. Brown, 8 Vet. App. 374 (1995). In Walsh v. Wilkie, the Court further held, that the Board needs to consider the obesity-intermediate step theory predicated on aggravation where appropriate. Thus, the Court held that proper interpretation of G.C. Prec. Op. 1-2017 requires consideration of both proximate causation and aggravation in its analytical framework: (1) whether the service-connected disability caused the veteran to become obese/aggravated the veteran's obesity; (2) if so, whether the obesity/aggravation of obesity as a result of the service-connected disability was a substantial factor in causing the current disability; and (3) whether the current disability would not have occurred but for obesity caused/obesity aggravated by the service-connected disability. If these questions are answered in the affirmative, then the current disability may be service connected on a secondary basis. Walsh v. Wilkie, 32 Vet. App. 300 (2020). The Board finds that the preponderance of the evidence finds that Veteran's service-connected degenerative disc disease of the lumbar spine (lumbar spine disability) caused weight gain, which was a substantial factor in causing the Veteran's diabetes. With regard to a current disability, the Veteran has a diagnosis of diabetes mellitus. Thus, the first element of service connection is met. Regarding secondary service connection, the Board notes that the Veteran has been service connected for lumbar spine disability. Thus, the second element of secondary service connection is met. The remaining question is whether there is a medical nexus between the Veteran's current disability of diabetes mellitus and his service-connected lumbar spine disability with obesity serving as an intermediate step. To support his claim, the Veteran has supplied two medical opinions authored by his private physician, S. L. Holwerda, MD. See February 2016 and October 2021 VA private medical opinion. Dr. Holwerd opines that the Veteran's low back disability prevented or lessen the Veteran's ability to exercise, which caused weight gain/obesity. The Veteran's obesity, therefore, has caused or aggravated his diabetes mellitus. Dr. Holwerd highlighted that the medical literature supports that the, "impairment of exercise related to chronic back pain leads to obesity which is directly tied to the incidence of diabetes mellitus." While not couched in the exact language cited previously, these opinions clearly demonstrate that each element of the obesity intermediate step framework have been met. These opinions demonstrate that the Veteran's service-connected back disability has led to obesity, that his obesity has led to his diabetes diagnosis, and that his diabetes would not have occurred but for his obesity. Thus, considering the forgoing, the Board finds the evidence in relative equipoise as to a causal relationship between Veteran's low back disability and his obesity. As such, the preponderance of the evidence is for finding that Veteran's diabetes mellitus is proximately due to or aggravated by service-connected lumbar spine disability with obesity serving as a substantial factor in the development or aggravation of his diabetes. As such, service connection is granted. See 38 C.F.R. § 3.303 (b); Walsh v. Wilkie, 32 Vet. App. 300 (2020). Evan M. Deichert Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J.R. Higgins 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.