Citation Nr: A21017804 Decision Date: 11/03/21 Archive Date: 11/03/21 DOCKET NO. 190616-96082 DATE: November 3, 2021 ORDER Entitlement to service connection for diabetes mellitus, type II is denied. FINDING OF FACT Diabetes mellitus, type II (diabetes) was not manifest in service or within one year. The disability is not otherwise attributable to service. CONCLUSION OF LAW Diabetes was not incurred in or aggravated by active service, nor may it be presumed to have been incurred therein. 38 U.S.C. §§ 1101, 112, 1113, 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 November 1979 to August 1983. A rating decision was issued under the legacy system in September 2014. In July 2018, the Veteran opted into the modernized review system, also known as the Appeals Modernization Act (AMA), by submitting a Rapid Appeals Modernization Program (RAMP) election form and selecting the higher-level review (HLR) lane. The agency of original jurisdiction (AOJ) issued a RAMP HLR decision November 2018, which is the decision on appeal. In the June 2019 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Hearing docket. Therefore, the Board may consider the evidence of record at the time of the RAMP opt-in, as well as any evidence submitted by the Veteran or his representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). A hearing was held before the undersigned veterans law judge in May 2021. The transcript is of record. During the hearing, the VLJ clarified the issues, asked if there was outstanding evidence and held the file open for the submission of evidence. Such actions comply with 38 C.F.R. § 3.103. 1. Entitlement to service connection for diabetes mellitus, type II To establish service connection a Veteran must generally show: "(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 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 also be established for disability on the basis of a presumption that certain chronic diseases, to include diabetes, manifesting themselves to a certain degree within a certain time after service must have had their onset in service. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309(a). For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "Chronic." 38 C.F.R. § 3.303 (b). When the disease identity is established (leprosy, tuberculosis, multiple sclerosis, etc.), there is no requirement of evidentiary showing of continuity. Id. Continuity of symptomatology is required only where the condition noted during service (or in the presumptive period) is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. Id. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. Id. Effective March 14, 2017, 38 C.F.R. §§ 3.307 and 3.309 were amended to add eight diseases to the list of diseases associated with contaminants present in the water supply at U.S. Marine Corps Base Camp Lejeune, North Carolina, from August 1, 1953, to December 31, 1987. The amendments apply to claims received by VA on or after January 13, 2017, and claims pending before VA on date. Amended 38 C.F.R. §§ 3.307 and 3.309 establish presumptive service connection for Veterans, former reservists, and former National Guard members who served at Camp Lejeune for no less than 30 days (either consecutive or nonconsecutive) during this period, and who have been diagnosed with any of the following eight diseases: adult leukemia; aplastic anemia and other myelodysplastic syndromes; bladder cancer; kidney cancer; liver cancer; multiple myeloma; non-Hodgkin's lymphoma; and Parkinson's disease. In addition, the amendments establish a presumption that these individuals were disabled during the relevant period of service, thus establishing active military service for benefit purposes. This amendment implements a decision by the Secretary of Veterans Affairs that service connection on a presumptive basis is warranted for claimants who served at Camp Lejeune and later develop the certain diseases listed above. The Veteran does not have an enumerated disease and is not considered disabled during his service. Diabetes is not presumed to be related to his exposure to contaminated water at Camp Lejeune during his service. However, the absence of a disease from the presumptive list does not preclude a veteran from otherwise proving that his disability resulted from exposure to contaminated water at Camp Lejeune. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). Accordingly, the Board will consider whether entitlement to service connection can be granted on another basis. Service treatment records do not contain any indication of diabetes or its symptoms. At separation the Veteran denied dizziness, frequent urination, and recent gain or loss of weight. There was no sugar in his urine. The Veteran was diagnosed with diabetes nearly twenty years after his separation from active service, and medical records do not show manifestation of symptoms in the year after his separation, nor has the Veteran asserted that symptoms were manifest within one year. Medical records similarly do not contain any indication that his diabetes may be related to his service, to include his exposure to the contaminated water at Camp Lejeune. The Veteran has submitted an article discussing a potential link between diabetes and trichloroethylene (TCE), one of the chemicals present in the water at Camp Lejeune. However, the article concerned type I diabetes, not type II, which the Veteran has. There was no specific evidence showing a link between TCE and type II diabetes. The Board notes that the Veteran has not received a VA examination for his diabetes. VA's duty to assist includes providing a medical examination when it is necessary to make a decision on a claim. 38 U.S.C. § 5103A (d); 38 C.F.R. § 3.159. Such development is necessary if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but (1) contains competent evidence of diagnosed disability or symptoms of disability, (2) establishes that the Veteran suffered an event, injury or disease in service, or has a presumptive disease during the pertinent presumptive period, and (3) indicates that the claimed disability may be associated with the in-service event, injury, or disease, or with another service-connected disability. 38 C.F.R. § 3.159 (c)(4); McLendon v. Nicholson, 20 Vet. App. 79, 83-86 (2006). The threshold for finding a link between a current disability and service so as to require medical examination is low. However, the threshold has not been met in this case, as there is no evidence of record suggesting a link between the Veteran's current disability and his service other than the Veteran's lay assertions. Accordingly, the Board finds that the preponderance of the evidence weighs against a finding that the Veteran's diabetes is related to his active service, to include exposure to contaminants in the water at Camp Lejeune. With regard to chronic disease, the Board concludes that, while the appellant has diabetes, it did not manifest in service. He did not have characteristic manifestations sufficient to identify the disease entity since testing was normal at that time. Here, diabetes mellitus was not noted during service; rather the separation examination disclosed that the endocrine system was normal and urinalysis was negative for sugar. There is no credible evidence of diabetes in service or within one year of separation and there is no evidence linking the remote onset to service, to include exposure. The preponderance of the evidence is against the claim and there is no doubt to be resolved. H. N. SCHWARTZ Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Creegan, Amanda 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.