Citation Nr: 21072443 Decision Date: 12/03/21 Archive Date: 12/03/21 DOCKET NO. 16-00 383 DATE: December 3, 2021 ORDER Entitlement to service connection for diabetes mellitus, type II, is denied. FINDING OF FACT The currently diagnosed diabetes mellitus, type II, was not incurred in service, is not otherwise related to service, and did not manifest within one year of service separation. CONCLUSION OF LAW The criteria for service connection for diabetes mellitus, type II, are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1137, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January 1971 to January 1973. This appeal is before the Board of Veterans' Appeals (Board) from a May 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Houston, Texas. In August 2018, the Veteran testified during a Board hearing before the undersigned Veterans Law Judge via videoconference. A transcript is included in the claims file. In September 2019, the Board dismissed a claim of service connection for high cholesterol and denied the remaining claims of entitlement to service connection for hypertension and diabetes. The Veteran appealed the denials to the United States Court of Appeals for Veterans Claims (Court), which vacated the denial in a January 2021 order granting a joint motion for partial remand (JMPR). In May 2021, the Board granted the claim of entitlement to service connection for hypertension and remanded the claim of entitlement to service connection diabetes for compliance with the terms of the JMPR. Entitlement to service connection for diabetes mellitus, type II. The Veteran contends that his diabetes mellitus is related to service. 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). Additionally, for Veterans who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities, such as diabetes mellitus, are presumed to have been incurred in service if manifest to a compensable degree within one year of discharge from service. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. Alternatively, service connection may be established under 38 C.F.R. § 3.303(b) by (a) evidence of (i) the existence of a chronic disease in service or during an applicable presumption period under 38 C.F.R. § 3.307 and (ii) present manifestations of the same chronic disease, or (b) when a chronic disease is not present during service, evidence of continuity of symptomatology. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Factual Background In this case, service treatment records (STRs) are silent for complaints, diagnoses, and/or treatment for diabetes mellitus during service. A September 28, 1972, STR noted a blood fasting glucose test of 102 mg/dL; however, as explained in further detail below, the September 2021 VA medical examiner determined that this finding was acute and did not meet the criteria for a diabetes diagnosis. Furthermore, the Veteran did not have any complaints pertaining to diabetes at service separation, and the September 1972 service separation examination report noted a negative blood sugar test, as well as a normal clinical evaluation of the endocrine system. Following service, the Veteran was not diagnosed with diabetes mellitus type 2 until approximately the year 2003, i.e., 30 years after his separation from service. See June 14, 2006, Private Treatment Record (noting that the Veteran was diagnosed with type 2 diabetes in 2003). In a May 2016 VA treatment record, the Veteran reported that he had been diabetic for the past 14 years. The Veteran was afforded a VA diabetes examination in September 2021. The VA examiner reviewed the Veteran's STRs and noted that the fasting blood sugar reading of 102 was "acute only" and that the Veteran's STRs were otherwise silent for diagnosis or treatment for type II diabetes during service. The examiner stated, "However, a FBG of 102 does not meet criteria for diagnosis for Type 2 Diabetes Mellitus." The examiner further noted that the Veteran was not diagnosed with diabetes until 2003. He opined that it was, therefore, at least less likely as not (i.e., 50 percent probability or less) that the Veteran's current diabetes mellitus was related to his September 1972 blood fasting glucose level of 102 milligrams per deciliter, or was otherwise related to service and that a nexus had not been established. The Board has reviewed the remainder of the evidence, including the Veteran's VA treatment records, private treatment records, his statements of record, and hearing testimony, and notes that he has presented no other argument as to the onset/continuity of his diabetes and/or why he believes that his diabetes is related to service. Analysis After a thorough review of the lay and medical evidence outlined above, the Board concludes that the currently diagnosed diabetes mellitus, type II, did not manifest to a compensable degree in-service or within a presumptive period, and continuity of symptomatology is not established. 38 U.S.C. §§ 1101(3), 1112, 1113, 1137; 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a). Moreover, the evidence is against a finding that diabetes mellitus, type II, was incurred in service, or is otherwise attributable to service. 38 C.F.R. § 3.303(a), (d). As noted, STRs do not reveal any complaints, findings, treatment, or diagnoses of diabetes mellitus, type II. Although there is a single fasting blood glucose reading of 102 in September 1972, there is no contemporaneous diagnosis of, or follow-up for diabetes; and the September 2021 VA medical examiner expressly noted that this finding was "acute" and not indicative of a diabetes diagnosis. Moreover, no diabetes symptomatology or diagnosis was noted on the separation discharge examination and all relevant objective findings were normal. Accordingly, service connection for diabetes mellitus, type II, on a direct incurrence basis pursuant to 38 C.F.R. § 3.303(a) is denied. In this same vein, the only medical nexus opinion of record is also against the claim on a direct basis. As noted, after a physical evaluation of the Veteran and a review of the medical evidence of record, the September 2021 VA examiner opined that it was less likely than not that his current diabetes mellitus was related to service, to include the September 1972 blood fasting glucose level of 102 milligrams per deciliter. In so finding, the examiner essentially indicated that the in-service blood glucose level of 102 was acute and not indicative of diabetes and that Veteran had not been diagnosed with diabetes until approximately 30 years after separation. The Board considers the opinion to be highly probative as to the issue of nexus as it was rendered after a thorough review of the Veteran's STRs and medical history and is supported by sound medical rationale. Notably, there are no medical opinions of record to the contrary. With respect to presumptive service connection, post-service treatment records show that the Veteran was not diagnosed with diabetes mellitus type 2 until approximately the year 2003, i.e., decades outside of the applicable one-year presumptive period. Accordingly, service connection for diabetes mellitus on a presumptive basis as a chronic disease is also denied. 38 C.F.R. § 3.307(a)(3). Lastly, the record does not reflect, nor does the Veteran contend that a continuity of diabetes symptomatology exists in this case. Indeed, the Veteran, himself, reported an onset of diabetes in approximately 2002; as noted, the first objective notations of diabetes are not shown until approximately 2003. Therefore, service connection on the basis of continuity of symptomatology since service is denied. 38 C.F.R. § 3.303(b). Notably, the Veteran has not provided any medical evidence purporting to link his diabetes to service. While the Veteran believes that his diabetes mellitus is related to service, he is not competent to provide a nexus opinion in this case. This issue is also medically complex, as it requires specialized medical education, and the ability to interpret complicated diagnostic medical testing. See Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the findings of the September 2021 VA medical examiner who unequivocally concluded that diabetes mellitus was not related to service. Although the Veteran is entitled to the benefit of the doubt where the evidence is in approximate balance, the benefit of the doubt doctrine is inapplicable where, as here, the preponderance of the evidence is against the claim. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra. The claim is thus denied. JONATHAN B. KRAMER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board H. Hoeft 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.