Citation Nr: 21005461 Decision Date: 02/01/21 Archive Date: 02/01/21 DOCKET NO. 14-41 614 DATE: February 1, 2021 ORDER Service connection for diabetes mellitus, type II, is denied. FINDING OF FACT The Veteran’s diabetes mellitus, type II, was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury or disease. 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; 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 August 1994 to October 2008. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2013 rating decision of the VA Regional Office (RO) in San Diego, California. In May 2018, the Board remanded the claim for further development. The Board finds that there has been substantial compliance with its prior remand. See Stegall v. West, 11 Vet. App. 268 (1998). During remand status, an October 2020 rating decision granted service connection for left mental nerve neuropathy (claimed as nerve damage in mouth). As the RO granted in full the benefit sought by the Veteran in this matter, there is no remaining allegation of error of fact or law for appellate consideration. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997) (noting that a grant of service connection extinguishes appeals before the Board). The RO sent to the Veteran an October 2020 supplemental statement of the case that addressed the remaining issue on appeal, entitlement to service connection for diabetes mellitus, type II. Lastly, it is noted that in the December 2014 Form 9, the Veteran requested a hearing before the Board. The hearing was scheduled for October 2017, and the Veteran was deemed a no-show for the hearing. To date, the Veteran has not provided evidence of good cause for the failure to show. As such, the Veteran’s hearing request is withdrawn. 38 C.F.R. § 20.704(d). Entitlement to service connection for diabetes mellitus, type II. The Veteran contends that his diabetes mellitus had its onset prior to service separation. See Form 9 (December 2014). The Board concludes that the preponderance of the evidence is against finding that his diabetes was shown as chronic in service; manifested to a compensable degree within the applicable presumptive period; continuity of symptomatology being established; or that the claimed disability is otherwise etiologically related to an in-service injury or disease. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 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). Certain chronic diseases (e.g. diabetes mellitus) will be presumed related to service if they were shown as chronic (reliably diagnosed) in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service, with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013); Fountain v. McDonald, 27 Vet. App. 258 (2015); 38 C.F.R. §§ 3.303, 3.307, 3.309. The Veteran’s service treatment records (STRs) show no clinical findings consistent with diabetes mellitus or symptoms indicative thereof. In this regard, the Veteran’s STRs show that his glucose levels were tested in October 2002 and in June 2008, which resulted in 89 mg/dL and 91mg/dL, within normal range. Moreover, in February 2008, the Veteran underwent a periodic health assessment, in which, he reported no new symptoms, no previous hospitalization, and no dietary change. The examiner assessed the Veteran with “normal routine history and physical adult,” and released him without limitations. In July 2008, the Veteran underwent a separation examination, in which, he denied, among other things, endocrine symptoms. After examination, and review of lab results, to include the June 2008 glucose results, the clinician assessed the Veteran with “normal routine history and physical,” and found him qualified for service separation without limitations. While medical records associated with the claims file show that the Veteran is currently diagnosed with diabetes mellitus, the earliest mention of treatment of record is in 2010, years after his discharge. See CAPRI (February 2020). This passage of time is a factor for consideration when making a finding of direct service connection. See Maxson v. West, 12 Vet. App. 453 (1999). VA examination report, dated in October 2019, shows that the Veteran was diagnosed with diabetes mellitus, type II. In making the diagnosis, the examiner noted that test results in April 2011 and September 2011 showed A1C levels of 6.5 percent or above. Additionally, the examiner noted that a November 2010 test result revealed random plasma glucose of or greater than 200 mg/dL with classic symptoms of hyperglycemia. In a corresponding VA medical opinion, the clinician found the Veteran’s diabetes mellitus was less likely than not incurred in or caused by the claimed in-service injury, event or illness. The Board finds the VA medical opinion of high probative value. The probative value of medical opinion evidence is based on the medical expert’s personal examination of the patient, the his or her knowledge and skill in analyzing the data, and the medical conclusion reached. Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). Whether a medical professional provides a basis for his or her medical opinion goes to the weight or credibility of the evidence in the adjudication of the merits. See Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998). Other factors for assessing the probative value of a medical opinion are the physician’s access to the claims folder and the thoroughness and detail of the opinion. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000); Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Here, the Board finds the VA medical opinion of high probative value for the following reasons: The medical opinion is based on sufficient facts and data (e.g., the Veteran’s lay statements, in-service and post-service medical records); the medical opinion is the product of reliable principles and methods; and the result of principles and methods reliably applied to the facts. See Nieves-Rodriguez, 22 Vet. App. at 302 (citing to Federal Rules of Evidence on expert witnesses). Further, the VA medical opinion contains clear conclusions with supporting data, and also a reasoned medical explanation connecting the two. Id. at 301. The clinician, in forming her conclusion, considered the Veteran’s theory of causation and provided a discussion of the relevant and significant medical history, clinical findings, and medical knowledge that support the negative medical opinion. Indeed, the opinion notes the Veteran’s report of excessive urination, in which, he argues is a sign of diabetes mellitus; however, the opinion then found the normal blood glucose test results, to include the one done prior to separation, made it unlikely that his reports of excessive urination was due to diabetes. In consideration of the above, the VA medical opinion shows that the clinician found the Veteran’s contention that his disability stemmed from service of diminished or low persuasion. The Board, thus, finds the VA medical opinion of high probative value as it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Furthermore, there is no competing medical opinion of record. Accordingly, the Board finds that the VA medical opinion is dispositive of the issues at hand. While the Veteran is competent to report his symptoms, he is not competent to diagnose himself as having diabetes in service as this determination is based on laboratory findings of fasting blood sugar level by a trained medical professional. Additionally, he is not competent to link his post-service onset of diabetes to in-service disease or injury as he lacks the requisite medical expertise to formulate a medical opinion as the causes of diabetes are complex and simply not susceptible to observation or analysis of a layperson. Indeed, this is an intricate matter that requires an understanding of various bodily systems. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Therefore, to the extent that the Veteran suggests that diabetes had its onset in service or is otherwise related thereto, the Board assigns the Veteran’s statements diminished probative value. Given the above, the competent, credible evidence of record does not reflect that the Veteran’s diabetes mellitus had its onset in service or is otherwise etiologically related to an in-service injury or disease. Further, the competent, credible evidence of record does not show that his diabetes mellitus manifested to a compensable degree within the applicable presumptive period, or that he experienced continuity of symptomatology. The Board assigns greater probative value to the Veteran’s in-service and post-service medical records, which contain no objective finding for diabetes mellitus until years after separation from service. See Curry v. Brown, 7 Vet. App. 59, 68 (1994) (contemporaneous evidence has greater probative value than history as reported by the claimant); Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (holding that the Board may take into consideration the passage of a lengthy period of time in which the Veteran did not complain of the disorder at issue); Forshey v. West, 12 Vet. App. 71, 74 (1998), aff’d sub nom., Forshey v. Principi, 284 F.3d 1335, 1358 (Fed. Cir. 2002) (finding that the definition of evidence encompasses “negative evidence” which tends to disprove the existence of an alleged fact). The Board additionally assigns greater probative value to the VA medical opinion than to the Veteran’s uncorroborated medical opinion. This is because the medical professional is shown, through the comprehensiveness and detailedness of the medical opinion, to have possessed the necessary education, training, and expertise to provide the requested opinion. Additionally, the opinion is also shown to have been based on a review of the Veteran’s record and is accompanied by a sufficient explanation as to why the Veteran’s current disability did not have its onset during service or is related to his service. The opinion, moreover, reflects a reasoned medical explanation with consideration of lay statements, and relevant in-service and post medical records. Nieves-Rodriguez, 22 Vet. App. at 304. It is clear from the medical opinion that the clinician reviewed the Veteran’s claims file and considered the subjective complaints of the Veteran. Also, the medical opinion is supported by a rationale that the Board can use to weigh against the other evidence of record. On balance, the weight of the evidence is against the claim. Accordingly, the claim is denied. There is no doubt to resolve. See 38 U.S.C. § 5107(b). C.A. SKOW Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Griffey, 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.