Citation Nr: 21005550 Decision Date: 02/01/21 Archive Date: 02/01/21 DOCKET NO. 15-06 682 DATE: February 1, 2021 ORDER Service connection for diabetes is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran’s diabetes began during his service, within a year of his discharge, or is otherwise related or attributable to his service. CONCLUSION OF LAW The criteria are not met for entitlement to service connection for diabetes. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.   REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active military service from August 1991 to October 1999. Service connection for diabetes is denied. The Veteran contends that his diabetes began while he was in service. He says he had elevated glucose levels on testing in December 1999, so just two months following his separation from service, therefore, his diabetes likely incepted during his service. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active military service in the line of duty. 38 U.S.C. § 1110; 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 an injury; and (3) a causal relationship (“nexus”) between the current disability and the disease or injury in service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Since considered a “chronic” disease, per se, diabetes also may be presumed to have been incurred in service if it manifested to a compensable degree (meaning to at least 10-percent disabling) within a year of the Veteran’s separation from service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). Here, though, the Board concludes that, while the Veteran has a current diagnosis of diabetes, the preponderance of the evidence weighs against finding that it began during his service, or within a year of his discharge, or is otherwise related or attributable to his service.   His contentions notwithstanding, VA treatment records show the Veteran was not diagnosed with diabetes until 2012, over a decade after his separation from service. His VA treatment records consistently show he was newly diagnosed with diabetes, meaning during 2012 or thereabouts. These records, and the other evidence in his claims file, do not contrarily evidence symptoms of or treatment for this disease prior to 2012. He has not provided any probative evidence indicating he had diabetic symptoms earlier, meaning during his service from 1991 to 1999 or shortly following his separation from service, meaning during the one-year presumptive “grace period” following conclusion of his service allowing for initial manifestation of this disease to, in turn, warrant presuming it was incurred during his service. Further, after being asked to comment on the origins of the Veteran’s diabetes as directed in the Board’s March 2020 remand of this claim, the July 2020 VA compensation examiner opined that the Veteran’s diabetes is not at least as likely as not related to an in-service injury, event, or disease. The examiner specifically addressed the December 1999 laboratory record the Veteran cited as showing an elevated blood glucose level of 124. But the examiner clarified that the laboratory result did not appear to be a fasting blood sugar reading. As there was no indication from the report that it was a fasting blood sugar level, it was most likely a random blood sugar level. In that case, the level would need to be 200 or greater to suggest diabetes rather than 124. The examiner further reviewed the Veteran’s service treatment records (STRs) showing that, in August 1999, a laboratory report documented a normal fasting blood sugar of 99. The examiner found that the STRs did not show evidence of diabetic symptoms, such as weight loss, polyuria, or polydipsia to suggest diabetes. Because the STRs did not show any evidence of diabetic symptoms, and the in-service fasting glucose finding was normal, the examiner found no indication of the onset of diabetes during the Veteran’s service or even within a year of his discharge. In summation, this VA examiner reiterated that the December 1999 glucose level was likely not a fasting glucose result, as such was not stated on the laboratory report as was normally indicated. Given such, the finding was normal. This commenting VA examiner also reviewed the post-service treatment records showing consistently that the Veteran was newly diagnosed with diabetes in 2012, in support of the conclusion reached. This VA 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. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Diabetes is a complex, not merely simple, disease; therefore, determining when it onset is beyond the Veteran’s lay competence, including since, as the VA examiner highlighted, the diagnosis generally is predicated on the results of objective clinical data (fasting blood sugar levels). Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the July 2020 VA medical opinion obtained on remand of this claim. See King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2012) (indicating lay evidence must demonstrate some competence and affirming the Court's conclusion that the Board did not improperly discount the weight of a lay opinion in finding a medical expert's opinion more probative on the issue of medical causation). KEITH W. ALLEN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Erdheim 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.