Citation Nr: 21007981 Decision Date: 02/11/21 Archive Date: 02/11/21 DOCKET NO. 14-24 874 DATE: February 11, 2021 ORDER Entitlement to service connection for diabetes mellitus type II, to include as due to service in Southwest Asia, and to include as due to service-connected disabilities, is denied. FINDING OF FACT Diabetes mellitus type II was not manifest in active service or within one year of service discharge; any current diabetes mellitus is not otherwise etiologically related to such service or to a service-connected disability. CONCLUSION OF LAW The criteria for service connection for diabetes mellitus type II, to include as due to service in Southwest Asia and to include as due to service-connected disabilities, have not been met. 38 U.S.C. §§ 1110, 1112, 1113 (2012); 38 C.F.R. § 3.303, 3.307, 3.309, 3.310 (2019). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty with periods of service from October 1990 to July 1991, July 1997 to March 1999, April 2003 to June 2003, and August 2008 to September 2008. It is noted that the Veteran received a dishonorable discharge for his service in the Marine Corps from July 1997 to March 1999 and that that period cannot be considered for VA disability purposes. This case was remanded in July 2017 and again in January 2020 for additional development. The matter has now returned to the Board for further appellate review. Entitlement to service connection for diabetes mellitus type II, to include as due to service in Southwest Asian and to include as due to service-connected disabilities The Veteran contends that his diabetes mellitus type II was incurred as a result of his service in the Southwest Asian theater. Alternatively, the Veteran contends that his diabetes mellitus type II is attributable to his service-connected disabilities. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303 (a) (2019). “To establish a right to compensation for a present disability, a Veteran must 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”- the so-called “nexus” requirement.” Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Certain chronic diseases, including diabetes mellitus type II, may be presumed to have been incurred in or aggravated by service if manifest to a compensable degree within one year of discharge from service, even though there is no evidence of such disease during service. 38 U.S.C. §§ 1101, 1112, 1113 (2012); 38 C.F.R. §§ 3.307, 3.309(a) (2019). While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. Id. Here, however, the Veteran’s diabetes mellitus did not manifest until well after service, and there is no indication of this condition prior to, during, or within one year of service. Secondary service connection is also warranted for any permanent increase in severity (aggravation) of a nonservice-connected disability that is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310 (b) (2019). VA will not concede that a nonservice-connected disease or injury was aggravated by a service-connected disease or injury unless the baseline level of severity of the nonservice-connected disease or injury is established by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the nonservice-connected disease or injury. 38 C.F.R. § 3.310 (b) (2019); see also Allen v. Brown, 7 Vet. App. 439, 448 (1995). Turning to the record, the Veteran’s service treatment records (STRs) are silent as to any diagnoses of, complaints of or treatments for any symptoms related to diabetes mellitus type II and the Veteran’s post-service treatment records show that the Veteran was diagnosed with diabetes mellitus type II in 2007. In June 2019, the Veteran was afforded a VA examination in connection with his claim. The examiner confirmed a diagnosis of diabetes mellitus type II. It was reported that the onset of this disorder was in October 2007. The examiner opined that it was less likely than not that the Veteran’s diabetes mellitus was caused by the Veteran’s active service in the Southwest Asia theatre. Further, the examiner explained, that the diabetes mellitus is not known to be caused by any exposures in Southwest Asia and it is not known to be caused by posttraumatic stress disorder (PTSD). Ultimately, the examiner determined that the Veteran’s diabetes mellitus was as likely as not secondary to the Veteran’s obesity. Pursuant to the Board’s January 2020 remand, another VA examination was conducted in February 2020. The examiner confirmed the diagnosis of diabetes mellitus type II. Further, the examiner opined that the Veteran’s diabetes mellitus type 2 was neither caused nor aggravated beyond its natural progression by the Veteran’s service-connected PTSD. In support of this conclusion, the examiner explained that diabetes mellitus type II is caused by several factors, including, being aged 45 or older, being overweight and obesity, not being physically active, insulin resistance, and genetics. The examiner noted that the Veteran reported a family history of diabetes mellitus type II. Additionally, the examiner further explained that there is no direct correlation between PTSD and the onset of diabetes mellitus type II, even though unhealthy behaviors can sometimes, but not always be associated with PTSD. Moreover, the examiner explained that aggravation or worsening of the disease usually is a result of noncompliance with either medications, diet, being physically active, or all of these. In this case, the examiner found that the Veteran’s pertinent lab work fluctuated in both worsening and improved control over the years and that the Veteran specifically reported compliance with treatment. The Board concludes that, while the Veteran has a current disability of diabetes mellitus type II, the preponderance of the evidence is against finding that the Veteran’s diabetes mellitus type II is proximately due to or the result of, or aggravated beyond its natural progression by his service-connected PTSD. 38 U.S.C. §§ 1110, 1131; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310(a). Specifically, the competent medical evidence of record indicates that there is no link between PTSD and the onset of diabetes mellitus type II. Moreover, the February 2020 VA examiner further explained that aggravation or worsening of diabetes mellitus type II is caused through noncompliance with recommended treatments. The examiner further noted that Veteran reported full compliance with recommended treatments. Moreover, the Board finds that the Veteran’s diabetes mellitus type II was not caused by his service in Southwest Asia. Specifically, the June 2019 VA examiner found that there is exposures in Southwest Asian known to cause diabetes mellitus type II. The Board acknowledges that the Veteran himself has claimed his diabetes mellitus type II is directly related to his active service. However, while the Veteran is competent to report (1) symptoms observable to a layperson, e.g., weight gain; (2) a diagnosis that is later confirmed by clinical findings; or (3) a contemporary diagnosis, he is not competent to independently render a medical diagnosis or opine as to the specific etiology of a condition. See Davidson v. Shinseki, 581 F.3d 1313 (2009). Consequently, the Veteran’s lay assertions of medical diagnosis or etiology are afforded little probative value and cannot constitute evidence upon which to grant the claim for service connection. Latham v. Brown, 7 Vet. App. 359, 365 (1995). As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See generally Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001). MICHAEL D. LYON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Scanlan, 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.