Citation Nr: 21009030 Decision Date: 02/18/21 Archive Date: 02/18/21 DOCKET NO. 17-36 636 DATE: February 18, 2021 ORDER Entitlement to service connection for diabetes mellitus, type II is denied. FINDING OF FACT The evidence of record does not reflect that Veteran has been diagnosed with diabetes mellitus at any point during the period on appeal. CONCLUSION OF LAW The criteria for service connection for diabetes mellitus, type II have not been met. 38 U.S.C. § 1110 (West 2014); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2019). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from May 1955 to September 1955, from December 1960 to October 1962, and from September 1967 to May 1975. He had a hearing before the undersigned Veterans Law Judge at the Regional Office in St. Petersburg, Florida, in May 2018. This claim was then remanded in July 2018 to obtain a medical opinion. The Board has thoroughly reviewed all evidence in the claims file. The analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, on the claim, and the Board’s reasons for rejecting evidence favorable to the Veteran. The Veteran must not assume the Board has overlooked evidence not explicitly discussed herein. Neither the Veteran nor his attorney has raised any issues with the duty to notify, the duty to assist, or the conduct of his Board hearing as to the duties discussed in Bryant v. Shinseki, 23 Vet. App. 488, 496-97 (2010). See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board . . . to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist or Bryant hearing deficiency argument). Thus, the Board need not discuss any potential issues in this regard. Service connection may be established for disability resulting from personal injury suffered or disease contracted in the line of duty in the active military, naval, or air service. 38 U.S.C. §§ 1131; 38 C.F.R. § 3.303. In order to prevail on the issue of service connection there must be (1) competent evidence of a current disability; (2) medical evidence, or in certain circumstances, lay evidence of in-service occurrence or aggravation of a disease or injury; and (3) competent evidence of a nexus between an in-service injury or disease and the current disability. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The Veteran is seeking service connection for diabetes mellitus, type II. The Veteran’s VA treatment records have shown elevated glucose levels, a possible sign of the development of diabetes mellitus. See VA treatment records, March 2016 and April 2016. However, upon review of the claims file, the Board finds no medical evidence documenting a diagnosis of diabetes mellitus, type II. The Board acknowledges that the Veteran was noted in a December 2008 VA mental disorders examination report as being borderline diabetic. However, a diagnosis of diabetes mellitus was not provided at that time, nor were laboratory findings identified to support a diagnosis of diabetes mellitus. In an October 2020 Disability Benefits Questionnaire (DBQ), the examiner noted that there was no official diagnosis of diabetes mellitus, type II. The Veteran was noted as having impaired fasting glucose and receiving no treatment. The examiner noted that there is no diagnosis because the Veteran has had fluctuating elevated fasting glucose levels that are not consistently above 126 mg/dl to be deemed a diabetic. More importantly, his A1C values have been in a normal range. The A1C is a more sensitive indicator of long-term glucose control. In an October 2020 VA opinion, the examiner determined that the claimed condition was less likely than not incurred or caused by the claimed in-service injury, event, or illness. The examiner noted that there is no formal diagnosis of diabetes based on repeated fasting glucose and A1C values were 5.8, 5.7, and 5.8. The reference range is 3.4 to 6.1 percent. The A1C is a more stable, longterm indicator of glucose control than fluctuating fasting glucose levels. The Veteran served in Vietnam twice. There is a nexus between exposure to Agent Orange and risk of developing diabetes, but the Veteran does not have a diagnosis of diabetes, but has abnormal fasting glucose levels of 125, 105, and 116. The reference range is 65 to 99. These are the most current glucose levels available from the medical records. The Veteran is hyperglycemic but not diabetic. The Court of Appeals for Veterans Claims (Court) has noted that a diagnosis of impaired glucose is not equivalent to a diagnosis of diabetes mellitus type 2. Waugerman v. Shinseki, No. 08-2685, 2011 WL 337152, at 4 (Vet. App. Feb. 4, 2011) (citing Dorland’s Illustrated Medical Dictionary 1960 (31st ed. 2007) (defining “impaired glucose tolerance” as “a term denoting values of fasting plasma glucose or results of an oral glucose tolerance test that are abnormal but not high enough to be diagnostic of diabetes mellitus” (emphasis added)); see also Smith v. Derwinski, 1 Vet. App. 235, 238 (1991) (“Courts may take judicial notice of facts not subject to reasonable dispute.” (citing Fed. R. Evid. 201 (b))). (The Board notes that Waugerman is referenced not as a precedent, but rather as a definition of a fact not subject to reasonable dispute.) Instead, impaired glucose tolerance merely refers to abnormal results on laboratory testing. The Board notes that there is nothing in law or fact to suggest that elevated glucose, in and of itself, diminishes earning capacity in any way. Accordingly, elevated glucose cannot properly be considered a “disability” for purposes of VA benefits. Cf. Schedule for Rating Disabilities; Endocrine System Disabilities, 61 Fed. Reg. 20,440, 20,445 (May 7, 1996) (indicating that diagnoses of hyperlipidemia, elevated triglycerides, and elevated cholesterol are laboratory results and are not, in and of themselves, disabilities). Therefore, the Board finds there is no persuasive medical evidence of record diagnosing the Veteran with diabetes mellitus and the only medical opinion of record on the matter specifically found that the Veteran does not have diabetes mellitus. Moreover, while the Veteran may believe he has diabetes mellitus related to his active duty service, he has no medical training or expertise, so his opinions are not competent evidence of a nexus relationship. In sum, the evidence does not establish the Veteran has been diagnosed with diabetes mellitus at any point during the period on appeal, and his impaired fasting glucose constitutes only a laboratory result. Accordingly, the evidence does not establish the presence of a current disability. In the absence of a current disability, there can be no valid claim. Therefore, the Veteran's appeal is denied. MICHELLE L. KANE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. Durham, 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.