Citation Nr: 21023267 Decision Date: 04/20/21 Archive Date: 04/20/21 DOCKET NO. 16-21 932 DATE: April 20, 2021 ORDER Entitlement to service connection for diabetes mellitus is denied. FINDING OF FACT Diabetes mellitus was not shown in service or many years thereafter; and, the preponderance of the evidence fails to establish that diabetes mellitus is etiologically related to active service. CONCLUSION OF LAW The criteria for service connection for diabetes mellitus are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service in the Air Force from September 1979 to April 1983. The appeal originates from a September 2014 decision of a Department of Veterans Affairs (VA) Regional Office. The matter was remanded in October 2018 for a VA examination with opinion, which was obtained in October 2019. There has been substantial compliance with the Remand directives. It is noted that the Board also remanded the claim of service connection for a right hip disorder. A June 2020 rating decision granted service connection for the right hip and the issue is no longer before the Board. Entitlement to service connection for diabetes mellitus. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease initially diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection for a disability requires evidence of: (1) a current disability; (2) a disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Certain chronic diseases, such as diabetes mellitus, will be presumed related to service if they were shown as chronic 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; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). The Veteran contends that she was diagnosed with hypoglycemia in service and that this progressed to diabetes mellitus. See June 2011 Statement. The October 2019 examination reflects a diagnosis of diabetes mellitus Type II. Element (1) of Shedden is met. Service treatment records are silent for a diagnosis of diabetes mellitus. The Veteran described many health conditions but denied a history of sugar or albumin in the urine on a March 1983 report of medical history at separation. The endocrine system was evaluated as normal at a contemporaneous examination and urinalysis was negative for albumin and sugar. However, a February 1983 service treatment record reflects the Veteran’s reported history of chronic hypoglycemia with an ostensible assessment of hypoglycemia. Such is sufficient to meet Shedden element (2) with respect to an in-service medical condition. Regarding Shedden element (3) or a nexus, the October 2019 examiner opined that diabetes mellitus is less likely as not related to service. The examiner determined that there was no evidence of hyperglycemia or other signs of diabetes during military service or shortly thereafter. The examiner questioned the noted hypoglycemia, referencing a November 1984 treatment record clarifying that it was based on the Veteran’s self-assessment from migraines, weight loss, and “an old glucose test.” This is consistent with the February 1983 service treatment record, which did not indicate any diagnostic testing establishing hypoglycemia. Moreover, the examiner explained that hypoglycemia is not an expected finding of untreated diabetes and that the Veteran herself did not indicate treatment for diabetes until 2010. There is no competent opinion to the contrary. Turning to presumptive service connection, the record does not reflect a diagnosis of diabetes mellitus within one year of separation. Medical treatment records show that the Veteran was first diagnosed with diabetes mellitus in 2010. She does not contend otherwise. As to continuity of symptomatology, the only symptoms the Veteran appears to link to diabetes mellitus are migraines and hypoglycemia. See June 2011 Statement. Even assuming that she had continuous migraines and hypoglycemia, the October 2019 examiner specified that the latter was not linked to diabetes mellitus, and the medical evidence does not relate a history of migraines to diabetes mellitus. To the contrary, the Veteran underwent a VA examination in June 1983 shortly after separation, at which time the examiner noted that rather than migraine headaches, she actually had “typical tension headaches, which occur in the posterior neck.” Consideration is given to the personal assertions of the Veteran that her diabetes mellitus is related to in-service hypoglycemia. However, while lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), the specific issue in this case falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The disability at issue is not a condition that is readily amenable to probative lay comment regarding etiology. The Veteran is competent to report observable symptoms, but there is no indication that she is competent to etiologically link any such symptoms to a current diagnosis. She is not shown to possess the requisite medical training, expertise, or credentials needed to render a diagnosis or a competent opinion as to medical causation. Nothing in the record demonstrates that she received any special training or acquired any medical expertise in evaluating her disorder. See King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2012). Accordingly, the lay evidence does not constitute competent medical evidence and lacks probative value. The lay opinion is also outweighed by the VA opinion. Amanda E.H. Gibson Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Alhinnawi 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.