Citation Nr: 21023806 Decision Date: 04/21/21 Archive Date: 04/21/21 DOCKET NO. 18-48 858 DATE: April 21, 2021 ORDER Entitlement to service connection for diabetes is denied. FINDING OF FACT The preponderance of the evidence of record is against finding that the Veteran has or has had Type I or Type II Diabetes Mellitus at any time during or approximate to the pendency of this claim. CONCLUSION OF LAW The criteria are not met for entitlement to service connection for diabetes. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from March 1971 to January 1973 and had additional National Guard service from March 1973 to October 1992. This appeal to the Board of Veterans’ Appeals (Board) is from a March 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified in support of this claim during a hearing in July 2020 before the undersigned Veterans Law Judge (VLJ) of the Board. A transcript of the hearing is of record. The Board subsequently, in December 2020, remanded this claim back to the RO (Agency of Original Jurisdiction (AOJ)) for medical comment needed to assist in deciding this claim. That additional development since has been completed, as directed. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding that a remand by the Board confers upon the Veteran, as a matter of law, the right to compliance with the remand instructions); but see also D'Aries v. Peake, 22 Vet. App. 97, 105 (2008) (holding that only “substantial” rather than strict or exact compliance with the Board's remand directives is required under Stegall); accord Dyment v. West, 13 Vet. App. 141, 146-47 (1999). Entitlement to service connection for diabetes The Veteran asserts that he has diabetes due to exposure to an herbicide agent 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). Diabetes is one of the “chronic” conditions that may be presumed to have been incurred in service – either because it initially manifested to a compensable degree (meaning to at least 10-percent disabling) within a year of the Veteran’s discharge from service (but only active duty (AD) service qualifies for this presumption, not also active duty for training (ACDUTRA) or inactive duty training (INACDUTRA)) or because it is presumptively associated with exposure to an herbicide agent (including especially the dioxin in Agent Orange). See 38 U.S.C. §§ 1101, 1112, 1113, 1116; 38 C.F.R. §§ 3.307, 3.309. But even more fundamental to the claim is first establishing the Veteran has diabetes or that he at least has at some point since filing his claim for this condition or contemporaneous to that. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). If he does not satisfy this threshold preliminary proof requirement, then, for all intents and purposes, there is no diabetes to, in turn, relate or attribute to his military service. In January 2021, pursuant to the Board’s December 2020 remand directive, the Veteran underwent a VA diabetes examination. The VA examiner evaluated the Veteran and determined that, while he has impaired fasting glucose, he does not have diabetes. A private treatment record from earlier, in September 2015, shows the Veteran was diagnosed with diabetes based on an elevated A1C HGB [blood test] value of 6.2%. But the January 2021 VA examiner explained that this finding does not meet the minimum threshold requirement of 6.5% to be considered diabetes. After that September 2015 blood test, the private doctor started the Veteran on an oral hypoglycemic medication, which in turn caused him some hypoglycemic symptoms – including dizziness associated with a very low glucose value. He consequently was then ordered to stop taking that medication, as reflected in a private treatment record from February 2016. VA treatment records then show that VA doctors explained to him that his diagnosis is impaired fasting glucose, not diabetes, and that he never had high enough glucose values to meet the minimum threshold requirements to receive a diagnosis of diabetes. The January 2021 VA examiner consequently has explained, in rather exhaustive detail, why the Veteran does not have this claimed condition of diabetes. Moreover, this VA examiner discussed the earlier dated evidence suggestive of this diagnosis and clarified what it really meant or represented. This issue of whether the Veteran has diabetes (much less because of his service) is medically complex, not merely simple, as it requires specialized medical education and the ability to interpret the results of complicated diagnostic medical testing, including specifically assessing blood sugar levels and corresponding percentages. See Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. See Kahana v. Shinseki, 24 Vet. App. 428 (2011); 38 C.F.R. § 3.159(a)(1) and (2). As such, the Board finds that the Veteran has not had the required confirmation of diabetes at any time contemporaneous to or since the filing of his claim for this condition and, resultantly, service connection for diabetes is not warranted. KEITH W. ALLEN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Pak 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.