Citation Nr: 21025155 Decision Date: 04/27/21 Archive Date: 04/27/21 DOCKET NO. 16-11 794 DATE: April 27, 2021 ORDER Entitlement to service connection for diabetes mellitus, to include as secondary to obesity caused by service-connected acquired psychiatric disorder and back condition, is granted. FINDING OF FACT The Veteran’s diabetes mellitus is proximately due to his obesity caused by his service-connected acquired psychiatric disorder and back condition. CONCLUSION OF LAW The criteria for entitlement to service connection for diabetes mellitus, to include as secondary to obesity caused by service-connected acquired psychiatric disorder and back condition, have been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the U.S. Army from June 1968 to December 1969. The Board of Veterans’ Appeals (Board) remanded the issue of entitlement to service connection for diabetes mellitus for further development in April 2020 and September 2018. Specifically, the Board instructed the regional office (RO) to schedule the Veteran for a VA examination pertaining to his claim. Entitlement to service connection for diabetes mellitus, to include as secondary to obesity caused by service-connected acquired psychiatric disorder and back condition, is granted. The Veteran contends that his diabetes mellitus is secondary to his obesity, which is caused by his service-connected acquired psychiatric disorder and back condition. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 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 injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection may also be established on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disability. 38 C.F.R. § 3.310(a). Secondary service connection may also be established for a disorder which is aggravated by a service-connected disability; compensation may be provided for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310(b); Allen v. Brown, 8 Vet. App. 374 (1995). In order to prevail on the issue of secondary service connection, the record must show: (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998); see also Allen, supra. Obesity in of itself is not a disability eligible for service connection. Marcelino v. Shulkin, 29 Vet. App. 155 (2018). That notwithstanding, obesity may act as an “intermediate step” between a service-connected disability and a current disability that may be service-connected on a secondary basis under 38 C.F.R. § 3.310(a). See Walsh v. Wilkie, 32 Vet. App. 300 (2020). As the Veteran is service-connected for an acquired psychiatric disorder and back condition and contends that these two service-connected conditions caused his weight gain, obesity could be the “intermediate step” between his service-connected conditions and his diabetes mellitus. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). As will be addressed below, the Board finds that service connection for diabetes mellitus is warranted on a secondary basis. Consequently, the Board will not address direct service connection further herein. First, the record shows the Veteran has been diagnosed with diabetes mellitus, type II. See December 2013 Medical Treatment Record – Non-Government Facility. Thus, the first element of secondary service connection has been met. Wallin, 11 Vet. App. at 512. Regarding secondary service connection, the Board notes that the Veteran is service connected for an acquired psychiatric disorder and a back condition; thus, the second element of secondary service connection is met. Wallin, 11 Vet. App. at 512. The remaining question is whether there is a medical nexus between the Veteran’s currently diagnosed diabetes mellitus and his service-connected acquired psychiatric disorder and back condition. As to this matter, the evidence conflicts. A private opinion provided by Dr. J.W., who was the Veteran’s treating physician, was associated with the Veteran’s claim file in December 2013. She noted that the Veteran began smoking in 1968 and was diagnosed with anxiety in 1969. She explained that the Veteran started smoking in an attempt to self-treat his anxiety. The Veteran quit smoking in 1991, and he began to gain weight through overeating, which was another method of self-treatment for his anxiety. When his weight increased from 235 pounds to 355 pounds, he became diabetic. Because diabetes is not found in the Veteran’s family history and he was not exposed to Agent Orange during his service, there was a definite causal effect between his weight gain that linked his anxiety to his diabetes mellitus. The Veteran appeared for a VA examination in January 2021, in which the examiner opined the Veteran’s diabetes mellitus is less likely than not proximately due to or the result of the Veteran’s service-connected acquired psychiatric disorder, back condition, or obesity. He found that there was no aggravation by the acquired psychiatric disorder or the back condition because the Veteran’s diabetes was well-controlled. He cited the Mayo Clinic and explained that type II diabetes develops when the body becomes resistant to insulin or when the pancreas is unable to produce enough insulin. The examiner explained that, while why it happens is unknown, genetics and environmental factors, such as being overweight and inactive, seem to be contributing factors. However, the January 2021 examiner also acknowledged that there was at least a 50 percent probability that weight gain with smoking cessation and mental triggers could also cause weight gain. Despite these acknowledgments, the examiner noted that he could not find supporting evidence that lower back pain would cause 100 pounds of weight gain and that obesity alone caused diabetes mellitus. (Continued on the next page)   After careful consideration, the Board finds that the evidence regarding nexus is at least in equipoise, particularly when considering the private 2013 opinion and lay evidence of record. The Board notes that while the January 2021 examiner gave negative nexus opinions, he conceded that smoking cessation, mental triggers, and inactivity can cause weight gain, and that being overweight and inactive are contributing factors to developing diabetes; thus, the January 2021 opinion also provides supportive evidence. When the evidence for and against a claim is in relative equipoise, the Board has an obligation to resolve all reasonable doubt in favor of the Veteran. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Resolving all reasonable doubt in the Veteran’s favor, the Board finds that the third element of secondary service connection is established. Shedden, 381 F.3d at 166-67. Thus, service connection for diabetes mellitus is warranted. A. S. CARACCIOLO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. L. Park, 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.