Citation Nr: 21029617 Decision Date: 05/14/21 Archive Date: 05/14/21 DOCKET NO. 16-33 353 DATE: May 14, 2021 ORDER Entitlement to service connection for diabetes mellitus type II is granted. FINDING OF FACT The Veteran's diabetes mellitus type II manifested to a compensable degree within one year of his separation from service and is not attributable to intercurrent causes. CONCLUSION OF LAW The criteria for entitlement to service connection for diabetes mellitus type II are met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from June 2001 to June 2010. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Atlanta, Georgia. This matter is in VA's legacy appeals system. Entitlement to service connection for diabetes mellitus type II The Veteran asserts that his diabetes mellitus type II (diabetes) manifested to a compensable degree within one year of his separation from service. Certain chronic diseases 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 has a current diagnosis of diabetes as evidenced by treatment records showing his diagnosis and ongoing treatment since October 2011. Diabetes is an enumerated condition under 38 C.F.R. § 3.309(a); Walker, 708 F.3d 1331. The Veteran's DD 214 shows that the Veteran had active service from June 28, 2001 to June 30, 2010. Post-service treatment records show that the Veteran was first diagnosed with diabetes in October 2011 when he sought treatment at a VA emergency department for symptoms including thirst, polyuria, and unexplained weight loss. While the Veteran's diabetes was diagnosed outside of the one-year period following his separation from service, there is evidence that his condition began and manifested to a compensable degree within that period. In May 2020, a VA examiner opined that the Veteran's diabetes more likely than not had its onset within one year of separation from service. The rationale was that the Veteran's pre-separation examination showed a fasting blood glucose of 106 mg/dl (normal range is 74 106 mg/dl), an obese BMI, and a family history of diabetes, all consistent with the Veteran being on the cusp of pre-diabetes when he left service. By the time of his diagnosis in October 2011 the Veteran's blood glucose level had risen to 912 mg/dl. The examiner opined that this data was consistent with the Veteran developing prediabetes soon after separation, with increased glucose and decreased insulin production due to pancreatic islet cell exhaustion, eventually developing into diabetes, with fasting blood glucose higher than 106 mg/dl, within one year of separation. There is no conflicting medical opinion of record, and the Board finds that the May 2020 VA examiner's opinion is based on a full review of the record and is consistent with the evidence of record. The Board therefore finds that the Veteran's diabetes had its onset within one-year of the Veteran's separation from service. The question that remains before the Board is whether the Veteran's diabetes manifested to a compensable level within one year of his separation from service. Diagnostic Code 7913 provides a structured scheme of specific, successive, cumulative criteria. Each higher rating includes the same criteria as the lower rating plus distinct new criteria. Middleton v. Shinseki, 727 F.3d 1172, 1178 (Fed. Cir. 2013). A 10 percent rating is warranted when diabetes is manageable by restricted diet only. A 20 percent rating is warranted when diabetes requires one or more daily injection of insulin and restricted diet, or an oral hypoglycemic agent and restricted diet. A 40 percent rating is warranted when it requires one or more daily injection of insulin, restricted diet, and regulation of activities. Regulation of activities is defined as avoidance of strenuous occupational and recreational activities. A 60 percent rating is warranted when diabetes requires one or more daily injection of insulin, restricted diet, and regulation of activities with episodes of ketoacidosis or hypoglycemic reactions requiring one or two hospitalizations per year or twice a month visits to a diabetic care provider, plus complications that would not be compensable if separately evaluated. A 100 percent rating is warranted when diabetes requires more than one daily injection of insulin, restricted diet, and regulation of activities, with episodes of ketoacidosis or hypoglycemic reactions requiring at least three hospitalizations per year or weekly visits to a diabetic care provider, plus either progressive loss of weight and strength or complications that would be compensable if separately evaluated. While the Veteran was not prescribed a restricted diet or medication within one year of his separation from service, there is evidence that this treatment would have been appropriate during that period. The Veteran has stated that after separating from service he did not have medical insurance and spent months trying to get an appointment with a VA treatment provider as his symptoms increased before he finally went to an emergency room for help in October 2011. The Veteran's treatment records show that upon diagnosis in October 2011 the Veteran was prescribed an oral hypoglycemic agent before he was discharged from the emergency department. Once he was diagnosed the Veteran was able to schedule an appointment with a VA diabetes educator within one month. At his first scheduled appointment the Veteran was assigned a restricted calorie diet. Resolving all reasonable doubt in favor of the Veteran, the Board finds that the severity of his blood glucose levels upon diagnosis, combined with the speed of his treatment providers prescribing both a restricted diet and an oral hypoglycemic agent, indicate that this would have been the appropriate level of treatment for his diabetes when it originally manifested several months before that. As a chronic condition, any subsequent manifestations are service-connected unless attributable to intercurrent causes. No intercurrent causes have been shown in this case and therefore the Veteran's diabetes mellitus type II is attributable to service. L. M. BARNARD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Zimmerman, Micah 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.