Citation Nr: 21039834 Decision Date: 07/01/21 Archive Date: 07/01/21 DOCKET NO. 16-44 741 DATE: July 1, 2021 ORDER Service connection for diabetes mellitus, type II, is denied. FINDING OF FACT Diabetes mellitus, type II, is not shown to be causally or etiologically related to any disease, injury, or incident during service, and did not manifest to a compensable degree within one year of separation from active duty. CONCLUSION OF LAW The criteria for service connection for diabetes mellitus, type II, have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1131, 1137, 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 from March 1968 to April 1998. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2013 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In February 2019, the Board remanded the claim on appeal, as well as claims for entitlement to service connection for dizziness and atrial fibrillation. While on remand, an October 2020 rating decision granted service connection for vertigo with hearing loss and tinnitus and atrial fibrillation with signs of hypertensive heart disease. As such represents a full grant of the benefits sought with respect to such issues, they are no longer before the Board. Grantham v. Brown, 114 F.3d 1156, 1159 (Fed. Cir. 1997). The remaining issue now returns for further appellate review. Additional evidence was received subsequent to the most recent supplemental statement of the case. As the evidence is not pertinent to the claim on appeal, a remand for RO consideration of the evidence is not necessary. See 38 C.F.R. § 20.1304(c). The Veteran has a separate appeal pending for issues involving the right knee, left ring finger, left knee, and right shoulder. A separate decision by the Board will be issued under a different docket number, which will be sent to the Veteran and his representative under separate cover at a later date. Entitlement to service connection for diabetes mellitus, type II. The Veteran contends he has diabetes mellitus, type II (herein after "diabetes") that began in service, as is demonstrated by his glucose levels. A. Applicable Law Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). Additionally, where a veteran served for at least 90 days during a period of war or after December 31, 1946, and manifests certain chronic diseases, such as diabetes mellitus, to a degree of 10 percent within one year, from the date of termination of such service, such disease shall be presumed to have been incurred or aggravated in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1137; 38 C.F.R. §§ 3.307, 3.309. Where a veteran served for at least 90 days during a period of war or after December 31, 1946, and manifests certain chronic diseases, such as diabetes mellitus, to a degree of 10 percent within one year, from the date of termination of such service, such disease shall be presumed to have been incurred or aggravated in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1137; 38 C.F.R. §§ 3.307, 3.309. Alternatively, when a disease at 38 C.F.R. § 3.309(a) is not shown to be chronic during service or the one year presumptive period, service connection may also be established by showing continuity of symptomatology after service. 38 C.F.R. § 3.303(b). However, the use of continuity of symptoms to establish service connection is limited only to those diseases listed at 38 C.F.R. § 3.309(a) and does not apply to other disabilities which might be considered chronic from a medical standpoint. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). B. Discussion This claim is denied as the most probative evidence of record establishes that the Veteran's diabetes was not incurred during service. Service treatment records (STRs) dated July 1986 and January 1998 reflect glucose readings of 98 mg/dL and 84 mg/dL, respectively. Additional STRs note that urinalyses conducted in August 1980 and October 1997 reflect negative glucose. The only other references to glucose levels or diabetes are found in annual Dental Health Questionnaires completed in October 1989, November 1990, December 1991, and February 1993, in which the Veteran stated he did not have diabetes. Further, such disorder is not documented on his January 1998 retirement examination. A urinalysis at that time was negative for sugar. The Board notes, in his January 2015 letter, the Veteran specifically contended that his glucose levels have been consistently between 100 and 119 ml/dl during his military service, and the "Medical World" subsequently lowered the standard to less than 100 such that he would be identified as diabetic. The Board has considered the Veteran's assertions as to the etiology of his diabetes mellitus, type II; however, as a lay person, he does not have the requisite training and experience necessary to address such a complex medical matter. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). In this regard, the diagnosis and etiology of diabetes involve a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship and, thus, may not be competently addressed by lay statements. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). This requires an understanding of the current state of medicine on this subject and the ability to interpret complex diagnostic testing corresponding to that medicine. The Veteran has demonstrated that he is not competent in this area. For instance, contrary to his assertion regarding the "lowered standard" for diagnosing diabetes, a November 2019 VA examiner contradicted his belief by establishing that the American Diabetes Association (ADA) criteria requires two separate fasting glucose readings greater than 126 mg/dL to diagnosis diabetes. Moreover, whether the symptoms the Veteran reportedly experienced during or after service are in any way related to diabetes, is a matter that also requires medical expertise to determine. See Clyburn v. West, 12 Vet. App. 296, 301 (1999). Accordingly, the Veteran's opinion as to the onset and etiology of his diabetes is not competent evidence and, consequently, is afforded no probative weight. Looking to the medical evidence of record, VA treatment records reflect a diagnosis of diabetes, as well as impaired glucose tolerance. In this regard, the Veteran underwent a glucose tolerance test in July 2011. At such time, his glucose levels were 242 at 1 hour and 176 at 2 hours, and he was diagnosed with diabetes based on this test. However, the provider noted that previously, the Veteran did not meet the criteria for diabetes by fasting blood sugar but had been in the prediabetic range. VA treatment records reflect 5.7% A1C with a fasting glucose reading of 120 mg/dL, a fasting glucose reading of 98 mg/dL, 5.6% A1C, 5.6% A1C, 5.6% A1C, 5.5% A1C, and 5.8% A1C, with a fasting glucose reading of 125 mg/dL. See June 2011, August 2013, August 2015, December 2016, October 2017, August 2018, and January 2020 records, respectively. Pursuant to the February 2019 remand, the Veteran underwent VA examination in November 2019. Diabetes, type I or II, was not shown on examination. Rather, the examiner noted the Veteran had a diagnosis of impaired fasting glucose/impaired glucose tolerance (IGT). In this regard, the VA examiner found no evidence of a diagnosis of diabetes upon review of the Veteran's clinical records, but noted glucose levels of 98 mg/dL and 100 mg/dL in January 2000 and October 2001 respectively, indicating that the Veteran's impaired fasting glucose/impaired glucose tolerance had its onset greater than 3 years after service. Specifically, the examiner noted glucose readings ranging from 100 to 118 mg/dL, with readings of 173 mg/dL in August 2008 and 160 mg/dL in January 2017. The examiner explained that ADA criteria requires two separate fasting glucose readings greater than 126 mg/dl to diagnosis diabetes. In this regard, the examiner noted food status [fasting] was not documented at the time of the Veteran's January 2017 glucose testing, and based on other laboratory data at that time, it is highly unlikely that such value was obtained in a fasting state. Thus, she opined the objective laboratory data is overwhelmingly against a diagnosis of diabetes for the Veteran. The VA examiner further discussed the Veteran's diagnosis of diabetes contained in various VA and private treatment records. In this regard, the examiner stated that while IGT was definitively documented in July 2011, and additional elevated glucose levels between 2003 and 2011, such data is insufficient for diagnosis as the timing in relation to last food is not noted within the laboratory data. The Board affords great probative weight to the November 2019 VA examiner's opinions as such considered all of the pertinent evidence of record, to include the statements of the Veteran and relevant medical history, and provided a complete rationale, relying on and citing to the records reviewed. Moreover, the examiner offered clear conclusions with supporting data as well as reasoned medical explanations connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). Overall, there is some conflicting evidence as to whether the Veteran has a current diagnosis of diabetes. Even with such a diagnosis, it comes more than 13 years post-separation, and evidence prior to July 2011 indicates the Veteran did not have diabetes, but instead IGT, as found by the November 2019 VA examiner and the July 2011 VA clinician. Even the diagnosis of IGT is shown to have an onset well after service, which weighs against a finding that the precursor to the disease had its first onset during service. (Continued on the next page) Therefore, diabetes is shown by the competent evidence to not be causally or etiologically related to any disease, injury, or incident during service and did not manifest to a compensable degree within one year of separation from service. Thus, service connection for such disorder cannot be granted. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not applicable and the claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra. Corey Bosely Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. M. Kelly, 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.