Citation Nr: 21042391 Decision Date: 07/12/21 Archive Date: 07/12/21 DOCKET NO. 16-00 605 DATE: July 12, 2021 ORDER Entitlement to service connection for diabetes mellitus is denied. FINDING OF FACT The preponderance of the evidence of record is against finding that the Veteran was diagnosed with diabetes mellitus at any time during or proximate to the pendency of the claim. CONCLUSION OF LAW The criteria for entitlement to service connection for diabetes mellitus have not been met. 38 U.S.C. §§ 1110, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from July 1965 to January 1969. The Board remanded this case in September 2018. The remand directed the regional office (RO) to ask the Veteran to identify and authorize release of any outstanding medical treatment records, obtain the Veteran's updated VA treatment records, and, if the records did not establish the presence of diabetes mellitus, schedule the Veteran for a VA examination to determine whether he suffers from diabetes mellitus. Pursuant to the remand, the RO asked the Veteran in October 2019 to identify any outstanding medical treatment records. The Veteran submitted a completed VA Form 21-4142 in November 2019, and records from the medical treating source listed on that VA Form 21-4142 were subsequently obtained. The RO also obtained the Veteran's updated VA treatment records, afforded the Veteran a VA examination in December 2020, and obtained a VA addendum opinion in April 2021. The December 2020 VA examination and the April 2021 VA addendum opinion are responsive to the relevant September 2018 remand directive and provide the information required to render a decision on the appeal. Accordingly, the Board finds that VA at least substantially complied with the September 2018 remand. See 38 U.S.C. § 5103A(b); Stegall v. West, 11 Vet. App. 268, 271 (1998); D'Aries v. Peake, 22 Vet. App. 97, 105 (2008). The Veteran's representative argued in a June 2021 brief that the RO improperly obtained the December 2020 VA examination and April 2021 VA addendum opinion because the September 2018 Board remand directed the RO to do so "If, and only if, treatment records do not establish the presence of diabetes mellitus", but the medical treatment records do establish a diagnosis of diabetes mellitus. The representative also argued in that brief that the April 2021 VA addendum opinion contains a contradiction. However, as discussed below, the Board finds that the April 2021 VA addendum opinion is probative and not contradictory, and that the competent evidence of record is against finding that the Veteran was diagnosed with diabetes mellitus at any time during or proximate to the pendency of the claim. Therefore, the Board finds no error in the RO's actions. Neither the Veteran nor his representative has raised any other issues with regard to the duty to notify or duty to assist as they pertain to the issue denied in this decision. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board . . . to search the record and address procedural arguments when the veteran fails to raise them before the Board."); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). The analysis in this decision focuses on the most relevant evidence and on what the evidence shows or does not show with respect to the issue denied in this decision. The Veteran should not assume that evidence that is not explicitly discussed in the decision has been overlooked. See Timberlake v. Gober, 14 Vet. App. 122 (2000) (noting that the law requires only that reasons for rejecting evidence favorable to the claimant be addressed).. Entitlement to service connection for diabetes mellitus The Veteran contends that he has diabetes mellitus that is related to in-service exposure to herbicide agents. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 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). Certain diseases, to include diabetes mellitus, type 2, may be presumed to have been incurred in service where a veteran was exposed to herbicide agents while on active service, even when there is no evidence of such a disease during the period of service. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307(a)(6), 3.309(e). The Board has previously found that the evidence in this case is at least in equipoise as to whether the Veteran was exposed to herbicide agents during his service in Thailand during the Vietnam era. Therefore, the question for the Board is whether the Veteran has a current disability of diabetes mellitus, type 2, such that service connection must be granted on a presumptive basis under 38 C.F.R. §§ 3.307 and 3.309. The Board concludes that the Veteran does not have a current diagnosis of diabetes mellitus, type 2, and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). In his claim, the Veteran indicated that he was first treated for diabetes in September 2007 by a Dr. Tomasso. However, records obtained from Dr. Tomasso do not confirm such a diagnosis. Rather, they show that the Veteran has been determined to be prediabetic and has been prescribed Metformin. They also show that the Veteran has had high blood glucose readings, including 109 in September 2016, 145 in June 2017, and 109 in December 2017, as well as A1C readings, including 6.2 in September 2016 and 5.7 in December 2017. In addition, Dr. Tomasso completed a VA Form 21-0960E-1, Diabetes Mellitus Disability Benefits Questionnaire (DBQ), in October 2012 in which he described the Veteran's condition as "impaired fasting glucose" and declined to diagnose the Veteran with diabetes mellitus, type 2. Thus, Dr. Tomasso's treatment records and October 2012 DBQ do not show a diagnosis of diabetes mellitus, type 2. The Veteran's VA treatment records show that the Veteran has reported a past medical history of prediabetes, that he has impaired glucose tolerance, and that he had a high blood glucose reading of 123 in January 2014. They also show that the Veteran has been prescribed Metformin. They do not show that the Veteran has been diagnosed with diabetes mellitus, type 2. Treatment records dated in December 2020 and January 2021 note a history of DM2, but then state that the Veteran is "prediabetic." The December 2020 VA examiner provided conflicting information as to whether the Veteran has a diagnosis of diabetes mellitus, type 2. Specifically, she first marked on a diabetes mellitus DBQ form that there is an official diagnosis of diabetes mellitus, type 2, but then indicated under the "Diagnostic Testing" section that the diagnostic criteria for diabetes mellitus, type 2, have not been met based on plasma glucose testing or A1C. In an accompanying opinion, the examiner stated, "Veteran does not have elevated glucose or meet the VA criteria of diabetes, However, veteran has been taking Metformin for many years which is likely controlling his diabetes." The April 2021 VA addendum opinion was obtained to clarify the statements in the December 2020 DBQ and opinion and establish whether the Veteran has a diagnosis of diabetes mellitus, type 2. The examiner who provided the VA addendum opinion reviewed the record and determined that the Veteran's diagnosis is "impaired fasting glucose". In support of that finding, the examiner explained that the Veteran does not meet the VA criteria for diabetes mellitus, type 2. Specifically, there is no evidence of record to show fasting plasma glucose levels of 126 on two different dates, hemoglobin A1C of 6.5 on two different dates, or at least one of each result. In addition, although the Veteran is taking Metformin, which controls his blood sugar levels, he does not have evidence of record to establish a diagnosis of diabetes mellitus, type 2. The Board affords the April 2021 VA addendum opinion probative value because it was based on a review of the record and is consistent with the record. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Prejean v. West, 13 Vet. App. 444 (2000). As discussed above, the record does not show that the Veteran has been formally diagnosed with diabetes mellitus, type 2. He has not met the diagnostic criteria for diabetes mellitus, type 2, as described by the December 2020 and April 2021 VA examiners. He had a blood glucose rating of 145 on one occasion, but did not have a blood glucose reading of 126 or greater on two separate dates or at least one A1C reading of 6.5 or greater. The Board further finds that the April 2021 VA addendum opinion sufficiently clarifies any contradictory statements contained in the December 2020 VA examination and opinion. The April 2021 VA examiner explained that, based the clinical evidence, the Veteran does not meet the diagnostic criteria for diabetes mellitus, type 2. He also explained that the fact that the Veteran has been prescribed Metformin is not in and of itself indicative of a diagnosis of diabetes mellitus, type 2. The Board acknowledges the references in the medical treatment records to the Veteran's reported prior history of diabetes mellitus, type 2, and to the assessments of diabetes mellitus, type 2, based on that reported history. However, those references to reported medical history and the assessments based on the reported medical history are not acceptable diagnoses because they are based on Veteran's self-reported history rather than any accepted diagnostic criteria. The record does not show that the Veteran has the medical knowledge and expertise to diagnose a disability such as diabetes mellitus, type 2. See Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Therefore, any diagnosis based on the Veteran's own self reporting, even when included in the assessment or diagnosis portion of a medical treatment note, is not probative in showing that he has been diagnosed with diabetes mellitus, type 2. Additionally, the notations in the medical records that the Veteran has prediabetes or impaired fasting glucose reflect that the Veteran has not been diagnosed with diabetes mellitus, type 2. Furthermore, the findings of prediabetes and impaired fasting glucose are descriptions of laboratory values, which are not themselves a disease upon which VA disability benefits can be based. See Schedule for Rating Disabilities; Endocrine System, 61 Fed. Reg. 20440, 20445 (May 7, 1996) (Supplementary Information); see also https://medlineplus.gov/prediabetes.html (last accessed July 8, 2021; stating, "Prediabetes means that your blood glucose, or blood sugar, levels are higher than normal but not high enough to be called diabetes."). Therefore, prediabetes and impaired fasting glucose are not indicative of a diagnosis of diabetes mellitus, type 2, and are not themselves disabilities for which service connection may be granted. In summary, the Board finds that the preponderance of the evidence of record is against finding that the Veteran was diagnosed with diabetes mellitus at any time during or proximate to the pendency of the claim. In view of the foregoing, the Board concludes that the preponderance of the evidence is against the claim for entitlement to service connection for diabetes mellitus. Because the preponderance of the evidence is against the claim, the doctrine of reasonable doubt is not for application, and the claim must be denied. 38 U.S.C. § 5107(b); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). MICHAEL MARTIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. J. Anthony, 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.