Citation Nr: 22014005 Decision Date: 03/11/22 Archive Date: 03/11/22 DOCKET NO. 15-20 484 DATE: March 11, 2022 ORDER Entitlement to service connection for diabetes mellitus, type II (DMII), with diabetic peripheral polyneuropathy, is granted. FINDING OF FACT The Veteran's diabetes mellitus, type II, had its onset during active duty service. CONCLUSION OF LAW The criteria for entitlement to service connection for diabetes mellitus, with diabetic peripheral polyneuropathy have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty service with the U.S. Army from March 1973 to February 1978. He was then a member of the Army Reserve, with multiple periods of active and inactive duty for training (ACDUTRA and INACDUTRA, respectively), and a period of active duty from September 1990 to October 1990. This case comes before the Board of Veterans' Appeals (Board) on appeal from an August 2013 rating decision of the Department of Veterans Affairs (VA) agency of original jurisdiction (AOJ). During the pendency of the appeal, the AOJ granted service connection for nerve damage (left hand), nerve damage (left arm), and acquired psychiatric disability, which is a full grant of the benefits sought on appeal; therefore, the issue of service connection for nerve damage (left hand), nerve damage (left arm), and acquired psychiatric disability is not before the Board. See May and October 2021 rating decisions. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish entitlement to service-connected compensation benefits, a Veteran must show: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service-the so-called "nexus" requirement." Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Active service includes periods of ACDUTRA during which an individual was disabled or died from a disease or injury incurred or aggravated in line of duty. 38 C.F.R. § 3.6(a). Service connection may also be granted for disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). Determinations as to service connection will be based on review of the entire evidence of record, to include all pertinent medical and lay evidence, with due consideration to VA's policy to administer the law under a broad and liberal interpretation consistent with the facts in each individual case. 38 U.S.C. § 1154(a); 38 C.F.R. § 3.303(a). Service treatment records (STRs) reveal normal blood glucose readings through at least an April 1988 periodic examination. An October 1989 correspondence indicated that the Veteran was ordered for annual training for 18 days starting October 17, 1989, in Egypt. A December 1989 treatment record included in the STRs stated the doctor suspect that the Veteran was "developing diabetes mellitus" based on his recent history. The Veteran reported a 3-month history of dizziness, frequent urination, excessive thirst, and weight loss. The Veteran's urine showed traces of protein and 4+ glucose. There was a large number of ketones present. The Veteran was put on a diet and prescribed DiaBeta. January 1990 treatment records documented that he still had elevated glucose levels. A March 1990 VA treatment note formally noted the diagnosis of type II diabetes. In February 2019, the Veteran testified that he was diagnosed with DMII in the 1980s. He noted that his unit was called to deploy; however, he was considered nondeployable because of his DMII. The Veteran felt that his time in the reserves caused his DMII. He indicated that he did not get DMII until he came back from Egypt. A March 2021 DMII disability benefits questionnaire (DBQ) documented that he was diagnosed with DMII The examiner opined that the claimed condition was at least as likely as not (50 percent or greater probability) incurred in or caused by the claimed in-service injury, event, or illness. She explained that the Veteran had elevated glucose readings while in-service. She indicated that the Veteran did not have DMII prior to his service. She noted that he was diagnosed with DMII, type II in the 1980s while in military service with a glucose reading of 351 with symptoms related to uncontrolled diabetes. On August 2021 an addendum opinion, the examiner noted that although the VA notes he was diagnosed with elevated glucose levels in 1981, a diagnosis of DMII was not confirmed until January of 1991. Routine military medical examinations dated January 10, 1984 and April 12, 1988 were silent for a diabetes condition/diagnosis. She opined that the Veteran's claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. Her rationale was that the Veteran's diagnosis of DMII was in January 1990 and was not during a period of active duty service. The fasting blood sugars that were completed and confirmed this diagnosis were taken based on symptoms occurring in late 1989, approximately October through December of that year, which was not a period of active service. Setting aside the apparent confusion over the timeline reflected in the VA examinations and opinion, the Board notes that the December 1989 treatment record indicated that he was seen soon after deployment. The Veteran presented symptoms that were indicative of DMII and testing was done. Following testing the Veteran was prescribed medication (DiaBeta) and was finally diagnosed as early as January 1990. While this diagnosis was made after active duty service, it was based on the symptoms which were reported starting during the period of ACDUTRA in October 1989. Therefore, resolving any benefit of the doubt in favor of the Veteran, the Board finds the evidence is at least in equipoise with respect to whether the diabetes mellitus had its onset during active military service. Service connection is warranted WILLIAM H. DONNELLY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Baxter 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.