Citation Nr: 22015221 Decision Date: 03/16/22 Archive Date: 03/16/22 DOCKET NO. 16-18 622 DATE: March 16, 2022 ORDER Entitlement to service connection for diabetes mellitus type II, secondary to hypertension (HTN) is granted. FINDING OF FACT The evidence is in relative equipoise as to whether the diabetes mellitus type II is causally related to the service-connected HTN. CONCLUSION OF LAW The criteria for service connection for diabetes mellitus type II, as secondary to service-connected HTN, have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January 1969 to January 1989. This case comes before the Board of Veterans' Appeals (Board) from a May 2015 rating decision from a Department of Veterans Affairs (VA) regional office (RO). This matter was previously before the Board in September 2018, May 2020 and November 2021. The November 2021 Board decision remanded the claims for service connection for coronary artery disease CAD and diabetes mellitus type II. The claim for service connection for CAD was granted in a December 2021 rating decision. As this satisfies the claim on appeal, the matter of service connection for CAD is no longer before the Board. The only remaining issue on appeal is entitlement to service connection for diabetes mellitus type II. Service Connection Service connection may be established for disability resulting from personal injury suffered or disease contracted in the line of duty from active military, naval, or air service. 38 U.S.C. §§ 1110, 1131. "To establish a right to compensation for a present disability, 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) (citing Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that which is pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection may be granted for a disability which is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310(a). Additional disability resulting from the aggravation of a nonservice-connected disability by a service-connected disability is also compensable under 38 C.F.R. § 3.310(a). Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). 1. Entitlement to service connection for diabetes mellitus, secondary to hypertension (HTN) The Veteran seeks service connection for diabetes mellitus type II. He contends that such is directly due to his service, and/or as secondary to or aggravated by service-connected HTN and/or coronary artery disease. The evidence of record shows that the Veteran has a diagnosis of diabetes mellitus type II. Thus, the question becomes whether the current disability is related to his service or to a service-connected disability. A June 2021 VA examination found that the Veteran's diabetes mellitus was less likely than not due to service on a direct basis. By way of rationale, the examiner noted "no sufficient treatment record that will support that the illness was incurred in or caused by claimed in service-injury, event, or illness." A December 2021 VA examiner was also asked to opine on whether the Veteran's diabetes mellitus was caused or aggravated by his service-connected HTN or CAD. The examiner found that the Veteran's diabetes mellitus was not caused or aggravated by his service connected conditions. With regard to causation, the examiner found that "[w]hile [h]ypertension and [a]therosclerosis can worsen the conditions related to [d]iabetes, I can't find any medical literature that identifies [h]ypertension and [a]therosclerosis as direct cause of [d]iabetes [m]ellitus." With regard to aggravation, the examiner opined that HTN "can lead to many complications of diabetes, including diabetic eye disease and kidney disease, or make them worse. Most people with diabetes will eventually have high blood pressure, along with other heart and circulation problems." Upon review of the record, the Board finds the evidence is in equipoise as to whether the Veteran's current diabetes mellitus type II is secondary to his service-connected HTN. Although the June 2021 and December 2021 VA examiners offered a negative nexus opinion, the June 2021 VA examiner based their opinion on a lack of treatment in service, which is not a sufficient basis on which to deny a claim for service connection. Moreover, the December 2021 rationale lends support of a nexus on a secondary basis as it found that both CAD and HTN can worsen diabetic conditions and, HTN in specific, can worsen complications of diabetes. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for diabetes mellitus type II is warranted as secondary to service-connected HTN. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. MARJORIE A. AUER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Kelsey Love, 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.