Citation Nr: 22017543 Decision Date: 03/25/22 Archive Date: 03/25/22 DOCKET NO. 16-47 493 DATE: March 25, 2022 ORDER Entitlement to service connection for diabetes mellitus is denied. FINDING OF FACT Diabetes mellitus did not manifest during active service or within one year of service and is not otherwise related to service or a service-connected disability. CONCLUSION OF LAW The criteria for entitlement to service connection for diabetes mellitus have not been met. 38 U.S.C. §§ 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1979 to June 1982. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2015 rating decision. The issue was remanded for additional development in January 2020 and October 2021. In August 2019, the Veteran testified at a personal hearing before a Veterans Law Judge who is unavailable to participate in this decision. The Veteran did not respond to a notice in July 2021 informing him of his right to another hearing and his request for a Board hearing is considered to have been satisfied. The transcript of that hearing is of record. Service Connection for Type II Diabetes Mellitus Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131. Service connection connotes many factors but basically it means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein. 38 C.F.R. § 3.303(a). Service connection may be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a). Any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease, will be service connected. 38 C.F.R. § 3.310(b). Compensation may be established for any incremental increase in disabilityany additional impairment of earning capacityin nonservice-connected disabilities resulting from service-connected conditions, above the degree of disability existing before the increaseregardless of its permanence. Ward v. Wilkie, 31 Vet. App. 233, 239 (2019). Generally, the evidence 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. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). The term "disability" for VA compensation purposes refers to the functional impairment of earning capacity rather than the underlying cause of the impairment. See Saunders v. Wilkie, 887 F.3d 1356, 1364-68 (Fed. Cir. 2018). Certain chronic diseases, including diabetes mellitus, are subject to presumptive service connection if manifest to a compensable degree within one year from separation from service even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1112, 1113, 1137; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). Under 38 C.F.R. § 3.303(b), an alternative method of establishing the second and third Shedden element is through a demonstration of continuity of symptomatology if the disability claimed qualifies as a chronic disease listed in 38 C.F.R. § 3.309(a). It is the policy of VA to administer the law under a broad interpretation, consistent with the facts in each case, with all reasonable doubt to be resolved in favor of the claimant. 38 C.F.R. § 3.102. Service treatment records are negative for complaint, treatment, or diagnosis related to diabetes mellitus. There is likewise no evidence that diabetes mellitus was diagnosed within a year of service discharge. Records document the initial diagnosis over a decade after service. The Veteran does not argue the contrary. Rather, he asserts that diabetes mellitus developed secondary to his service-connected hypertension. Service connection is established hypertension, visual field loss and pseudophakia, a kidney condition, cerebral atherosclerosis, and erectile dysfunction. VA treatment records dated in December 2005 show the Veteran reported having been diagnosed with diabetes mellitus. Subsequent records note treatment for type II diabetes mellitus. VA examination in November 2020 included a diagnosis of type I diabetes mellitus. A date of diagnosis in 2000 was provided. No information was provided as to basis for the diagnosis. The examiner found that the Veteran's diabetes mellitus was less likely proximately due to or the result of his service-connected hypertension. It was noted that diabetes mellitus was not caused by hypertension and was likely caused by a combination of genetic susceptibility and environmental factors. A January 2022 VA medical opinion found the Veteran's diabetes mellitus was less likely proximately due to or the result of a service-connected condition. Reference was made to medical literature indicating type II diabetes mellitus occurred when the pancreas did not make enough insulin to regulate glucose in the bloodstream. It was noted the medical literature did not support hypertension as causative for type II diabetes mellitus, but that individuals with hypertension had an increased risk for type II diabetes mellitus. The examiner explained that hypertension itself did not cause an elevation of blood glucose or a decrease in insulin production and that a direct causative effect was not medically established. The VA examiner also found that the medical literature did not support hypertension as an aggravating factor for type II diabetes mellitus, and that the evidence did not indicate that hypertension had aggravated the Veteran's type II diabetes mellitus. Hypertension was described as a condition which occurs when the force of blood against the artery walls is too high. It did not result in elevated glucose or insulin dysfunction. Though it is common for individuals to have both of these conditions, the examiner state the medical literature does not support a causal relationship. Considering the evidence, the Veteran's diabetes mellitus was found to be less likely aggravated beyond its natural progression by hypertension. Based upon the evidence of record, the Board finds that diabetes mellitus was not manifested during or within one year of the Veteran's active service. There is again no evidence of a diagnosis of either type I or type II diabetes mellitus within one year of active service. The Board notes that the November 2020 VA examiner checked the box on the examination form noting a diagnosis of type I diabetes mellitus. However, no additional comments were provided as to the basis for the change of diagnosis. The record otherwise establishes a diagnosis of diabetes mellitus type II. Thus, in the absence of explanation or other indication of type I diabetes mellitus, the November 2020 report is found to have been a typographical error. The Board further finds that the persuasive of the evidence fails to establish that the Veteran's diabetes mellitus type II is etiologically related to service or a service-connected disability. The January 2022 VA opinions is persuasive and based upon adequate rationale. The examiner is shown to have reviewed of the evidence of record, including applicable medical literature, and to have adequately considered the credible lay statements and reported symptom manifestation history of record. See Dalton v. Nicholson, 21 Vet. App. 23 (2007). There is no competent medical opinion to the contrary. Consideration has also been given to the Veteran's personal assertions that he has diabetes mellitus as a result of active service. However, while lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), the specific issue in this case falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The disability at issue is not a condition that is readily amenable to lay diagnosis or probative comment regarding etiology. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). In conclusion, the Board finds service connection for diabetes mellitus is not warranted. The persuasive evidence is against the claim. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Douglas 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.