Citation Nr: 22018322 Decision Date: 03/28/22 Archive Date: 03/28/22 DOCKET NO. 20-21 218 DATE: March 28, 2022 ORDER Entitlement to service connection for diabetes mellitus type 2 (DM II) is granted. FINDING OF FACT The evidence of record is at least evenly balanced as to whether the Veteran's DM II first manifested in service. CONCLUSION OF LAW The criteria for entitlement to service connection for DM II have been met. 38 U.S.C. § 1110, 1131, 5107(b); 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 October 1987 to October 1994. This case comes before the Board of Veterans' Appeals (Board) on appeal from a January 2019 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO), which denied service connection for DM II. In June 2019 the Veteran filed a notice of disagreement (NOD) and in March 2020 the RO issued a statement of the case (SOC). In May 2020 the Veteran filed a substantive appeal (via VA Form 9). In March 2022 the Veteran testified during a virtual hearing before the undersigned Veterans Law Judge. The hearing transcript is not currently associated with the record. However, as the instant decision grants the benefit sought in full, there is no prejudice to the Veteran by proceeding without the hearing transcript. Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service incurrence of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted for a disease first diagnosed after service when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Certain chronic diseases, including DM II, may be presumed to have been incurred in or aggravated by service if manifest to a compensable degree within one year of discharge from service, even though there is no evidence of such disease during service. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309(a). Additionally, for chronic diseases service connection may be established under 38 C.F.R. § 3.303(b) if a chronic disease or injury is shown in service, and subsequent manifestations of the same chronic disease or injury at any later date, however remote, are shown, unless clearly attributable to intercurrent causes. DM II A January 2019 VA examiner noted that the Veteran was diagnosed with DM II dating back to November 2007. Thus, a current disability has been demonstrated. The remaining question is whether the Veteran's DM II manifested in service or to a compensable degree within 1 year following his separation from active service. The Veteran was not diagnosed with DM II while in service. However, there are numerous service treatment records (STRs) that indicate the Veteran experienced fatigability, dizziness, weight loss, and fainting while on active duty, which are symptoms associated with DM II. A September 1989 STR indicates that a physician likened these symptoms to "probable diabetes." On the December 2020 Statement of Accredited Representative (VA Form 646) the Veteran's representative argued that the September 1989 STR note constitutes a provisional diagnosis of DM II. Further, a September 1994 STR indicates that the Veteran was assessed for DM II, though it is unclear whether he was diagnosed at this time or shortly thereafter. Therefore, it is at least as likely as not that the Veteran's symptoms were early manifestations of his subsequently diagnosed DM II, and the reasonable doubt created by this relative equipoise in the evidence must be resolved in favor of the Veteran. 38 C.F.R. § 3.102 (the benefit of the doubt doctrine applies to any point within a claim as well as its ultimate disposition). The January 2019 VA examiner opined it is less likely than not that the Veteran's DM II was incurred in or caused by his active duty service. The VA examiner explained that the Veteran's fasting sugar and glucose laboratory results showed normal findings and that his in-service treatment records ruled out DM II. The VA examiner also explained that medical records indicate the Veteran was first diagnosed with DM II on November 7, 2007, which was over 12 years after being discharged from the military. Although the November 2007 diagnosis was made several years after the Veteran's service, the date of diagnosis is not dispositive. Establishing service connection on a presumptive basis does not require that a chronic disease be diagnosed within the applicable time period; rather, symptoms that manifest within this time period may subsequently be determined to have been early manifestations of a chronic disease. See 38 C.F.R. § 3.307(c); Traut v. Brown, 6 Vet. App. 495 (1994); 38 C.F.R. § 3.307(c) ("This will not be interpreted as requiring that the disease be diagnosed in the presumptive period, but only that there be then shown by acceptable medical or lay evidence characteristic manifestations of the disease to the required degree, followed without unreasonable time lapse by definite diagnosis"). Therefore, the January 2019 VA opinion is entitled to no probative weight as the VA examiner did not consider whether the Veteran's symptomatology could be considered early manifestations of his subsequently diagnosed DM II. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (most of the probative value of a medical opinion comes from its reasoning). For the foregoing reasons, the evidence is at least evenly balanced as to whether the Veteran's DM II first manifested in service. As the reasonable doubt created by this relative equipoise in the evidence must be resolved in favor of the Veteran, entitlement to service connection for DM II is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Jonathan Hager Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Miller, 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.