DIABETES MELLITUS

ERIC S. LEBOFF · 2026 · Case ID: 26000895

DENIED

Summary

The veteran, who served from June 1980 to April 1992, appeals the denial of service connection for type II diabetes mellitus. The veteran contends the diabetes began in service or is due to his service-connected conditions, including Behcet's Syndrome, chronic uveitis, renal insufficiency, valvular heart disease, hypertension, and pancytopenia. The Board reviewed multiple VA medical opinions from May 2013 through August 2024. These opinions consistently concluded that the veteran's diabetes was not related to service or proximately due to his service-connected conditions. The opinions cited the veteran's family history, obesity, and other lifestyle factors as the primary causes of his type II diabetes, noting that steroid eye drops, while potentially causing temporary glucose elevation, did not permanently aggravate or cause the diabetes. Service treatment records did not indicate any diabetes-related complaints or treatment during service. Post-service records showed an initial diagnosis in 2012, with a family history of diabetes noted. The Board found no evidence of continuity of symptomatology from service to the post-service diagnosis. The Board also found that the benefit of the doubt doctrine was not applicable as the evidence weighed against the claim. Therefore, service connection for type II diabetes mellitus was denied.

Rationale

No positive medical opinion supporting nexus to service.; Multiple VA opinions against service connection.; No evidence of in-service onset or continuity of symptomatology.; Diabetes likely due to independent risk factors (obesity, family history).

Special Benefit

NO SPECIAL BENEFIT

Docket No.

11-11 734

Full Decision Text

Citation Nr: 26000895
Decision Date: 01/22/26 Archive Date: 01/22/26

DOCKET NO. 11-11 734
DATE: January 22, 2026

ORDER

Entitlement to service connection for type II diabetes mellitus is denied.

FINDING OF FACT

The evidence of record persuasively weighs against finding that the Veteran's type II diabetes mellitus was shown as chronic in service or manifested to a compensable degree within the applicable presumptive period; continuity of symptomatology is established; and the disability is otherwise related to an in-service injury or disease.

CONCLUSION OF LAW

The criteria for service connection for type II diabetes mellitus are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 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 June 1980 to April 1992.

This matter comes before the Board of Veterans' Appeal (Board) on appeal of a June 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office.

The issue on appeal was previously remanded by the Board in August 2024 for additional development. Specifically, the Board instructed that an opinion be obtained addressing whether the Veteran's diabetes mellitus is related to service and/or proximately due to or aggravated by his service-connected auto-immune/Behcet's Syndrome, chronic uveitis, renal insufficiency and valvular heart disease, hypertension, and pancytopenia. This development was completed, and the claim was readjudicated in an April 2025 supplemental statement of the case. Thus, the Board concludes there has been substantial compliance with the remand with respect to the Veteran's claim, and it will proceed with adjudication of this issue. Stegall v. West, 11?Vet. App.?268 (1998).

1. Entitlement to service connection for type II diabetes mellitus.

The Veteran is seeking service connection for his type II diabetes mellitus, which he contends began in service and/or is due to his service-connected disabilities. See 4/27/13 VA Form 21-4138.

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38?U.S.C. §§?1110, 1131, 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).???

For veterans who served 90 days or more of active service, certain chronic diseases are presumed to have been incurred in service if the disease manifested to a compensable degree within one year of discharge from service. 38 U.S.C. §§ 11101, 1112; 38 C.F.R. §§ 3.303, 3.309. Alternatively, when a disease at 38 C.F.R. § 3.309(a) is not shown to be chronic during service or within the one-year presumptive period, service connection may also be established by showing continuity of symptomatology after service. 38 C.F.R. § 3.303(b). However, the use of continuity of symptoms to establish service connection is limited to those diseases listed in 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331, 1337 (Fed. Cir. 2013). Diabetes mellitus is a chronic disease listed in 38 C.F.R. § 3.309(a).

Service connection is also warranted for a disability which is proximately due to or the result of a service-connected disease or?injury. 38?C.F.R. § 3.310(a). Such secondary service connection?is warranted for any increase in severity of a nonservice-connected disability that is proximately due to or the result of a service-connected disability.?38 C.F.R. § 3.310(b).

The claimant is entitled to the benefit of the doubt when there is an "approximate" (meaning nearly equal) balance of positive and negative evidence regarding any material determination. See Lynch v. McDonough, 999 F.3d 1391 (
C.F.R. § 3.309(a).

Here, the Veteran has a current diagnosis of type II diabetes mellitus. See 7/15/21 VA Examination at 2. He contends that his diabetes is related to service and/or his service-connected disabilities of auto-immune disease/Behcet's Syndrome, chronic uveitis, renal insufficiency and valvular heart disease, hypertension, pancytopenia, and any medications he takes for such. See 4/27/13 VA Form 21-4138; 3/3/15 VA Form 21-4138. He is service connected for the aforementioned disabilities.

Service treatment records do not show any complaints or treatment related to diabetes.

Post-service treatment records show that the Veteran was initially diagnosed with diabetes in 2012 and that he has a family history of diabetes. See 7/15/21 VA Examination at 2; see also 10/28/11 CAPRI at 2.

In May 2013, a VA examiner opined that the Veteran's diabetes is not proximately due to his pancytopenia with cyclic neutropenia, including any medication he takes for such, as diabetes is caused by insulin resistance, which is not affected by pancytopenia. See 5/18/13 VA Opinion at 5. The medication for pancytopenia also does not lead to diabetes.

In March 2016, the Veteran underwent a VA examination for his diabetes. The VA examiner opined that the Veteran's diabetes was not proximately due to his chronic uveitis with uveitic glaucoma and the topical steroid drops he puts in his eyes for such because his diabetes was likely due to his overweight condition, which is a more significant risk factor for type II diabetes rather than the steroid eye drops. See 3/17/16 VA Opinion at 3.

In June 2016, a VA examiner opined that the Veteran's diabetes was not proximately due to or aggravated by his topical ocular steroids he used for his uveitis with uveitic glaucoma. See 6/10/16 VA Opinion at 2. The examiner explained that while steroids can temporarily aggravate diabetes, there was no permanent aggravation in the Veteran's condition as the Veteran was already noted to have elevated blood glucose noted in October 2011, prior to his steroid use.

In March 2017, the Veteran underwent another VA examination for his diabetes. The VA examiner opined that the Veteran's diabetes was not proximately due to or aggravated by his auto-immune disease/Behcet's Syndrome, and pancytopenia with cyclic neutropenia, including any medication including steroids. See 3/21/17 VA Opinion at 2-4. The VA examiner explained that while treatment and medications could temporarily cause changes in glucose levels, once treatment is stopped, it is less likely that the temporary treatment would cause long term diabetes. Steroids can also temporarily aggravate diabetes, but again, once the steroids are stopped, the glucose level for patients reverts to baseline with no long-term consequences. The VA examiner also addressed the articles submitted by the Veteran regarding topical steroids for eye conditions and their effects on glucose and HbA1c levels. The article itself also noted that the steroids caused a temporary increase in glucose and HbA1c levels but did not demonstrate a long-term increase of such. Thus, the Veteran's diabetes is more likely due to other independent factors.

In June 2019, a VA opinion was submitted in which the examiner opined that he agreed with another VA physician, Dr. C.E., that the Veteran's diabetes is not related to service. See 6/27/19 VA Opinion at 3. The VA examiner explained that diabetes is caused by risk factors such as family history, ethnicity, and obesity, and that obesity was the most important factor in causing diabetes. Here, the Veteran had a BMI of 35, which is considered obese, and the most likely etiology of the
caused a temporary increase in glucose and HbA1c levels but did not demonstrate a long-term increase of such. Thus, the Veteran's diabetes is more likely due to other independent factors.

In June 2019, a VA opinion was submitted in which the examiner opined that he agreed with another VA physician, Dr. C.E., that the Veteran's diabetes is not related to service. See 6/27/19 VA Opinion at 3. The VA examiner explained that diabetes is caused by risk factors such as family history, ethnicity, and obesity, and that obesity was the most important factor in causing diabetes. Here, the Veteran had a BMI of 35, which is considered obese, and the most likely etiology of the Veteran's diabetes, including other genetic factors.

In December 2019, the Veteran underwent a VA examination for his diabetes. The VA examiner opined that the Veteran's diabetes was not related to service because he did not exhibit symptoms of diabetes in service, was not diagnosed with diabetes until more than 15 years post service, and he had multiple clinical risk factors that increased one's likelihood of having diabetes such as family history, his African American ethnicity, obesity, and lifestyle. See 12/19/19 VA Opinion at 5.

The December 2019 VA examiner also opined that the Veteran's diabetes was not proximately due to his topical eye steroid drops for the same reasons previously explained. Additionally, steroid drops usually do not produce a systemic effect causing hyperglycemia and that glucocorticoid-induced hyperglycemia improves with reduction in the dose of glucocorticoid and usually reverses after stopping the steroid. Id. at 5-6.

In August 2020, a VA opinion was submitted in which the examiner opined that the Veteran's diabetes was not caused or aggravated by his pancytopenia with cyclic neutropenia, auto-immune/Behcet's Syndrome, or topical steroids. See 8/5/20 VA Opinion at 1. The examiner explained that hyperglycemia improves with reduction in the dose of glucocorticoid and reverse after cessation of the steroid, which was the case here. Topical steroid could unmask latent and undiagnosed diabetes but does not cause or aggravate it.

In November 2020, a VA opinion was submitted in which the examiner opined that the Veteran's diabetes was not proximately due to or aggravated by his auto-immune/Bechet's Syndrome, renal insufficiency and valvular heart disease, hypertension, pancytopenia with cyclic neutropenia, or any treatment/medications for such. See 11/10/20 VA Opinion at 2. The examiner explained that type II diabetes is often caused by several risk factors including obesity, a sedentary lifestyle, family history, age of over 45, and ethnicity such as African American. The Veteran had such risk factors, which were the causes of his diabetes. The examiner also stated that his steroid eye drops also did not cause his diabetes as the medication would only have caused a temporary increase in glucose levels and would return to normal levels.

In July 2021, the Veteran underwent a VA examination for his diabetes, in which the examiner opined that the Veteran's diabetes was not due to service as there were no complaints or symptoms related to such in service. See 7/13/21 VA Opinion at 2. The Veteran was also not diagnosed with diabetes until 2013, and he denied having it in service.

In August 2024 and April 2024, VA opinions were submitted by the same VA examiner who opined that the Veteran's diabetes was not related to service because the Veteran was not diagnosed with diabetes until 2013 and service treatment records do not show treatment and complaints related to such. See 8/24/24 VA Opinion at 3; 4/7/25 VA Opinion.

Also in August 2024, a VA opinion was submitted in which the VA examiner opined that the Veteran's diabetes was not proximately due to or aggravated by his service-connected auto-immune/Bechet's Syndrome, renal insufficiency and valvular heart disease, hypertension, pancytopenia with cyclic neutropenia, or any treatment/medications for such. See 8/24/24 VA Opinion at 3. The examiner explained that diabetes is caused by a combination of genetic, environmental, and lifestyle factors. Lifestyle factors play a critical role in causing diabetes such as overnutrition, obesity, physical inactivity, and poor diet. Here, the Veteran has many of these risk factors precent, which are the causes of his diabetes.

There are no other medical opinions of record addressing whether the Veteran's diabetes is related to service or his service-connected auto-immune/Bechet's Syndrome, renal insufficiency and valvular
renal insufficiency and valvular heart disease, hypertension, pancytopenia with cyclic neutropenia, or any treatment/medications for such. See 8/24/24 VA Opinion at 3. The examiner explained that diabetes is caused by a combination of genetic, environmental, and lifestyle factors. Lifestyle factors play a critical role in causing diabetes such as overnutrition, obesity, physical inactivity, and poor diet. Here, the Veteran has many of these risk factors precent, which are the causes of his diabetes.

Regarding direct service connection, there is no positive medical opinion of record supporting a nexus between the Veteran's diabetes and service, with the only opinions of record being against the claim. The June and December 2019 VA opinions, considered together, relied on medical literature and provided a clear rationale and an accurate understanding of the evidence; thus, they are deemed highly probative. In sum, the cumulative evidence of record shows that the Veteran's diabetes is not related to service. Accordingly, without a nexus, the Board finds the Veteran's diabetes is not due to service. 38 U.S.C. §§ 1101, 1110; 38 C.F.R. § 3.303.

With respect to presumptive service connection based on a chronic disability, the Board finds that the Veteran's diabetes cannot be presumptively linked to service. There is no evidence suggesting that the Veteran noticed symptoms of diabetes within a year of active service or evidence indicating a continuity of symptomatology of diabetes since service. The first post-service treatment record regarding diabetes was in October 2011, in which it was indicated the Veteran has family history of diabetes, about 19 years post service. He was diagnosed with diabetes the following year, about 20 years post service. There are no other medical records between the time the Veteran separated from service and his diagnosis post service. Further, there are no lay statements from the Veteran or other individuals suggesting the Veteran was experiencing diabetic symptoms within a year post service or for a continuous period of time post service. In fact, the Veteran consistently reported that his diabetic symptoms began after his steroid treatments, post service around 2013, which again is over 20 years post service. See 9/6/13 Medical Treatment Record-Government Facility at 146; VA Form 21-4138.

Therefore, the Veteran's diabetes did not have its onset until years after his separation from the military.?38 U.S.C. §§ 1101, 1110, 1112, 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309.?While diabetes is a form of organic disease of the nervous system, a chronic disease under 38?C.F.R. §?3.309(a), for which an award of service connection is permissible solely based on continuity of symptomatology, in this case such continuity of symptomatology is not established. Rather, it is refuted by the Veteran's own reported history.

With respect to secondary service connection, there is also no medical opinion of record supporting a nexus between the Veteran's service-connected diabetes and his service-connected auto-immune/Bechet's Syndrome, renal insufficiency and valvular heart disease, hypertension, pancytopenia with cyclic neutropenia, or any medication for such, including steroids, with the only opinions of record against the claim. The May 2013, March 2016, June 2016, March 2017, December 2019, August 2020, November 2020, and August 2024 VA opinions, considered together, relied on medical literature and provided a clear rationale and an accurate understanding of the evidence; thus, they are deemed highly probative. In sum, the cumulative evidence of record shows that the Veteran's diabetes is not proximately due to or aggravated by his service-connected disabilities. Without a nexus, service connection on a secondary basis cannot be established. 38 C.F.R. § 3.310.

In reaching its conclusions, the Board also considered the Veteran's various lay statements that his diabetes is related to service and/or his various service-connected disabilities, including medication he takes for such. Although the Veteran believes his diabetes disability is related to service and/or service-connected disabilities, and he is competent to report his symptoms and their onset, he is not competent to provide an opinion as to the etiology of his diabetes. See Layno v. Brown, 6?Vet. App.?465, 471 (1994); see also Kahana v. Shinse
due to or aggravated by his service-connected disabilities. Without a nexus, service connection on a secondary basis cannot be established. 38 C.F.R. § 3.310.

In reaching its conclusions, the Board also considered the Veteran's various lay statements that his diabetes is related to service and/or his various service-connected disabilities, including medication he takes for such. Although the Veteran believes his diabetes disability is related to service and/or service-connected disabilities, and he is competent to report his symptoms and their onset, he is not competent to provide an opinion as to the etiology of his diabetes. See Layno v. Brown, 6?Vet. App.?465, 471 (1994); see also Kahana v. Shinseki, 24?Vet. App.?428, 438 (2011). Thus, the Veteran's statements are outweighed by the other evidence of record, including the VA medical opinions.

The Board also considered the Veteran's various statements regarding bias and misconduct during VA examinations. See e.g., 12/18/23 Correspondence at 19. While the Board takes these statements seriously, it does not find any valid basis for such, and the case did not present circumstances which might give the impression of bias.

Accordingly, the Board finds the criteria for service connection for type II diabetes mellitus have not been met. The benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch, 21 F.4th 776 (Fed. Cir. 2021).

Eric S. Leboff

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board J. Sproviero

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.

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