PREDIABETES AND/OR HYPERGLYCEMIA

B. MULLINS · 2026 · Case ID: 26002007

MIXED

Summary

The veteran, who served in the United States Air Force from May 1985 to July 1990, appeals the denial of service connection for prediabetes/hyperglycemia and the grant of service connection for obesity and Total Disability based on Individual Unemployability (TDIU). The Board found that the veteran's prediabetes and hyperglycemia did not constitute a current disability for VA purposes, as the evidence indicated these were laboratory findings without functional impairment of earning capacity, and the evidence weighed against a service connection. Therefore, service connection for prediabetes/hyperglycemia was denied. Regarding obesity, the Board, applying the Adams v. Collins decision, found that the veteran's service-connected disabilities, including hypertension, kidney disability, PTSD, and uterine fibroids, impaired her ability to maintain a healthy diet and exercise, contributing to her obesity. The Board also found that the obesity acted as a perpetual harmful sequence, contributing to other service-connected disabilities and resulting in functional impairment. Service connection for obesity was granted on a secondary basis. For the TDIU claim, the Board found that the veteran's combined service-connected disabilities, specifically PTSD, hypertension, and kidney disability, precluded her from securing and following substantially gainful employment prior to November 3, 2017, when she was awarded a 100 percent disability rating. The Board resolved all reasonable doubt in the veteran's favor, granting entitlement to TDIU on an extraschedular basis.

Service Branch

AIR FORCE

Special Benefit

TDIU

Docket No.

14-14 521

Full Decision Text

Citation Nr: 26002007
Decision Date: 02/12/26 Archive Date: 02/12/26

DOCKET NO. 14-14 521
DATE: February 12, 2026

ORDER

The claim of entitlement to service connection for prediabetes and/or hyperglycemia is denied.

The claim of entitlement to service connection for obesity, to include as secondary to service-connected disabilities, is granted.

The claim of entitlement to a total disability rating based on individual employability (TDIU) is granted, subject to controlling regulations governing the payment of monetary awards.

FINDINGS OF FACT

1. The Veteran has not had a disability within the meaning of VA regulations regarding diabetes, prediabetes or hyperglycemia at any time during or approximate to the pendency of the claim.

2. The Veteran's obesity was due to or aggravated by service-connected disabilities.

3. During the period on appeal, the Veteran's service-connected disabilities rendered her unable to secure and follow a substantially gainful occupation.

CONCLUSIONS OF LAW

1. The criteria for service connection for prediabetes and/or hyperglycemia have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

2. The criteria for service connection for obesity as secondary to service-connected disabilities have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

3. The criteria for entitlement to a TDIU have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.1, 4.3, 4.16(b).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had honorable active duty service with the United States Air Force from May 1985 to July 1990.

These matters come before the Board of Veterans' Appeals (Board) from June 2016 and May 2018 rating decisions of the Department of Veterans Affairs (VA) Regional Office, which is the Agency of Original Jurisdiction (AOJ).

The Board previously remanded the issues on appeal in May 2019 (also finding entitlement to a TDIU raised by the evidence of record), August 2021, March 2022, and June 2024 (remanding for AOJ consideration of evidence obtained after issuance of an October 2023 supplemental statement of the case (SSOC)). As determined by the Board in its June 2024 remand, the AOJ has substantially complied with the Board's prior remand instructions. See Stegall v. West, 11 Vet. App. 268, 271 (1998); see also Dyment v. West, 13 Vet. App. 141, 146-47 (1999). The Board acknowledges that additional evidence, including VA treatment records, was added to the claims file after issuance of the most recent SSOC. Under 38 C.F.R. § 20.1305(c), any pertinent evidence that is submitted to the Board must be referred to the AOJ for initial review unless this right is waived by the appellant or representative in writing or on the record during a hearing, or if the Board issues a full allowance for the benefit(s) to which the evidence relates. Here, however, review of the evidence reveals that the information contained in the additional records is duplicative or cumulative of evidence already of record. For example, VA treatment records continue to identify the Veteran as having prediabetes, which is consistent with past VA treatment records. Therefore, additional delay for waiver or remand is not necessary as it will not result in additional benefit to the Veteran. Accordingly, the Board will proceed to the merits of the claims on appeal.

Service Connection

Service connection may be granted for 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).

Except as otherwise
of the claims on appeal.

Service Connection

Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for VA benefits. 38 U.S.C. § 5107(a). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b). The benefit-of-the-doubt rule applies if the competing evidence is "nearly equal" or in "approximate balance." The benefit-of-the-doubt rule does not apply when the evidence persuasively favors one side or the other. See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

1. The claim of entitlement to service connection for prediabetes and/or hyperglycemia.

The Veteran seeks service connection for prediabetes. See November 2017 VA 21-526 Veterans Application for Compensation (noting treatment for "pre-diabetes mellitus"); May 2023 VA Form 20-0995 Supplemental Claim (claiming "pre-diabetes).

The question for the Board is whether the Veteran has a current disability for VA purposes that began during service or is at least as likely as not related to an in-service injury, event, or disease.

The Board finds at the outset that the Veteran has not been diagnosed with diabetes mellitus during the period on appeal. Her VA treatment records, VA examinations, and lay statements consistently indicate that she is pre-diabetic. See, e.g., January 2024 VA examination; August 2024 VA treatment records (active problem list noting prediabetes); August 2022 VA examination; March 2017 VA Patient Results Notification; November 2017 VA 21-526; May 2023 VA Form 20-0995 Supplemental Claim.

Further, although VA treatment records note that the Veteran has a medical history of being assessed with prediabetes and hyperglycemia, such medical assessments do not establish the presence of a disability for which service connection can be granted. Instead, such findings are more akin to laboratory test results than disabilities. See, e.g., Schedule for Rating Disabilities; Endocrine System Disabilities, 61 Fed. Reg. 20,440, 20,445 (May 7, 1996) (commenting that hyperlipidemia, elevated triglycerides, and elevated cholesterol are laboratory test results, not disabilities).

The Board has considered that the disability rating schedule is meant to compensate veterans for conditions that result in the impairment of earning capacity, and that even in circumstances where a condition does not result in diagnosis, compensation may be available if the condition "reaches the level of a functional impairment of earning capacity." 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 4.1, Saunders v. Wilkie, 886 F.3d 1356, 1367-69 (Fed. Cir. 2018). In the Veteran's case, the evidence of record weighs against a finding that the Veteran has had functional impairment of earning capacity due to her laboratory findings of prediabetes or hyperglycemia. For example, an August 2022 VA clinician conducted a review of the Veteran's history of laboratory testing and opined that the Veteran "most likely would not experience symptoms with normal or slightly elevated glucose levels" as shown in her records. This clinician also noted that the Veteran had previously denied symptoms associated with diabetes mellitus. The lay and medical evidence of record shows that while the Veteran reported that she monitored her diet, she did not use oral hypoglycemic agents or insulin and did not require regulation of activities. According to a January 2024 VA examination, the clinician noted the Veteran's report that she was informed of her prediabetic status during an annual medical examination in 2014; however, the examiner opined that the Veteran did not have a current diabetes disability and noted no
's history of laboratory testing and opined that the Veteran "most likely would not experience symptoms with normal or slightly elevated glucose levels" as shown in her records. This clinician also noted that the Veteran had previously denied symptoms associated with diabetes mellitus. The lay and medical evidence of record shows that while the Veteran reported that she monitored her diet, she did not use oral hypoglycemic agents or insulin and did not require regulation of activities. According to a January 2024 VA examination, the clinician noted the Veteran's report that she was informed of her prediabetic status during an annual medical examination in 2014; however, the examiner opined that the Veteran did not have a current diabetes disability and noted no functional impact from the claimed condition. The Veteran's other lay statements of record do not otherwise indicate to the Board that her prediabetic status results in functional impairment. As such, the Board finds that the Veteran's claimed prediabetes does not result in functional impairment of earning capacity.

Thus, the Veteran does not have a current disability for which service connection may be granted and she has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007).

Accordingly, the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for prediabetes and/or hypoglycemia is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

2. The claim of entitlement to service connection for obesity, to include as secondary to service-connected disabilities.

The Veteran seeks service connection for obesity, secondary to a service-connected disability such as hypertension. See February 2016 VA 21-526 Veterans Application for Compensation.

During the pendency of this claim, the Court of Appeals for Veterans Claims (the Court) issued Adams v. Collins, 38 Vet. App. 273 (2025) addressing whether obesity may be considered a disability for VA purposes. The Court ultimately determined that (1) obesity may be a disability for purposes of 38 U.S.C. § 1110 if it results in a functional impairment of earning capacity (invalidating a 2017 VA General Counsel precedential opinion to the extent it determined obesity per se is not a disability); and (2) if obesity results in a functional impairment of earning capacity, it may be service connected on a secondary basis under 38 C.F.R. § 3.310. The Court explained that deciding whether a claimant's obesity causes functional impairment requires an "individualized assessment" of the "degree of impairment" caused by a claimant's obesity. Id., at 284; see also Wait v. Wilkie, 33 Vet. App. 8, 16 (2020). The Court declined to disturb the portion of the General Counsel's opinion that prohibited service connection for obesity as directly related to service (accepting that obesity is not a "disease" for purposes of 38 U.S.C. §§ 1110 and 1131).

Secondary service connection is warranted when either a service-connected disability causes another disability, or when a service-connected disability proximately causes the worsening of a preexisting disability. 38 C.F.R. § 3.310(a). The latter is an aggravation theory that entitles a Veteran to secondary service connection when a service-connected disability triggers "[a]ny increase in severity of a nonservice-connected disease... 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." 38 C.F.R. § 3.310(b); see generally El-Amin v. Shinseki, 26 Vet. App. 136, 138 (2013). Service connection is not limited to "single cause and effect" but also applies to conditions that "would have been less severe were it not for the service-connected disability." Spicer v. McDonough, 61 F.4th 1360, 1364 (Fed. Cir. 2023).

Considering the Court's decision in Adams, and upon review of the evidence of record, the Board finds service connection for obesity is warranted on a secondary basis.

First, the Veteran has been assessed with obesity, identified as an endocrine condition according to a September 2021 VA examination. Next, the Veteran's VA examination records show that her ability to adhere to a healthy eating
. 136, 138 (2013). Service connection is not limited to "single cause and effect" but also applies to conditions that "would have been less severe were it not for the service-connected disability." Spicer v. McDonough, 61 F.4th 1360, 1364 (Fed. Cir. 2023).

Considering the Court's decision in Adams, and upon review of the evidence of record, the Board finds service connection for obesity is warranted on a secondary basis.

First, the Veteran has been assessed with obesity, identified as an endocrine condition according to a September 2021 VA examination. Next, the Veteran's VA examination records show that her ability to adhere to a healthy eating plan and to exercise are impacted by her service-connected hypertension, kidney disability, and post-traumatic stress disorder (PTSD). For example, according to a June 2014 VA psychological examination, the Veteran reported wide fluctuations in appetite resulting in her gaining 10 pounds in the preceding month. See also September 2021 VA examination (noting the Veteran's report of weight gain following in-service trauma). According to an April 2017 VA kidney conditions examination, the Veteran's ability to exercise was significantly impacted by her need for kidney transplant surgery, which (among other things) resulted in daily nausea from her treatment medication and shortness of breath on exertion. A March 2019 VA nutrition assessment noted a direct negative impact on the Veteran's ability and motivation to exercise when experiencing symptoms of nausea and physical ailments. The Veteran's Social Security Administration (SSA) records also indicate that the Veteran experienced severe abdominal pain related to her service-connected uterine fibroids, which prevented her from walking more than a block.

The Veteran's SSA records also contain research published by the Journal of the American Medical Association (JAMA) summarizing that obesity is more prevalent among adults with disabilities and that "adults with a disability were more likely to be obese." The research noted that one contributing factor for developing obesity was physical inactivity and that individuals with disabilities had more barriers to exercise. According to the publication, "numerous studies suggest that obesity increases the risk of developing physical disability." The article noted that obesity itself was a "serious public health concern" that increased mortality and morbidity.

The Board finds the medical and lay evidence of record, as briefly excerpted above, to support a finding that the Veteran's service-connected disabilities, to include hypertension, a kidney disability, PTSD, and uterine fibroids, impaired the Veteran's inability to maintain a healthy diet and exercise, and thereby also contributed to her weight fluctuation and obesity.

As for functional impact resulting from obesity, the record contains evidence that the Veteran's obesity essentially acts as a perpetual harmful sequence upon the Veteran's other service-connected disabilities. For example, a January 2024 clinician opined that "obesity is a major risk for essential hypertension, diabetes and other morbidity," and that obesity itself can "contribute to the development of kidney disease because it mainly increases tubular reabsorption to impair pressure natriuresis and cause volume expansion via the activation of the SNS [Sympathetic Nervous System] and the RAS [Renin-Angiotensin System]." The Board finds this clinician to have implicitly concluded that the Veteran's obesity results in functional impairment of earning capacity by contributing to or worsening other service-connected disabilities, such as her kidney disease.

The Board notes that the exact quantification of the functional impairment caused by the Veteran's obesity will be made by the AOJ in assigning an initial rating for this condition; however, the Board finds the evidence at least in an approximate balance as to whether the Veteran's obesity is secondary to her service-connected disabilities.

Accordingly, the Board concludes that the essential criteria have been met for entitlement to service connection for obesity as secondary to service-connected disabilities. Service connection for obesity is thus granted. 38 C.F.R. § 3.310.

3. The claim of entitlement to a TDIU.

The Veteran contends that she is unable to work due to the combined impact of her service-connected disabilities.

In a January 2024 rating decision, the AOJ found the issue of entitlement to a TDIU moot, reasoning that the Veteran's service-connected disabilities were already rated as 100 percent disabling from the date the AOJ received the Veteran's TDIU application in October 2020 and that there was "no potential entitlement to an earlier effective date" for the benefit. The most recent rating decision codesheet shows that the Veteran has been in receipt of a 100 percent rating since November 3, 2017.

Regrettably, the AOJ's conclusion fails to acknowledge that in the Board's May 2019 remand, it found the Veteran's
work due to the combined impact of her service-connected disabilities.

Regrettably, the AOJ's conclusion fails to acknowledge that in the Board's May 2019 remand, it found the Veteran's claim of entitlement to a TDIU raised as part and parcel of her pending increased rating claims pursuant to Rice v. Shinseki, 22 Vet. App. 447 (2009). If a TDIU claim is part of an increased rating claim before the Board, the appeal period is the same as the underlying increased rating claim(s), and the Board retains jurisdiction over the issue even if the AOJ grants a TDIU for a portion of the period. See Payne v. Wilkie, 31 Vet. App. 373, 389 (2019); Harper v. Wilkie, 30 Vet. App. 356 (2018).

In this case, the Veteran's claim for an increased rating remained pending since receipt of her February 5, 2016, VA 21-526. See February 2016 Correspondence (cover page from representative indicating the Veteran also sought a higher disability rating for PTSD). As such, the Board will consider whether the Veteran's service-connected conditions warranted entitlement to a TDIU prior to the award of a 100 percent disability rating on November 3, 2017.

A TDIU may be assigned on a schedular basis, where the schedular rating is less than total and where a veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. 38 C.F.R. § 4.16(a). To qualify for schedular consideration of a TDIU, if there is only one such disability, this disability shall be ratable at 60 percent or more, and, if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more and sufficient additional disability to bring the combined rating to 70 percent or more. Id.

Pursuant to 38 C.F.R. § 4.16(b), when a claimant is unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities but fails to meet the percentage requirements for eligibility as set forth in 38 C.F.R. § 4.16(a), such case shall be submitted for extraschedular consideration. The Court recently held that the Board may assign a TDIU in the first instance, even where the Veteran does not meet the schedular requirements set forth in 38 C.F.R. § 4.16(a). Witkowski v. Collins, __ Vet. App. __, No. 24-0640, 2025 U.S. App. Claims LEXIS 1423, *29-30 (Oct. 21, 2025).

During the period on appeal but prior to November 3, 2017, the Veteran had the following service-connected disabilities: PTSD (rated 30 percent disabling from June 19, 2013, 50 percent from December 16, 2013, and 70 percent from May 18, 2023); a kidney disability associated with hypertension (rated as 100 percent from July 21, 2011, as 30 percent from March 2, 2015, and as 60 percent from May 18, 2023). The Veteran had multiple additional conditions assigned noncompensable ratings, including chronic obstructive pulmonary disease, hypertension, surgical scars, non-allergic rhinitis, and anemia. Effective on or after November 3, 2017, the Veteran was awarded service connection for multiple additional conditions. See March 2024 rating decision codesheet. The Veteran's combined disability evaluation was 100 percent from July 21, 2011, 50 percent from March 2, 2015, and 100 percent from November 3, 2017.

Based on the above ratings and upon consideration of the evidence of record, the Board concludes that the Veteran met the criteria for entitlement to a TDIU on an extraschedular basis prior to November 3, 2017. 38 C.F.R. § 4.16(b).

In so finding, the Board notes that
. Effective on or after November 3, 2017, the Veteran was awarded service connection for multiple additional conditions. See March 2024 rating decision codesheet. The Veteran's combined disability evaluation was 100 percent from July 21, 2011, 50 percent from March 2, 2015, and 100 percent from November 3, 2017.

In so finding, the Board notes that pursuant to 38 C.F.R. § 4.16(b), VA's policy is "that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled." The phrase "unable to secure and follow a substantially gainful occupation" contains both economic and noneconomic components. See Ray v. Wilkie, 31 Vet. App. 58, 73 (2019). The economic component refers to an occupation earning more than marginal income (outside of a protected environment) as determined by the U.S. Department of Commerce as the poverty threshold for one person. Id.; see also LaBruzza v. McDonough, 37 Vet. App. 111, 123-24 (2024) (employment in a protected environment means a lower income position that, due to the veteran's service-connected disability or disabilities, is shielded in some respect from competition in the employment market). The noneconomic component requires a determination as to a veteran's ability to secure and follow such employment. Id. Attention should be given to the veteran's history, education, skills, and training; whether the veteran has the physical ability (both exertional and nonexertional) to perform the types of activities required by the occupation at issue (e.g., lifting, bending, sitting, standing, walking, climbing, as well as auditory and visual limitations); and whether the veteran has the mental ability to perform the activities required by the occupation at issue (e.g., memory, concentration, ability to adapt to change, handle work place stress, get along with coworkers, and demonstrate reliability and productivity). Id.

An award of TDIU is an individualized determination, specific to a veteran's particular circumstances, e.g., their history, education, skills, and training. See Todd v. McDonald, 27 Vet. App. 79, 85 (2014). It does not require a showing of 100 percent unemployability. Roberson v. Principi, 251 F.3d 1378, 1385 (Fed. Cir. 2001). The ultimate question is whether they are capable of performing the physical and mental acts required by employment, not whether they can find employment. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993).

In its May 2019 remand, the Board noted that the "record is replete with information suggestive that the Veteran is unable to work due to her service-connected disabilities." According to TDIU applications submitted by the Veteran, she completed high school and college but has not worked on a full-time basis since 2005. She has engaged in volunteer activities and intermittent employment (every other year) as a ballot worker, which earned her marginal income of 58 dollars per month.

Prior to November 3, 2017, the Veteran's ability to secure and follow a substantially gainful occupation was impacted by the physical effects of her kidney disability and hypertension, as well as by the mental effects of her service-connected PTSD. For example, in an April 2017 VA examination regarding kidney conditions, a clinician noted that the Veteran was status post kidney transplant surgery, was on multiple medications that caused side effects, and opined that it would be "difficult at this time for [the Veteran] to engage in gainful employment." According to an April 2016 psychiatric examination, the Veteran's occupational and social functioning was impacted by her chronic depressed mood, anxiety and panic attacks, and sleep impairment with nightmares. In a June 2023 VA PTSD examination, the Veteran described the circumstances leading to the termination of a prior full-time job, which related to a significant personal dispute and conflict with one of her children. Her psychiatric disability has resulted in her experiencing ideations of self-harm and harm of others. Id.

(Continued on the next page)

The Board notes that the Veteran's SSA records also weigh in favor of awarding a TDIU prior to November 3, 2017.
] to engage in gainful employment." According to an April 2016 psychiatric examination, the Veteran's occupational and social functioning was impacted by her chronic depressed mood, anxiety and panic attacks, and sleep impairment with nightmares. In a June 2023 VA PTSD examination, the Veteran described the circumstances leading to the termination of a prior full-time job, which related to a significant personal dispute and conflict with one of her children. Her psychiatric disability has resulted in her experiencing ideations of self-harm and harm of others. Id.

(Continued on the next page)

The Board notes that the Veteran's SSA records also weigh in favor of awarding a TDIU prior to November 3, 2017. These records show that she received a fully favorable disability determination in 2010 and that SSA determined that as of January 2016, the Veteran continued to be disabled due to hypertension and chronic kidney disease (among other conditions). In her SSA application, the Veteran reported that her kidney disability impaired her from engaging in strenuous activity and lifting, and other symptoms included frequent urination, nausea, and lethargy.

Having considered the evidence of record, the Board finds the evidence for and against assignment of a TDIU to be in approximate balance. Resolving all reasonable doubt in favor of the Veteran, the Board finds that during the appeal period prior to November 3, 2017, the Veteran's PTSD, hypertension, and kidney disability combined to preclude the Veteran from the ability to secure and follow a substantially gainful occupation consistent with her education, skills, training, and work history. As such, the criteria for entitlement to a TDIU have been met. 38 C.F.R. § 4.16(b).

B. MULLINS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board C. Hart, 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.

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