DIABETES MELLITUS

Summary

The Veteran, a U.S. Navy Veteran who served from October 19, 1955, to January 23, 1959, sought service connection for diabetes mellitus (DM) type II, claiming it was secondary to his service-connected unspecified anxiety disorder with major depressive disorder (MDD), with obesity as an intermediate step. The Board of Veterans' Appeals reviewed the case, which had undergone multiple previous decisions and reviews, including a Higher-Level Review that identified a duty to assist error. The Veteran submitted private medical opinions in March 2024 from Dr. R.D. and R.T., RN, stating that his DM was at least as likely as not associated with weight gain due to depression and inability to exercise. The VA issued a conflicting opinion in June 2024, suggesting dietary adjustment rather than exercise limitation as the cause of obesity and DM. However, the Board found the AOJ's favorable findings of a DM diagnosis and a positive nexus opinion linking the condition to service, supported by the private opinions, were not rebutted by clear and unmistakable error. Applying the benefit of the doubt, the Board granted service connection for DM type II as secondary to the service-connected anxiety disorder with MDD, via obesity as the intermediate step.

Rationale

Private medical opinions linked DM to weight gain from depression and inability to exercise.; AOJ made favorable findings of DM diagnosis and positive nexus.; Board found evidence insufficient to rebut favorable findings; applied benefit of doubt.

Full Decision Text

Citation Nr: A24074586
Decision Date: 11/14/24	Archive Date: 11/14/24

DOCKET NO. 240709-454396
DATE: November 14, 2024

ORDER

Entitlement to service connection for diabetes mellitus (DM) type II as secondary to unspecified anxiety disorder with major depressive disorder (MDD), via obesity as an intermediate step, is granted. 

FINDING OF FACT

The Veteran's DM type II was caused by his service-connected unspecified anxiety disorder with MDD by way of obesity as the intermediary step.

CONCLUSION OF LAW

The criteria are met for secondary service connection for DM type II via obesity as an intermediate step. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310(a); VAOPGCPREC 1-2017 (Jan. 6, 2017).

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served in the U.S. Navy from October 19, 1955, to January 23, 1959.

In March 2024, the Veteran filed a Supplemental Claim (Department of Veterans Affairs (VA) Form 20-0995) and sought service connection for DM due to weight gain from service-connected depression. Attached to the claim were medical opinions in support of the claim. 

On May 3, 2024, a rating decision was issued that continued the denial of service connection for DM, type II. Later, on May 7, 2024, the Veteran filed a Decision Review Request Higher-Level Review (HLR) of the May 3, 2024 rating decision by submitting an VA Form 20-0996. 

On May 14, 2024, a HLR decision was issued that determined that there had been a duty to assist error. The claim was recharacterized as entitlement to service connection for DM as secondary to unspecified anxiety disorder with MDD and it was transferred to the Supplemental Claim decision review option for additional development. See VA Form 20-0999 HLR Return. A rating decision was then issued on June 10, 2024 (mailed to the Veteran on June 12, 2024) that confirmed and continued the previous denial of service connection for DM type II.

In July 2024, the Veteran filed a Department of Veterans Affairs (VA) Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), selected the Direct Review Docket and listed the appeal issue as the denial of service connection for DM due to wight gain from service-connected depression contained in the rating decision June 2024 rating decision. 

As the Veteran has selected the Direct Review Docket, the Board may only consider the evidence of record at the time of the June 2024 agency of original jurisdiction (AOJ) Supplemental Review. See 38 C.F.R. §§ 20.300, 20.301. In November 2024, the Veteran waived the time to switch dockets. Williams v. McDonough, 37 Vet. App. 305 (2024); 38 C.F.R. § 20.202(c)(2). 

Entitlement to service connection for DM type II as secondary to unspecified anxiety disorder with MDD, via obesity as an intermediate step, is granted. 

The Veteran contends that his DM type II was caused by service-connected depression (he is service-connected for unspecified anxiety disorder with MDD) by way of obesity as the intermediate step. See March 2024 VA Form 20-0995; see also July 2024 VA Form 10182.

Service connection shall be granted on a secondary basis under 38 C.F.R. § 3.310 where it is demonstrated that a service-connected disorder caused or aggravated a nonservice-connected disability. The AOJ has entered a favorable finding that the Veteran has a current disability of diabetes mellitus, type II. He is in receipt of service connection for an unspecified anxiety disorder with MDD. The remaining question is whether, but for the service-connected psychiatric disability, the Veteran would not have diabetes. 

VA issued a General Counsel Precedent Opinion (GC Prec. Op. 1-2017) stating that while obesity is not a disability for VA compensation purposes, obesity can serve as an "intermediate step" between a service-connected and nonservice-connected condition under 38 C.F.R. § 3.310(a). See Walsh v. Wilkie, 32 Vet. App. 300 (2020). 

The Board finds that the evidence of record establishes that the Veteran's service-connected disabilities meet the statutory and regulatory criteria to establish entitlement to DM type II secondary to service-connected unspecified anxiety disorder with M
 MDD. The remaining question is whether, but for the service-connected psychiatric disability, the Veteran would not have diabetes. 

VA issued a General Counsel Precedent Opinion (GC Prec. Op. 1-2017) stating that while obesity is not a disability for VA compensation purposes, obesity can serve as an "intermediate step" between a service-connected and nonservice-connected condition under 38 C.F.R. § 3.310(a). See Walsh v. Wilkie, 32 Vet. App. 300 (2020). 

The Board finds that the evidence of record establishes that the Veteran's service-connected disabilities meet the statutory and regulatory criteria to establish entitlement to DM type II secondary to service-connected unspecified anxiety disorder with MDD by way of obesity as the intermediate step. This conclusion is explained below.

In March 2024, the Veteran provided private medical opinions dated in March 2024, including one from Dr. R.D. and one from R.T, RN. In the opinions from Dr. R.D. and R.T. RN, they both opined that "the current diagnosis of diabetes is at least as likely as not (50 percent or greater probability) associated with weight gain and affected by the inability to properly exercise the body due to depression [he] is suffering with for many years." 

In a June 2024 VA medical opinion the examiner opined that DM type II and unspecified anxiety disorder with MDD are not medically related, that "[r]egarding the cause of diabetes type 2 [due to] weight gain from unspecified anxiety disorder with major depressive disorder, this condition does not preclude all forms of exercise and in and of itself did not cause her obesity" and that "If one is unable to be very physically active for some reason, then one's dietary intake should be adjusted to balance our bodies' energy requirements so that we do not have resultant weight gain."

In the June 10, 2024 rating decision on appeal, the AOJ made favorable findings that the Veteran has been diagnosed with DM type II and that "[a] nexus, or link, has been established between your claimed issue and an in-service event or injury. Private Medical Opinions received on March 20, 2024, link your condition with obesity caused by inability to properly exercise due to depression." These findings are binding unless rebutted by evidence that identifies a clear and unmistakable error in the favorable finding. See 38 C.F.R. § 3.104(c).

The Board finds the evidence, as discussed above, is insufficient to rebut the favorable findings of a diagnosis for DM and the positive medical nexus favorable finding. Thus, the Board finds that, with resolution of the doubt in his favor, the Veteran's DM type II was caused by his service-connected unspecified anxiety disorder with MDD by way of obesity as the intermediary step.

Accordingly, entitlement to service connection for DM type II as secondary to unspecified anxiety disorder with MDD, via obesity as an intermediate step, is granted.

 

 

J. B. FREEMAN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Imber, M.

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.