DIABETES MELLITUS

Summary

The veteran, who served in the Naval Reserve with active duty from December 1990 to June 1991, appeals the denial of service connection for diabetes mellitus type II and kidney stones. The veteran claimed diabetes was secondary to PTSD and related to Southwest Asian theater service and toxic exposures. Kidney stones were claimed as related to Southwest Asian theater service, dehydration, and as a complication of service-connected sarcoidosis. The Board found the evidence persuasively weighed against a nexus for both conditions. For diabetes, the Board found the VA examiner's opinion adequate and persuasive, noting the veteran's risk factors (family history, overweight, sedentary lifestyle) were the likely cause, not service or toxic exposures. The Board also found the veteran's claim of secondary connection to PTSD unsupported by competent evidence. For kidney stones, the Board found the VA examiner's opinion adequate and persuasive, attributing the condition to risk factors like age, male gender, diabetes, UTIs, and dietary factors, rather than service or toxic exposures. The Board also found the veteran's claims of dehydration and connection to sarcoidosis unsupported by competent evidence. Both conditions manifested years after service and were not linked to service or presumptive periods. Service connection for both diabetes mellitus type II and kidney stones was denied.

Rationale

Weight of evidence persuasively against nexus to service; VA opinion persuasive: diabetes likely due to risk factors, not service/exposures; Veteran's claim of secondary connection to PTSD unsupported by competent evidence

Full Decision Text

Citation Nr: A25111110
Decision Date: 12/30/25	Archive Date: 12/30/25

DOCKET NO. 250403-532255
DATE: December 30, 2025

ORDER

Entitlement to service connection for diabetes type II is denied. 

Entitlement to service connection for kidney stones is denied.

FINDINGS OF FACT

1. The evidence of record persuasively weighs against finding that diabetes mellitus began during active service, manifested within one year of service, or is otherwise related to an in-service injury, disease, or exposure.

2. The evidence of record persuasively weighs against finding that kidney stones began during active service, manifested within one year of service, or is otherwise related to an in-service injury, disease or exposure.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for diabetes mellitus have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 3.317.

2. The criteria for entitlement to service connection for kidney stones have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.317.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served as a member of the Navel Reserve with active duty for training from October 1987 to March 1988 and active duty from December 1990 to June 1991. This matter comes before the Board of Veterans' Appeals (Board) from an August 2024 Higher-Level Review (HLR) decision by a Department of Veterans Affairs (VA) agency of original jurisdiction (AOJ). The HLR was based on evidence in the record at the time of a September 2023 decision. See 38 C.F.R. § 3.2601.

In April 2025, the Veteran filed a timely VA Form 10182 Notice of Disagreement (NOD). He selected the Evidence Submission docket. Therefore, the Board may only review evidence in the record at the time of the initial September 2023 decision and evidence submitted with and within 90 days of the April 2025 NOD. 38 C.F.R. § 20.303.

Evidence was added to the claims file during a period of time when new evidence was not allowed. As the Board is deciding the claims, it may not consider this evidence in its decision. 38 C.F.R. § 20.300. The Veteran may file a Supplemental Claim and submit or identify this evidence.  38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

Service connection may be established for disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty, in the active military, naval, or air service. 38 U.S.C. § § 1110, 1131. Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

In order to establish service connection on a direct basis, the record requires competent evidence showing: (1) the existence of a present disability; (2) in service incurrence or aggravation of an injury or disease; 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, 1167 (Fed. Cir. 2004). In the absence of proof of a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225(1992).

Some chronic diseases may be presumed to have been incurred in service, if they become manifest to a degree of ten percent or more within the applicable presumptive period. 38 U.S.C. §§ 1101(3), 1112(a); 38 C.F.R. §§ 3.307(a), 3.309(a). For those listed chronic conditions, a showing of continuity of symptoms affords an alternative route to service connection. 38 C.F.R. § 3.303(b); Walker
. Cir. 2004). In the absence of proof of a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225(1992).

Some chronic diseases may be presumed to have been incurred in service, if they become manifest to a degree of ten percent or more within the applicable presumptive period. 38 U.S.C. §§ 1101(3), 1112(a); 38 C.F.R. §§ 3.307(a), 3.309(a). For those listed chronic conditions, a showing of continuity of symptoms affords an alternative route to service connection. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F. 3d 1331 (Fed. Cir. 2013). Diabetes and renal conditions with a presumptive period of one year following separation from service, are listed conditions.

Service connection may be granted for a Persian Gulf veteran with a qualifying chronic disability that became manifest to any degree at any time. 38 U.S.C. § 1117(a)(1); 38 C.F.R. § 3.317(a)(1). A qualifying chronic disability is a chronic disability that may result from an undiagnosed illness or a medically unexplained chronic multi-symptom illness (MUCMI). 38 C.F.R. § 3.317(a)(2)(i).

A Persian Gulf veteran is defined as a veteran who served on active military, naval or air service in the Southwest Asia theater of operations during the Persian Gulf War, which includes Saudia Arbia. 38 C.F.R. § 3.317(e)(1). 

The Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act, was enacted on August 10, 2022. Section 405 of the PACT Act reduces the threshold for establishing eligibility when considering presumptive service connection for Persian Gulf War veterans. Presumptive conditions under 38 C.F.R. § 3.317(a) and (b) may now manifest to any degree at any time.

Additionally, the PACT Act expanded the definition of a Persian Gulf veteran to include those who served in the countries of Afghanistan, Israel, Egypt, Turkey, Syria, and Jordan, along with those who served in the Southwest Asia theater of operations as defined in 38 C.F.R. § 3.317(e).

Pursuant to the SPACT Act, exposure to burn pits and other toxins (BPOT) is presumed for "covered veterans," i.e., those who served in specific locations on or after specific dates. 38 U.S.C. § 1119. Any veteran who, on or after August 2, 1990, performed active military, naval, air, or space service while assigned to a duty station in and/or airspace above Bahrain; Iraq; Kuwait; Oman; Qatar; Saudi Arabia; Somalia; the United Arab Emirates; the neutral zone between Iraq and Saudi Arabia; the Gulf of Aden; the Gulf of Oman; the Persian Gulf; the Arabian Sea; or the Red Sea will be presumed BPOT exposed, as will any veteran who, on or after September 11, 2001, performed active military, naval, air, or space service while assigned to a duty station in and/or airspace above Afghanistan; Djibouti; Egypt; Jordan; Lebanon; Syria; Yemen; or Uzbekistan. 38 U.S.C. § 1119; VBA Letter 20-22-10 at 7, Processing Claims Involving the PACT Act, 87 Fed. Reg. 78,543 (Dec. 22, 2022). Certain diseases will be presumed related to service for veterans with in-service toxic exposure, including BPOT exposure. 38 U.S.C. § 1120.

Here, the Veteran had active service in the Southwest Asia theater of operations from December 1990 to May 1991, specifically in Saudia Arabia, and is thus considered a Persian Gulf veteran. 38 C.F.R. § 3.317(e). He is also a "covered veteran" with presumed BPOT exposure under 38 U.S.C. § 1119.

Diabetes Mellitus

The Veteran contends that his diabetes mellitus is related to his service, specifically his service in the Southwest Asian theater. The Veteran stated in his claim that his diabetes was secondary to his service-connected posttraumatic stress disorder (PTSD). The AOJ issued binding favorable findings of a current diagnosis of diabetes mellitus and service performed in the Southwest Asian theater. See 38 C.F.R. § 3.104.

The Veteran's service treatment records do not indicate any diagnosis, treatment, complaint, or symptom of diabetes mellitus in-service. 

The
.R. § 3.317(e). He is also a "covered veteran" with presumed BPOT exposure under 38 U.S.C. § 1119.

Diabetes Mellitus

The Veteran contends that his diabetes mellitus is related to his service, specifically his service in the Southwest Asian theater. The Veteran stated in his claim that his diabetes was secondary to his service-connected posttraumatic stress disorder (PTSD). The AOJ issued binding favorable findings of a current diagnosis of diabetes mellitus and service performed in the Southwest Asian theater. See 38 C.F.R. § 3.104.

The Veteran's service treatment records do not indicate any diagnosis, treatment, complaint, or symptom of diabetes mellitus in-service. 

The Veteran's private treatment records indicate that the Veteran was diagnosed with diabetes mellitus in June 1998. 

In September 2022, the Veteran underwent a VA diabetes mellitus examination. In March 2023, a different examiner provided medical opinions relating to the Veteran's diabetes mellitus. She opined that the diabetes mellitus was less likely than not incurred in or caused by the Veteran's military service to include Gulf War service or toxic exposure. The examiner reasoned that diabetes mellitus is a disease with a clear and specific etiology and diagnosis. She explained that the Veteran carried several risk factors for diabetes mellitus separate from his military service. The examiner stated that the most significant factor was his family history, which included his mother and brother both having diabetes mellitus. The examiner also noted the Veteran was considered as overweight consistently in the late 1990s and early 2000s. The examiner noted that it was likely the Veteran had a sedentary or less active lifestyle. The examiner remarked that such were also risk factors for diabetes mellitus. She concluded that it is the culmination of risk factors that resulted in the diabetes mellitus. She further found that the diabetes mellitus was less likely than not caused by the toxic exposure risk activities after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran. The examiner stated that the medical literature does not support diabetes mellitus was related to the Veteran's toxic exposures and reiterated that it was likely due to the culmination of his risk factors.  

The Board finds that the March 2023 VA medical opinion is adequate, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Board finds the examiner's opinion is persuasive because she explained that the Veteran's diabetes is likely due to his cumulative risk factors and not his service or exposures in service. 

The Board finds that the Veteran is not competent to determine his diabetes is secondary to his PTSD. See Kahana v. Shinseki, 24 Vet. App. 428 (2011). Further, the Board notes that VA did not provide a secondary service connection medical opinion regarding his diabetes and PTSD. The record does not contain any competent evidence of a link between the Veteran's diabetes mellitus and his PTSD. The Board finds that the Veteran's bare unsupported statement that his PTSD is related to his diabetes mellitus is insufficient to trigger VA to obtain a secondary medical opinion. 38 U.S.C. § 5103(d); McLendon v. Nicholson, 20 Vet. App. 83 (2006); see also generally Waters v. Shinseki, 601 F.3d 1274, 1278-79 (Fed. Cir. 2010) (a conclusory generalized lay statement suggesting a nexus between a current disability and service does not suffice to warrant a VA examination).

The Board finds that the Veteran's type II diabetes mellitus is a diagnosed condition, it cannot be considered an undiagnosed illness. 38 C.F.R. § 3.317(a)(1)(ii). Moreover, type II diabetes mellitus is not a MUCMI because it is considered to have partially understood pathophysiology and etiology. 38 C.F.R. § 3.317(a)(2)(ii). Thus, presumptive service connection for type II diabetes mellitus under § 3.317 is not warranted. Further, although the Veteran is a "covered veteran" with presumed BPOT exposure, the Veteran's type II diabetes mellitus is not among those diseases which can be presumed due to BPOT exposure pursuant to 38 U.S.C. § 1119. Therefore, presumptive service connection due to BPOT exposure is not warranted under 38 U.S.C. § 1120.

The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease, or manifested
 § 3.317(a)(2)(ii). Thus, presumptive service connection for type II diabetes mellitus under § 3.317 is not warranted. Further, although the Veteran is a "covered veteran" with presumed BPOT exposure, the Veteran's type II diabetes mellitus is not among those diseases which can be presumed due to BPOT exposure pursuant to 38 U.S.C. § 1119. Therefore, presumptive service connection due to BPOT exposure is not warranted under 38 U.S.C. § 1120.

The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease, or manifested within one year of his service. Here, the Board finds the weight of the evidence is persuasively against a nexus between the diabetes mellitus and his service. The March 2023 VA opinion explained that the diabetes mellitus was less likely than not due to service or any toxic exposures in-service. Further, the disease manifested itself roughly 7 years after his separation from service. As diabetes mellitus did not manifest to a compensable degree within one year of the Veteran's discharge from service, presumptive service connection for this disability is not warranted. Direct service connection must also be denied. There is no evidence of diabetes mellitus in service, nor is there competent and credible evidence of a nexus to service. There is no reasonable doubt to be resolved in this case. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). 

Kidney Stones

The Veteran contends that his kidney stones is related to his service, specifically his service in the Southwest Asian theater to include his exposures and several bouts of dehydration while deployed. The Veteran also indicated that his kidney stones were a complication of his service-connected sarcoidosis.

The AOJ issued binding favorable findings of a current diagnosis of kidney stones; service performed in the Southwest Asian theater; and that kidney stones is a chronic disease under 38 C.F.R. § 3.309. See 38 C.F.R. § 3.104.

The Veteran's service treatment records do not indicate any diagnosis, treatment, complaint, or symptom of kidney stones.

In September 2022, the Veteran underwent a VA kidney examination. The examiner diagnosed the Veteran with ureterolithiasis. During the examination, the Veteran reported that he first went to the hospital in May 2022 with a urinary tract infection and was hospitalized. The Veteran passed a kidney stone. It was noted that the May 2022 incident was the first known stone, and two others were present on the scan. 

In March 2023, VA obtained an opinion regarding the Veterans kidney stones and ureterolithiasis. The examiner opined that the claimed condition was less likely than not caused by the TERAs after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran. The examiner explained that kidney stones and ureter stones are common diagnosis of the general public. Further, the examiner noted the Veteran carried risk factors of being over the age of forty, male, white, diabetic, history of urinary tract infections, and possible dietary factors (including fluid intake). The examiner explained that medical literature does not support nephrolithiasis or ureterolithiasis were related to toxic exposures during service, rather the culmination of these risk factors that resulted in the Veteran's nephrolithiasis and possible ureterolithiasis.   

The examiner further opined that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner noted that the Veteran's kidney stones is a disease with a clear and specific etiology and diagnosis. The examiner explained that the nephrolithiasis and/or ureterolithiasis were more likely than not related to the culmination of his risk factors discussed above. 

At the onset, the Board finds that the Veteran's statement that he had dehydration during service that would cause his kidney stones 30 years after separation from service is not competent. The Veteran has not shown the requisite medical knowledge to diagnose himself with dehydration during service, nor linking any perceived symptom of dehydration in-service to his current disability. See Kahana v. Shinseki, 24 Vet. App. 428 (2011).

In addition, the Board finds that the Veteran is not competent to determine his kidney stones was a complication of his service-connected sarcoidosis. Further, the Board notes that VA did not provide a secondary service connection medical opinion regarding his kidney stones and sarcoidosis. There is no indication in the record that his kidney stones are related to his
 Board finds that the Veteran's statement that he had dehydration during service that would cause his kidney stones 30 years after separation from service is not competent. The Veteran has not shown the requisite medical knowledge to diagnose himself with dehydration during service, nor linking any perceived symptom of dehydration in-service to his current disability. See Kahana v. Shinseki, 24 Vet. App. 428 (2011).

In addition, the Board finds that the Veteran is not competent to determine his kidney stones was a complication of his service-connected sarcoidosis. Further, the Board notes that VA did not provide a secondary service connection medical opinion regarding his kidney stones and sarcoidosis. There is no indication in the record that his kidney stones are related to his sarcoidosis. The Board finds that the Veteran's bare unsupported statement that his kidney stones are related to his sarcoidosis is insufficient to trigger VA to obtain a secondary medical opinion. 38 U.S.C. § 5103(d); McLendon, 20 Vet. App. at 83; see also generally Waters, 601 F.3d at 1278-79. 

The Board finds that the March 2023 VA medical opinion is adequate, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Board finds the examiner's opinion is persuasive because she explains that the Veteran's kidney stones are likely due to his cumulative risk factors and not his service or exposures in service. 

The Board finds that the Veteran's kidney stones diagnosed as either nephrolithiasis or ureterolithiasis (kidney stones or ureter stones) is a diagnosed condition and it cannot be considered an undiagnosed illness. 38 C.F.R. § 3.317(a)(1)(ii). Further, kidney stones or ureter stones are not among those diseases which can be presumed due to BPOT exposure pursuant to 38 U.S.C. § 1119. Therefore, presumptive service connection due to BPOT exposure is not warranted under 38 U.S.C. § 1120.

The Board finds the weight of the evidence is persuasively against a nexus between the stones and his service. First there is no indication of any kidney or ureter stones in-service, nor any evidence of any urinary tract infections in-service. Further, the March 2023 VA opinion explained that the nephrolithiasis and/or ureterolithiasis were less likely than not due to service or any toxic exposures in-service. As there is no competent and credible evidence of a nexus to service connect on a direct basis, it is not warranted. Finally, the disease manifested itself roughly 30 years after his separation from service. As the kidney stones did not manifest to a compensable degree within one year of the Veteran's discharge from service, presumptive service connection for this disability is not warranted. There is no reasonable doubt to be resolved in this case. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990).

 

 

WILLIAM H. DONNELLY

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Robert Batten

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.