Case A26011078

D. MARTZ AMES · 2026 · Case ID: A26011078

GRANTED

Summary

The veteran, who served in the United States Air Force from August 1992 to November 1995, appeals the denial of service connection for a skin disability and diabetes mellitus type II. The skin disability claim, initially denied by the RO, was reconsidered based on new and relevant evidence. The veteran asserted exposure to JP4 jet fuel during refueling tasks on the flight line as the cause. The Board found a current skin disability, dermatophytosis with secondary hyperpigmentation, and noted conflicting medical opinions. A VA examiner opined the fungal infection was unrelated to jet fuel exposure, while a private physician assistant concluded the exposure was a significant contributing factor to the veteran's persistent dermatitis with pruritus. The Board found the evidence evenly balanced and resolved doubt in the veteran's favor, granting service connection for the skin disability, noting the private opinion's explanation of jet fuel's impact on skin health and the veteran's MOS as an aircraft mechanic. For the diabetes mellitus type II claim, sought on a secondary basis to insomnia disorder with major depressive disorder, the Board also found the evidence evenly balanced. A VA examiner found insufficient evidence linking diabetes to insomnia, citing the later onset of insomnia relative to diabetes diagnosis. However, two private physician assistants provided opinions linking the veteran's diabetes to weight gain and sleep deprivation caused by his service-connected insomnia, citing medical literature on hormonal disruption and insulin resistance. The Board found these opinions probative, resolved doubt in the veteran's favor, and granted service connection for diabetes mellitus type II as secondary to insomnia.

Service Branch

AIR FORCE

Special Benefit

NO SPECIAL BENEFIT

Docket No.

200724-99399

Full Decision Text

Citation Nr: A26011078
Decision Date: 02/05/26 Archive Date: 02/05/26

DOCKET NO. 200724-99399
DATE: February 5, 2026

ORDER

Entitlement to service connection for dermatophytosis previously claimed as skin condition, to include dry skin scaling with irritation in groin and buttock areas, (skin disability) is granted.

Entitlement to service connection for diabetes mellitus type II, on a secondary basis, is granted.

FINDING OF FACT

1. Resolving reasonable doubt in the Veteran's favor, his skin disability was related to an in-service injury, event, or disease.

2. Resolving reasonable doubt in the Veteran's favor, his diabetes mellitus type II was due to and caused by the service-connected insomnia disorder with major depressive disorder.

CONCLUSION OF LAW

1. The criteria for service connection for skin disability are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for service connection for diabetes mellitus type II as secondary to service-connected insomnia disorder with major depressive disorder are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Air Force from August 1992 to November 1995.

This matter is on appeal to the Board of Veterans' Appeals (Board) from a July 2020 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In the July 2020 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran timely appealed the portion of the rating decision pertaining to the issues above and requested a hearing before the Board and an opportunity to submit evidence at the hearing and within 90 days following the hearing. 38 C.F.R. § 20.202. In the June 7, 2024, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of that hearing is of record.

Therefore, the Board may only consider the evidence of record at the time of the July 2020 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or his representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). Evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, and the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801.

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 of service connection for skin disability and diabetes mellitus type II, 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

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).

Service connection may also be established on a secondary basis 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). Secondary service connection may also be established for a nonservice-connected disability which is aggravated by a service-connected disability. In such an instance, the Veteran may be compensated for the degree of disability over and above the degree of disability
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).

Service connection may also be established on a secondary basis 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). Secondary service connection may also be established for a nonservice-connected disability which is aggravated by a service-connected disability. In such an instance, the Veteran may be compensated for the degree of disability over and above the degree of disability existing prior to the aggravation. 38 C.F.R. §?3.310(b); see Allen v. Brown, 7 Vet. App. 439, 448 (1995).

While obesity cannot be service-connected on a direct basis, and obesity cannot qualify as an in-service injury or disease for service connection purposes, obesity may serve as an "intermediate step" between a service-connected disability and a current disability that may be service connected on a secondary basis under 38 C.F.R. § 3.310(a). Walsh v. Wilkie, 32 Vet. App. 300 (2020); see also VAOGCPREC 1-2017. In such a case, the evidence would need to reflect that (1) a service-connected disability or disabilities caused the Veteran to become obese or aggravated the Veteran's obesity, (2) the obesity or aggravation of obesity resulting from service-connected disability or disabilities was a substantial factor in causing another disability, and (3) the disability would not have occurred but for the obesity caused by the Veteran's service-connected disability or disabilities or the obesity aggravated by the service-connected disability or disabilities. Walsh, 32 Vet. App. at 306-7.

1. Skin Disability

As an initial matter, an October 2019 rating decision denied the claim of service connection for skin condition, to include dry skin scaling with irritation in groin and buttocks area. The Veteran submitted a December 2019 supplemental claim application for the skin condition. The March 2020 rating decision found that new and relevant evidence had been received, and the claim was reconsidered. The RO then denied the claim of service connection for dermatophytosis. The Veteran then submitted a May 2020 supplemental claim application for the skin condition. The July 2020 rating decision on appeal found that new and relevant evidence had been received, and the claim was reconsidered. As the RO implicitly found new and relevant evidence for the claim, the Board finds this a favorable find that new and relevant evidence had been received and therefore, will proceed to address the claim on the merits. See 38 U.S.C. § 5104A; 38 C.F.R. § 3.104(c).

The Veteran contends that he has a skin disability that was caused by his active-duty service. See December 2019 Fully Developed Claim. Specifically, he states that he was exposed to JP4 jet fuel during refueling stages that occurred on the flight line. Id.

The Board concludes that the Veteran has a current disability that began during active service/is related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a).

The Veteran has a current skin disability. For example, during the February 2020 VA examination he was diagnosed with dermatophytosis with secondary hyperpigmentation. During the 90-day evidentiary window, the Veteran submitted a May 2024 private medical opinion which noted that the Veteran had dermatitis with pruritus. In a December 2019 VA treatment, he received a discharge diagnosis of chronic rash, and a provisional diagnosis of rash and other nonspecific skin eruptions. He was also assessed as having contact dermatitis. In a January 2020 VA treatment, he received a provisional diagnosis of unspecified contact dermatitis due to other chemical products.

During service, in a February 1993 service treatment, it was noted that the Veteran had mild pseudofolliculitis and mild skin irritation secondary to environment training. In a March 1993 service record, the Veteran was seen for complaints of mild pseudofolliculitis. During a July 1995 service treatment, it was noted that the Veteran had a history of pain and itching.

Thus, the question becomes
received a discharge diagnosis of chronic rash, and a provisional diagnosis of rash and other nonspecific skin eruptions. He was also assessed as having contact dermatitis. In a January 2020 VA treatment, he received a provisional diagnosis of unspecified contact dermatitis due to other chemical products.

Thus, the question becomes whether the current disability is related to service. On this question there are probative opinions in favor of and against the claim.

The evidence against the claim includes a February 2020 VA medical opinion where the examiner opined that the condition claimed was not incurred in or caused by the claimed in-service injury, event, or illness. In support of this conclusion, the examiner explained that the Veteran had a fungal infection of his skin with discoloration due to chronic inflammation. The examiner noted that there was no history of fungal infection in the service treatment records or other skin disorder except for pseudofolliculitis barbae. The examiner explained that jet fuel exposure does not cause fungal infection. Thus, there was no nexus established between the Veteran's current fungal infection with post-inflammatory hyperpigmentation and military service.

The evidence in favor of the claim includes a May 2024 private medical opinion by certified physician assistant A.T., submitted during the 90-day evidentiary window. After reviewing the record, physician assistant A.T. noted that the Veteran's duties during service were that of an aircraft mechanic which frequently exposed him to jet fuel during equipment refueling tasks when fuel were spilled on him and resulted in prolonged contact with his skin. Physician assistant A.T. noted that the Veteran began developing troublesome symptoms such as dark, scaly patches on his groin and buttocks, an area characterized by severe dryness and scaliness. Physician assistant A.T. noted that the skin discomfort escalated as his clothing exacerbated the irritation and itchiness. After the Veteran was discharged from service, physician assistant A.T. noted that the Veteran did not have any improvement in his condition and he was diagnosed with dermatitis with pruritus that has persisted since then. Physician assistant A.T. noted that toxic exposure was significant contributing factor to the development of dermatitis with pruritus. Service members are often exposed to various harmful substances, such as chemicals, solvents, fuels, and environmental toxins that can damage the skin barrier and alter immune function leading to susceptibility to inflammatory skin conditions. Thus, after reviewing the record, reported symptoms, and current medical literature, physician assistant A.T. opined that the Veteran's dermatitis with pruritus was caused by the service, to include as due to exposure to toxic exposure risk activity.

A review of the service personnel records indicate that the Veteran's MOS was that of Tactical Aircraft Maintenance Apprentice and his duties included repair, replacement, and troubleshooting of airframe, pneudraulic, and jet engine component.

Upon review of the record, the Board finds the evidence to at least be evenly balanced as to whether the Veteran's current skin disability arose in and was related to service. In that regard, the medical evidence confirms that the Veteran had a current skin disability. The Board acknowledges the February 2020 VA medical opinion where the examiner noted that jet fuel exposure does not cause fungal infection. However, the Board gives probative weight the May 2024 private medical opinion where physician assistant A.T. explained that the Veteran's exposure to jet fuel as a result of his duties as an aircraft mechanic caused his current skin disability to manifest during service and has continued since his discharge from service. The service personnel records show that the Veteran worked as an aircraft mechanic during service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for skin disability is warranted, and the claim is granted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

2. Diabetes Mellitus Type II

As an initial matter, a March 2020 rating decision denied the claim of service connection for diabetes mellitus type II. The Veteran submitted a May 2020 supplemental claim application for the diabetes issue. The July 2020 rating decision on appeal found that new and relevant had been received and the claim was reconsidered. As the RO implicitly found new and relevant evidence for the claim, the Board finds this a favorable finding that new and relevant evidence had been received and therefore, will proceed to address the claim on the
disability is warranted, and the claim is granted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

2. Diabetes Mellitus Type II

As an initial matter, a March 2020 rating decision denied the claim of service connection for diabetes mellitus type II. The Veteran submitted a May 2020 supplemental claim application for the diabetes issue. The July 2020 rating decision on appeal found that new and relevant had been received and the claim was reconsidered. As the RO implicitly found new and relevant evidence for the claim, the Board finds this a favorable finding that new and relevant evidence had been received and therefore, will proceed to address the claim on the merits. See 38 U.S.C. § 5105A; 38 C.F.R. § 3.104(c).

The Veteran contends that he has diabetes mellitus that was secondary to his sleep disorder. See December 2019 Fully Developed Claim.

The Veteran has a current diabetes mellitus type II disability. See February 2020 VA Examination Report, June 2020 VA Examination Repot; see also May 2020 Private Disability Benefits Questionnaire. Thus, the question becomes whether the current disability was caused by a service-connected disability.

The evidence against the claim includes a February 2020 VA medical opinion where the examiner opined that the claimed condition was not proximately due to or the result of his service-connected condition. In support of this conclusion, the examiner noted the Veteran's insomnia had an onset date of May 8, 2015. The Veteran was assessed with diabetes mellitus in December 2015. The Veteran's diabetes requires insulin during assessment suggesting his condition existed possibly years prior to diagnosis. Type 2 diabetes mellitus has shown to be associated with higher incidence of sleep disorders, and predominantly sleep apnea, which may be due to disease itself or because of secondary complications or associated comorbidities associated with diabetes. However, the examiner noted that there were insufficient clinical literature and evidence in the service treatment records to suggest his diabetes mellitus was a result of insomnia.

The evidence in favor of the claim includes a May 2020 private medical opinion by certified physician assistant P.D. After reviewing the record, physician assistant P.D. noted that the Veteran's diabetes was most likely secondary to his weight gain that led to obesity. The Veteran reported that his sleep disorder had caused him to have lack of desire to work out, anxiety when leaving the house, and low energy, which in turn have contributed significantly to his weight gain. He reported that he had normal weight in 1992 prior to his military service and he now weighed around 228 pounds, which has increased since his time in service. His entrance examination did not report any history of metabolic syndrome or diabetes, and he denied any other risk factors for diabetes. After reviewing the record, physician assistant P.D. opined that the Veteran's diabetes mellitus type II was secondarily linked to his service-connected sleep disorder and associated symptoms with obesity as an intermediate step. Physician assistant P.D. noted that the Veteran would not have likely developed diabetes mellitus type II without the weight gain caused by his service-connected disabilities. Physician assistant P.D. cited medical literatures to support the medical findings.

During the 90-day evidentiary window, the Veteran submitted a May 2024 private medical opinion by certified physician assistant A.T. After reviewing the record, physician assistant A.T. noted that the Veteran began experiencing significant health issues in 2015 from chronic insomnia. He described his symptoms as typically sleeping only two to three hours each night, which had directly contributed to the uncontrolled nature of his type II diabetes. Despite a strict regimen of insulin and metformin, the Veteran's sleep deprivation complicates his body's ability to manage blood sugar levels.

Physician assistant A.T. explained that insomnia, a condition marked by difficulty in falling or staying asleep, significantly contributes to the development of type II diabetes mellitus through various mechanisms. Chronic sleep deprivation disrupts the hormonal balance regulating appetite and glucose metabolism. Increased levels of ghrelin, which stimulates hunger, and decreased levels of leptin, which signals satiety, lead to overeating and weight gain, major risk factors for insulin resistance. Furthermore, insomnia activates the hypothalamic-pituitary-adrenal (HPA) axis, resulting in elevated cortisol levels that impair insulin sensitivity, exacerbating glucose intolerance. These hormonal and metabolic disruptions due to insomnia significantly elevate the risk of developing type II diabetes mellitus, underscoring the crucial link between adequate sleep and metabolic health. Thus, after reviewing the medical records, reported symptoms, and current medical literature, physician assistant A.T. opined that the Veteran's diabetes mell
s the hormonal balance regulating appetite and glucose metabolism. Increased levels of ghrelin, which stimulates hunger, and decreased levels of leptin, which signals satiety, lead to overeating and weight gain, major risk factors for insulin resistance. Furthermore, insomnia activates the hypothalamic-pituitary-adrenal (HPA) axis, resulting in elevated cortisol levels that impair insulin sensitivity, exacerbating glucose intolerance. These hormonal and metabolic disruptions due to insomnia significantly elevate the risk of developing type II diabetes mellitus, underscoring the crucial link between adequate sleep and metabolic health. Thus, after reviewing the medical records, reported symptoms, and current medical literature, physician assistant A.T. opined that the Veteran's diabetes mellitus type II was caused by the service-connected insomnia.

Upon review of the record, the Board finds the evidence to at least be evenly balanced as to whether the Veteran's current diabetes mellitus type II was due to and caused by the service-connected insomnia disorder with major depressive disorder. In making this determination, the Board notes that the medical evidence shows that the Veteran had a current disability for diabetes mellitus type II. The Board acknowledge the February 2020 VA medical opinion where the examiner noted that the Veteran's insomnia was diagnosed in May 2015 while his diabetes requires insulin during assessment suggesting his condition existed possibly years prior to diagnosis in December 2015. The Board has also considered the May 2024 private medical opinion where physician assistant A.T. adequately explained how the Veteran's insomnia likely caused his diabetes mellitus type II given that insomnia impacted hormonal balance and that insomnia also resulted in elevated cortisol levels that impair insulin sensitivity. The Board notes that there are probative opinions for and against the claim. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for diabetes mellitus as secondary to service-connected insomnia is warranted, and the claim is granted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

D. Martz Ames

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Mathew, 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.

Analyze in VA Law Explorer