DIABETES MELLITUS

M. TENNER · 2026 · Case ID: 26001129

DENIED

Summary

The Veteran, a Marine Corps Veteran who served from April 1975 to July 1977, including service at Camp Lejeune, appeals the denial of service connection for diabetes mellitus, type II. The Veteran pursued multiple theories of entitlement: direct service connection for diabetes, presumptive service connection due to Camp Lejeune water contamination, presumptive service connection as a chronic disease, and secondary service connection due to service-connected knee, lumbar spine, and psychiatric disabilities, with obesity as an intermediate step. The Board denied all theories. While the Veteran served at Camp Lejeune and diabetes is a chronic disease, it is not a presumptive condition linked to Camp Lejeune water contamination, nor did it manifest during service or within one year of separation. The Board found the Veteran's diabetes was diagnosed in 2006, well after service. Regarding direct service connection for Camp Lejeune exposure, the Board found VA medical opinions from May 2023 and July 2025 persuasive, concluding that diabetes is not linked to Camp Lejeune water contamination and that other factors like genetics and lifestyle are more likely causes. For secondary service connection, the Board found the evidence weighed against a causal or aggravating link between the Veteran's service-connected knee, lumbar spine, and psychiatric conditions, or obesity, and his diabetes, citing VA medical opinions that found these conditions pathophysiologically different and that the Veteran's diabetes predated significant obesity.

Rationale

Diabetes is not a listed presumptive disease for Camp Lejeune exposure.; Diabetes did not manifest during service or within one year of separation.; VA medical opinions found no causal link between Camp Lejeune exposure and diabetes.; Evidence weighed against direct service connection for Camp Lejeune exposure.

Service Branch

MARINE CORPS

Special Benefit

NO SPECIAL BENEFIT

Docket No.

15-01 689A

Full Decision Text

Citation Nr: 26001129
Decision Date: 01/29/26 Archive Date: 01/29/26

DOCKET NO. 15-01 689A
DATE: January 29, 2026

ORDER

Service connection for diabetes mellitus, type II, is denied.

FINDING OF FACT

The Veteran's diabetes is not shown in service and did not manifest to a compensable degree within the first post-service year. It is not etiologically related to exposure to contaminated water at Camp LeJeune, is not secondary to service-connected disability, and service-connected disabilities did not cause the Veteran to become obese such that his obesity caused or aggravated his diabetes.

CONCLUSION OF LAW

The criteria for service connection for diabetes, to include as secondary to service-connected disability, or to obesity, are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Marine Corps from April 1975 to July 1977, including service at Camp Lejeune, North Carolina.

This case comes before the Board of Veterans' Appeals (Board) on appeal from a March 2014 rating decision issued by a Regional Office of the United States Department of Veterans Affairs (VA), which denied the Veteran's claim for service connection for diabetes.

In July 2018, the Veteran testified at a videoconference Board hearing before the undersigned Veterans Law Judge (VLJ).

A November 2021 Board decision denied the Veteran's claim for service connection for diabetes mellitus, type II, to include as due to exposure to contaminated water at Camp Lejeune; and/or as secondary to service-connected bilateral knee disability, lumbar spine disability, and/or psychiatric disability, to include consideration of obesity as an "intermediate step." The Veteran appealed that decision to the United States Court of Appeals for Veterans Claims (Court). At the Court, the parties submitted a Joint Motion for Partial Remand. In it, they stipulated that the December 2020 and May 2021 VA medical opinions relied on by the Board were inadequate for the Board to make a fully informed decision on the claim for service connection for diabetes. The Court granted the parties' motion and returned the matter to the Board.

In November 2022, the Board remanded the Veteran's claim to comply with the Court's Order. In an August 2024 Supplemental Statement of the Case, the VA Regional Office denied his claim.

In May 2025, the Board again remanded the claim for further development. Specifically, the Board directed the Regional Office to schedule the Veteran for an examination regarding whether the Veteran's diabetes at least as likely as not had its onset or was otherwise etiologically related to an in-service injury, event, or disease, to include exposure to contaminated water during service at Camp Lejeune.

The Veteran was afforded additional VA examination in July 2025, and a September 2025 Supplemental Statement of the Case again denied the Veteran's claim.

The Board finds that the Regional Office substantially complied with its May 2025 Remand directive. Stegall v. West, 11 Vet. App. 268, 371 (1998) (finding that remand by the Board "confers on the veteran or other claimant, as a matter of law, the right to compliance with the remand orders" and imposes on the Secretary a "concomitant duty to ensure compliance with the terms of the remand").

The matter now returns to the Board for adjudication.

Evidentiary Standards

In deciding claims, it is the Board's responsibility to evaluate the entire record on appeal. VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits.

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b). It follows, that when the evidence persuasively favors one side or the other, the benefit-of-the-doubt rule is not applied. Lynch v. McDonough, 21 F.4th, 776 (Fed. Cir. 2021).

The law requires the Board address its reasons for rejecting evidence favorable to the Veteran. Timberlake v. Gober, 14 Vet. App. 122, 128-29 (2000). The Board must review the entire record but does not have to discuss
negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b). It follows, that when the evidence persuasively favors one side or the other, the benefit-of-the-doubt rule is not applied. Lynch v. McDonough, 21 F.4th, 776 (Fed. Cir. 2021).

The law requires the Board address its reasons for rejecting evidence favorable to the Veteran. Timberlake v. Gober, 14 Vet. App. 122, 128-29 (2000). The Board must review the entire record but does not have to discuss each piece of evidence. Gonzales v. West, 218 F.3d 1378, 1381 (Fed. Cir. 2000). The analysis below focuses on the most salient and relevant evidence of record, and on what this evidence shows, or fails to show, on the claim.

Any findings favorable to the Veteran made by the VA Regional Office in notification of a decision are binding on the Board unless rebutted by evidence that identifies a clear and unmistakable error in the favorable finding. 38 C.F.R. §?20.810(a). "Findings" means "conclusions on questions of fact and application of law to facts made by an adjudicator concerning the issue under review." Id.

Service Connection

VA provides compensation for a disability resulting from disease or injury incurred in or aggravated by service. This is referred to as a "service connection." 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(d). This case involves multiple legal theories of service connection.

Direct Service Connection

Generally, in order to be entitled to service connection there must be competent, credible evidence of (1) a current disability, (2) an in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). When these elements are satisfied, service connection may be granted on a direct basis.

Presumptive Service Connection-Chronic diseases

In addition, service connection may be established on a presumptive basis for certain "chronic diseases"-to include diabetes mellitus-that manifest in service or to a degree of 10 percent within one year from the date of separation from service. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.303(b), 3.307(a)(3), 3.309(a); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). The term "chronic disease" refers to those diseases in 38 U.S.C. 1101(3) and 38 C.F.R. § 3.309(a). For those listed chronic diseases, a showing of continuity of symptoms affords an alternative route to service connection when the requirements for application of the presumption are not met. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

Secondary Service Connection

Service connection may also be established on a secondary basis for a disability which is proximately due to or the result of, or aggravated by, a service-connected disability. 38 C.F.R. § 3.310(a), (b). Establishing service connection on a secondary basis requires evidence sufficient to show: (1) a current disability exists, (2) the veteran has a service-connected disability; and (3) the current disability was either (a) proximately due to or the result of; or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310(b); Allen v. Brown, 7 Vet. App. 439, 448 (1995). Where aggravation is the relied upon theory, compensation may only be provided to that degree over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310(b); Allen, 7 Vet. App. at 448.

Service Connection Based on Obesity

Obesity cannot qualify as an in-service event because it occurs over time and is based on various external and internal factors as opposed to a discrete incident or occurrence or series
imately due to or the result of; or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310(b); Allen v. Brown, 7 Vet. App. 439, 448 (1995). Where aggravation is the relied upon theory, compensation may only be provided to that degree over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310(b); Allen, 7 Vet. App. at 448.

Service Connection Based on Obesity

Obesity cannot qualify as an in-service event because it occurs over time and is based on various external and internal factors as opposed to a discrete incident or occurrence or series of discrete incidents or occurrences. VAOPGCPREC 1-17. VA General Counsel precedential opinions are binding on the Board. 38 U.S.C. § 7104(c); 38 C.F.R. § 14.507.

The Court of Appeals for Veterans Claims held that proper interpretation of VA General Counsel Opinion 1-17 requires consideration of both proximate causation and aggravation in its analytical framework. Walsh v. Wilkie, 32 Vet. App. 300 (2020). That is, (1) whether the service-connected disability caused the veteran to become obese or aggravated the veteran's obesity; if so, (2) whether such obesity or aggravation thereof was a substantial factor in causing the current disability; and, if so (3) whether the current disability would not have occurred but for such obesity or aggravation thereof. If these questions are answered in the affirmative, then the current disability may be service connected on a secondary basis.

Presumptive Service Connection-Camp Lejeune

For purposes of service connection, if a veteran was exposed to contaminated water at United States Marine Corps Base Camp Lejeune between August 1, 1953, and December 31, 1987, then VA presumes the development of certain diseases is due to that exposure. 38 C.F.R. §§ 3.307(a)(7)(i). Contaminants include trichloroethylene (TCE), perchloroethylene (PCE), benzene, and vinyl chloride found in the on-base water supply systems. 38 C.F.R. § 3.307(a)(7)(i).

Limitations were put in place describing the minimum qualifications for this presumption to apply VA regulation. 38 C.F.R. § 3.307(a)(7)(iii) provides that a veteran, or former reservist or member of the National Guard, who had no less than 30 days of service (consecutive or nonconsecutive) at Camp Lejeune during the period beginning on August 1, 1953, and ending on December 31, 1987, shall be presumed to have been exposed during such service to the contaminants in the water supply, unless there is affirmative evidence to establish that the individual was not exposed to contaminants in the water supply during that service.

The specified diseases that are deemed to be associated with exposure to contaminated water at Camp Lejeune are:

" Kidney cancer

" Liver cancer

" Non-Hodgkin's lymphoma

" Adult leukemia

" Multiple myeloma

" Parkinson's disease

" Bladder cancer

" Aplastic anemia and other myelodysplastic syndromes

If the Veteran meets the criteria for presumptive service connection, then this satisfies the second and third elements of the direct service-connection test, alleviating the need for direct evidence to establish these elements.

Analysis

Service connection for diabetes is denied.

The Veteran asserts numerous theories of entitlement for service connection for diabetes. First, there is an assertion that his diabetes was caused by contaminated water while stationed at Camp Lejeune, North Carolina (presumptively or on a direct basis). Second, he asserts his diabetes is a chronic condition associated with his military service (presumptively or on a direct basis). Third, he asserts his diabetes was caused or aggravated by his service-connected bilateral knee disability, lumbar spine disability, and/or psychiatric disability. Fourth, he asserts his service-connected bilateral knee disability, lumbar spine disability, and/or psychiatric disability caused his obesity, which in turn caused his diabetes. For the reasons that follow, the Board finds the Veteran is not entitled to service connection on any of these theories.

For each theory of service connection addressed in this decision, the Veteran must have a "current disability"; otherwise, there is nothing for which to grant service connection. The requirement for a veteran to have a "current disability" is satisfied when he or she has a disability (1) at the time a claim for VA
Third, he asserts his diabetes was caused or aggravated by his service-connected bilateral knee disability, lumbar spine disability, and/or psychiatric disability. Fourth, he asserts his service-connected bilateral knee disability, lumbar spine disability, and/or psychiatric disability caused his obesity, which in turn caused his diabetes. For the reasons that follow, the Board finds the Veteran is not entitled to service connection on any of these theories.

The Veteran asserts he had a diagnosis of diabetes in the 1980s. The Board finds the Veteran was medically diagnosed with diabetes in 2006 based on his medical records. See October 2006 VA Nursing Telephone Encounter Note (noting no prior history of diabetes); November 2006 VA Nutrition Consult (noting new diagnosis of diabetes); December 2020 VA Examination (confirming diagnosis of diabetes in 2006). In addition, since 2006, the Veteran was continuously treated for diabetes. Therefore, he has a current disability for purposes of service connection. See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Therefore, the first element of service connection, a current disability, is satisfied for each theory of service connection.

Presumptive Service Connection-Camp Lejeune

The Board first addresses the theory of entitlement to presumptive service connection based on presumed exposure to contained water at Camp Lejeune.

According to his military records, the Veteran served at Camp Lejeune from approximately August 1975 to October 1975, with subsequent service in February 1977 until his discharge in July 1977. His service during each period was consecutive. As such, the Veteran is presumed to have been exposed during such service to the contaminants in the water supply, and the Board finds no affirmative evidence to the contrary. 38 C.F.R. § 3.307(a)(7)(iii). Diabetes, however, is not a listed disease associated with contaminated water at Camp Lejeune. Therefore, presumptive service connection is not warranted. 38 C.F.R. § 3.309(f).

Even though a presumptive service connection is precluded for the Veteran's diabetes, a grant of service connection may be made on a direct basis. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994).

Presumptive Service Connection-Chronic disease

Diabetes is a chronic disease and may be presumptively service-connected if it manifested during the Veteran's active service or within one year of his separation from active service. 38 C.F.R. 3.303(b), 3.307(a)(3), 3.309(a). The Veteran separated from service in July 1977. His diabetes was not diagnosed until the 1980s, according to his lay statements, and his medical records indicate a diagnosis in 2006. A review of his in-service treatment records and post-service medical records does not reveal a diagnosis of diabetes while in service or within one year following his discharge from active service. The provisions of law regarding continuity of symptomatology are not for application. The Veteran's in-service medical records and post-service medical records do not "note" symptomatology that may reasonably be associated with diabetes during service or within one year following separation from active military service. Therefore, the Veteran is not entitled to presumptive service connection for diabetes as a chronic disease.

Direct service connection

For the reasons already discussed, the Veteran has a current diagnosis of diabetes. Therefore, the first element of direct service connection has been met.

The record, rather than the Veteran, reasonably asserts exposure to contaminated water at Camp Lejeune as an in-service event. Robinson v. Mansfield, 21 Vet. App. 545, 552 (2008), aff'd sub nom. Robinson v. Shinseki, 557 F.3d 1355 (Fed. Cir. 2009) (Board is required to consider theories of entitlement to benefits that are either raised by the claimant or reasonably raised by the record). For the reasons already discussed, the Veteran is presumed to have been exposed to contaminated water at Camp Lejeune. Therefore, the second element of direct service connection has been met
first element of direct service connection has been met.

The evidence of record weighs persuasively against finding that the Veteran's diabetes was due to his exposure to contaminated water at Camp Lejeune. In a December 2020 VA opinion and a May 2021 addendum opinion, a VA examiner opined that the Veteran's diabetes was less likely than not caused by his exposure to contaminated water at Camp Lejeune in service. The examiner reasoned that, based on her review of standard medical literature and Up-to-Date, an online medical reference, contaminated water at Camp Lejeune is not a risk factor associated with diabetes.

As discussed above, in July 2022 JMPR, the parties agreed that the December 2020 VA examiner provided a conclusory opinion when she did not explain why her review of the record and medical history led her to a negative opinion. Additionally, the May 2021 addendum opinion was also inadequate when the VA examiner merely relied on general medical articles without discussing facts pertaining to the individual veteran.

On subsequent VA examination in May 2023, the VA examiner opined that that the Veteran's diabetes was less likely than not incurred in or caused by an in-service event, injury, or illness. The VA examiner reasoned that the Veteran was separated from service in July 1977 and that his December 2003 medical records showed he was borderline diabetic, explaining that since no diagnosis of diabetes was made during active duty service no nexus was established.

The Veteran was afforded additional VA examination in July 2025. The VA examiner documented review of the Veteran's VA e-folder in combination with an in-person examination. The VA examiner opined that the Veteran's diabetes was less likely than not incurred in or caused by an in-service event, injury, or illness. The VA examiner reasoned that service treatment records did not support a chronic diagnosis, disability pattern or chronicity of care regarding the claimed diabetes disability while on active duty or directly after military service, noting that diabetes was established well after separation from service. The July 2025 VA Examiner additionally opined that the Veteran's diabetes was less likely than not caused by the indicated toxic exposure risk activity (exposure to contaminated water at Camp Lejeune) 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 VA examiner reasoned that multiple risk factors outside of military service, including hereditary, dietary and lifestyle, can contribute to diabetes, and that a thorough review of medical literature did not provide an indication of development of diabetes from exposure to contaminated water at Camp Lejeune.

Absent evidence to the contrary, the Board finds the May 2023 and July 2025 VA examiner's respective medical opinions the most credible and probative evidence of record addressing whether the Veteran's diabetes was caused by his exposure to contaminated water at Camp Lejeune. The examiners relied on accurate facts, considered the Veteran's relevant medical records, medical history, and lay statements, and provided well-reasoned medical judgments that connected the facts to the conclusions. Therefore, the Board concludes that the evidence is against finding a causal link between the Veteran's exposure to contaminated water at Camp Lejeune and his diabetes. Thus, third element of direct service connection is not satisfied.

Accordingly, service connection for diabetes on a direct basis is not warranted.

Secondary service connection

As already discussed, the Veteran has a current diagnosis of diabetes. Therefore, the first element of secondary service connection is satisfied.

As to the second element, a current service-connected disability, the Veteran is currently service-connected for a right knee disability, left knee disability, lumbar spine disability, and a psychiatric disability, which are the bases of his claim for secondary service connection. The Veteran has additional service-connected disabilities, but does not argue that his other service-connected disabilities are the basis for his secondary-service connection claim, nor does a reasonable review of the record raise such claims. Therefore, the Board finds the second element of secondary service connection is satisfied.

In association with the Veteran's claim for secondary service connection, he asserts that due to
discussed, the Veteran has a current diagnosis of diabetes. Therefore, the first element of secondary service connection is satisfied.

In association with the Veteran's claim for secondary service connection, he asserts that due to the above-cited service-connected disabilities, he has been unable to engage in proper fitness routines, which has subsequently caused him to gain weight to the point of obesity. Consequently, he asserts his diabetes was caused by or aggravated by his weight gain due to his above-cited service-connected disabilities.

The Board concludes the evidence weighs against finding that the Veteran's currently diagnosed diabetes was caused by or aggravated by one or more of his service-connected disabilities cited above, to include obesity as an intermediate step.

The December 2020 VA examiner opined that the Veteran's diabetes was less likely than not caused by his service-connected right knee disability, left knee disability, lumbar spine disability, or psychiatric disability. The December 2020 VA examiner conducted an examination of the Veteran, which included consideration of the Veteran's lay statements to her at the time of the examination. This is the extent of the examiner's rationale, and the Board finds it is not probative as it does not discuss any pertinent facts

The December 2020 VA examiner additionally opined that the Veteran's diabetes was less likely than not caused by or aggravated beyond its natural progression by his right knee disability, left knee disability, lumbar spine disability, or psychiatric disability. The examiner considered that the Veteran had an active post-service employment history and only began a sedentary position in 2008 based on his lay statements. The examiner accepted the Veteran's lay statement that he had a diagnosis of diabetes in the 1980s. After considering the Veteran's statements and medical history, the examiner concluded that the Veteran's diabetes was diagnosed before his obesity diagnosis as documented in a 1997 VA medical record, thus making it less likely that his current-service-connected disabilities led to his obesity and subsequently caused or aggravated his diabetes. She noted that the Veteran's diabetes is currently controlled by medication and found no evidence suggesting aggravation beyond the normal progression of the disease.

In an August 2021 addendum opinion, the examiner opined that the Veteran's diabetes was less likely than not caused by his service-connected right knee disability, left knee disability, lumbar spine disability, or psychiatric disability. The examiner indicated review of the Veteran's medical records, his lay statements, and the available evidence, to include a previous in-person examination. The examiner cited her reasoning contained in her May 2021 opinion (a prior addendum opinion) in which she stated that, based on her review of standard medical textbooks and Up-to-Date medical literature, diabetes and the Veteran's service-connected bilateral knee disabilities, lumbar spine disability, and psychiatric disability are pathophysiologically different conditions. "Pathophysiology" is defined as "physiology of disordered function." Dorland's Illustrated Medical Dictionary 1397 (32 ed. 2012). "Physiology" is defined as "(1) the science of the function of the living organism and its parts, and of the physical and chemical factors and processes involved. (2) the basic processes underlying the functioning of a specifies or class of organism, or any of its parts or processes." Id. at 1444. The examiner did not address whether the Veteran's service-connected orthopedic conditions caused or aggravated his obesity. Additionally, the VA examiner did not explain why the Veteran's developing diabetes prior to becoming obese foreclosed his obesity from aggravating his diabetes.

In an August 2021 addendum opinion, the VA examiner opined that the Veteran's diabetes was less likely than not aggravated by his service-connected right knee disability, left knee disability, lumbar spine disability, or psychiatric disability. The VA examiner reasoned that a review of standard medical textbooks including up to date medical literature combined with their medical experience, that the pathophysiology of diabetes is different than his service-connected right knee disability, left knee disability, lumbar spine disability or psychiatric disability.

The Veteran was afforded additional VA examination in June 2023. The VA examiner documented review of the Veteran's VA e-folder in combination with an in-person examination. The VA examiner opined that the Veteran's diabetes was less likely than not proximately due to or the result of the Veteran's service-connected disabilities. The VA examiner reasoned that the Veteran's service-connected disabilities did not cause the Veteran to become obese, and that it was less likely than not that the Veteran's obesity was a substantial factor in causing his diabetes. The VA examiner opined that obesity wasn't the sole cause of diabetes, noting other factors including genetic mutations, and a lesser-known hormone called amyline, as well as disturbances in the body's natural clock. They explained further that treatment for diabetes requires keeping close watch over blood sugar levels with a combination of medication, exercise, and diet, and that by paying close attention to what and when one eats, they can minimize and avoid the seesaw effect of rapidly changing blood sugar levels. The VA examiner also noted that environmental and genetic factors played a role and that several factors must come together for one to develop diabetes.

The VA examiner opined that the Veteran's diabetes was less likely than not aggravated due to the result of his service-connected right knee disability, left knee disability, lumbar spine, disability, or psychiatric disability. The VA examiner reasoned that diabetes is a metabolic condition that happen because of a problem in the way the body regulates and uses sugar, or glucose, as a fuel. This longterm condition results in too much sugar circulating in the blood. The pancreas does not produce enough insulin, a hormone that regulates the movement of sugar into the cells, and cells respond poorly to insulin and take in less sugar. The VA examiner explained that the Veteran's diabetes is a separate entity from his service-connected conditions and unrelated to it, stating that the medical literature does not support a causal medical relationship between diabetes and a right knee disability, left knee disability, lumbar spine disability, and psychiatric disability.

In a May 2024 addendum opinion, a VA examiner opined that while the claimant's obesity undoubtedly contributed to his diabetes, that that neither the development of obesity nor diabetes was linked to active duty.

In a July 2024 addendum opinion, a VA examiner provided a negative nexus opinion, stating only that they were unable to find any scientific or medical literature that suggested a right knee disability, left knee disability, lumbar spine disability, and psychiatric disability could cause individuals to become obese.

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Absent evidence to the contrary, the Board finds that the August 2021, May 2023, May 2024, and July 2025 respective VA medical opinions the most competent and probative evidence of record addressing whether the Veteran's diabetes was proximately due to or caused by or aggravated by his service-connected disabilities, to include with obesity as an intermediate step. The examiners relied on accurate facts, considered the Veteran's relevant medical records, medical history, and lay statements, and provided well-reasoned medical judgments that connected the facts to the conclusions. Therefore, the Board concludes that the evidence is against finding that the Veteran's diabetes was proximately due to or caused by or aggravated beyond its natural progression by his service-connected disabilities, to include with obesity as an intermediate step.

Accordingly, service connection for diabetes, to include on a secondary basis is not warranted.

M. Tenner

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Lee, P. M., 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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