DIABETES MELLITUS

MICHAEL LANE · 2026 · Case ID: 26003703

MIXED

Summary

The veteran, who served in the United States Marine Corps from September 1997 to September 2001 and for 10 days in March 2003, with additional service in the Marine Corps Reserve, appeals the denial of service connection for kidney stones and the grant of service connection for type II diabetes mellitus and nephropathy secondary to diabetes mellitus. The Board found that the veteran had type II diabetes mellitus during the appeal period, citing VA treatment records and a December 2025 VA medical opinion. For the diabetes claim, the Board found the evidence in equipoise regarding its relation to in-service prednisone use, granting service connection due to the benefit of the doubt. Regarding kidney stones, the Board found the evidence weighed against a current diagnosis, denying service connection. For nephropathy, the Board found a current diagnosis established and the evidence in equipoise regarding its secondary relation to diabetes mellitus, granting service connection due to the benefit of the doubt. The Board noted conflicting medical opinions on the nexus for both diabetes and nephropathy, ultimately granting both claims based on the benefit of the doubt doctrine.

Rationale

Conflicting medical evidence regarding nexus to service; Evidence in equipoise regarding in-service prednisone use; Benefit of the doubt applied for grant

Service Branch

MARINE CORPS

Special Benefit

NO SPECIAL BENEFIT

Docket No.

10-16 018

Full Decision Text

Citation Nr: 26003703
Decision Date: 03/23/26 Archive Date: 03/23/26

DOCKET NO. 10-16 018
DATE: March 23, 2026

ORDER

Entitlement to service connection for type II diabetes mellitus is granted.

Entitlement to service connection for kidney stones, to include as secondary to service-connected asthma, service-connected orthopedic disabilities, and diabetes mellitus, is denied.

Entitlement to service connection for nephropathy as secondary to diabetes mellitus is granted.

FINDINGS OF FACT

1. The evidence persuasively shows that the Veteran has had type II diabetes mellitus during the appeal period.

2. The evidence is in equipoise as to whether the type II diabetes mellitus is related to the in-service use of prednisone for asthma.

3. The evidence persuasively weighs against a finding that the Veteran has or has had kidney stones during the appeal period.

4. The evidence is in equipoise as to whether the nephropathy was caused by the type II diabetes mellitus.

CONCLUSIONS OF LAW

1. Resolving all reasonable doubt in the Veteran's favor, the criteria for service connection for type II diabetes mellitus have been met. 38 U.S.C. §§ 1110, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2026).

2. The criteria for entitlement to service connection for kidney stones, to include as secondary to service-connected asthma, service-connected orthopedic disabilities, and diabetes mellitus, have not been met. 38 U.S.C. §§ 1110, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310 (2026).

3. Resolving all reasonable doubt in the Veteran's favor, the criteria for entitlement to service connection for nephropathy as secondary to type II diabetes mellitus have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty with the United States Marine Corps from September 1997 to September 2001 and for 10 days in March 2003, with additional service in the Marine Corps Reserve.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2008 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO).

In June 2016, the Board remanded the claims for a hearing. In May 2017, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the electronic claims file.

The Board remanded the case in November 2017, April 2020, and August 2021 for further evidentiary development. In an April 2022 Board decision, the Board denied entitlement to service connection for diabetes mellitus, including as secondary to asthma or medication for asthma, and service connection for a kidney condition, to include as secondary to diabetes or medications taken for diabetes, asthma, and/or musculoskeletal disabilities.

In a December 2022 order granting a November 2022 joint motion for remand, the United States Court of Appeals for Veterans Claims (Court) vacated the Board's April 2022 decision and remanded the case to the Board. The parties to the joint motion noted that the rationale of a November 2021 VA medical opinion was insufficient and did not address whether the Veteran is currently diagnosed with diabetes and, if so, whether the disability is related to service or secondary to a service-connected disability. The parties also found that the kidney claim was inextricably intertwined with the diabetes claim.

To comply with the terms of the November 2022 joint motion, the Board remanded the claims in May 2023. In an April 2024 Board decision, the Board denied entitlement to service connection for diabetes and a kidney disability.

In a November 2024 order granting a November 2024 joint motion for remand, the Court vacated the Board's April 2024 decision and remanded the case to the Board. The parties to the joint motion found that remand was warranted because a September 2023 VA examination report was inadequate. The parties noted that the September 2023 examination provided no supporting rationale for an opinion as to why a June 2007 VA medical opinion diagnosing the Veteran with impaired fasting glucose, or pre-diabetes, was correct, and why later records diagnosing the Veteran with diabetes mellitus were incorrect. The parties also found that the Board wrongfully relied on the November 2021 VA medical opinion, which was previously found in the November 2022 joint motion to be inadequate due to an insufficient rationale. The parties directed the Board to obtain a new medical opinion that provided adequate rationale in support of any opinion regarding whether the Veteran has had a diagnosis of diabetes mellitus during the appeal period. The parties held that on remand, the Board shall not rely on either the November 2021 VA medical opinion on diabetes mellitus or the September 2023 VA medical opinion on diabetes mellitus as a basis for its decision. The parties also found that the kidney claim was inextricably intertwined with the diabetes claim.

To comply with the terms of the November 2024 joint motion the Board remanded the claims in March 2025. The Board again remanded the claims in August 2025.

VA's duties to notify and assist claimants in substantiating a claim for VA benefits are found at 38 U.S.C. §§ 5100, 5102, 5103, 5103A, 5107, 5126 and 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a).

Neither the Veteran nor her representative has not raised any issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board."); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to duty to assist argument).

Service Connection

1. Entitlement to service connection for diabetes mellitus

Governing law and regulations

In general, service connection may be granted for disability or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110. Notwithstanding the above, service connection may be granted for disability shown after service, when all of the evidence, including that pertinent to service, shows that it was incurred or aggravated in service. 38 C.F.R. § 3.303(a). To establish service connection for a claimed disorder, there must be (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999).

Analysis

The Veteran filed her claim for service connection for diabetes mellitus in August 2007. Turning first to Hickson element (1), current disability, there is conflicting medical evidence.

VA treatment records reflect that in June 2007, insulin resistance and glucose intolerance was diagnosed. In September 2008, a clinician noted that the Veteran was not diabetic and diagnosed impaired fasting glucose. In July 2009, a clinician noted that the Veteran has diabetes. VA treatment records show a diagnosis of diabetes from July 2009 to March 2024. In March 2018, a clinician noted that the Veteran has had type II diabetes mellitus since 2007. In March 2024, a clinician noted that the type II diabetes mellitus was probably cured after a weight loss.

A July 2011 VA examination report reveals a diagnosis of diabetes. The examiner noted that the subjective factor was the Veteran reporting a history of diabetes and that the objective factors were the Veteran taking metformin and controlling her diet.

Private treatment records reflect that in August 2011, a nephrologist diagnosed type II diabetes and that in September
the Veteran has diabetes. VA treatment records show a diagnosis of diabetes from July 2009 to March 2024. In March 2018, a clinician noted that the Veteran has had type II diabetes mellitus since 2007. In March 2024, a clinician noted that the type II diabetes mellitus was probably cured after a weight loss.

Private treatment records reflect that in August 2011, a nephrologist diagnosed type II diabetes and that in September 2012 it was noted that diabetes was diagnosed in 2007. Military dependent medical records show that type II diabetes mellitus was diagnosed in March 2016.

A February 2018 VA examination report reveals a diagnosis of type II diabetes mellitus with 2007 being the year of diagnosis. A December 2020 VA examination report shows a diagnosis of impaired fasting glucose that was diagnosed in 2007. A May 2025 VA examination report reveals a diagnosis of type II diabetes mellitus that was diagnosed in 2007. In a December 2025 medical opinion, a VA clinician stated that the medical records show a reported diagnosis of diabetes mellitus during the appeal period that began in August 2007. The clinician added that even if later VA examinations questioned or did not confirm an active diagnosis, the reported 2007 diagnosis still indicates that diabetes was present during the appeal period.

The Board places great weight on the various treatment records and the December 2025 VA medical opinion, which has a thorough basis. The evidence persuasively shows that the Veteran has had type II diabetes mellitus during the appeal period. Hickson element (1), current disability, is established.

As for Hickson element (2), in-service injury or disease, the Veteran's service treatment records reflect that in May 2000 she was taking prednisone. In mid-March 2001, prednisone was prescribed for 10 days. In late July 2001, a clinician noted that the Veteran was taking prednisone. Given that the Veteran was taking prednisone in May 2000 and from mid-March 2001 to at least late July 2001, Hickson element (2) is shown.

Regarding Hickson element (3), medical nexus, there is conflicting medical evidence on whether the diabetes is related to active service.

In a February 2018 medical opinion, the February 2018 VA examiner opined that it is less likely than not (less than a 50 percent probability) the diabetes was incurred in or caused by the claimed in-service injury, event, or illness. The clinician stated that there was no evidence of prolonged prednisone use. The doctor noted that she saw only a one-time 10-day course of prednisone prescribed in 2001. The physician stated that a one-time use does not lead to diabetes. The examiner added that she would be happy to revisit her opinion if evidence of long-term prednisone use is provided.

In a December 2020 medical opinion, the December 2020 VA examiner opined that it is less likely than not (less than a 50 percent probability) the diabetes was incurred in or caused by the claimed in-service injury, event, or illness. The clinician noted that the record shows the Veteran took prednisone for 10 days in 2001. The nurse practitioner stated that the impaired fasting glucose is unlikely related to the short-term use of systemic glucocorticoid therapy. The examiner added that it is medically recognized that the use of systemic glucocorticoid therapy can cause hyperglycemia but that this adverse effect subsides after the medication is discontinued. The clinician noted that impaired glucose or diabetes can occur following long-term use of steroids (three months or longer) in individuals with predisposed risk factors such as being overweight or having a family history of diabetes.

In a May 2025 medical opinion, a May 2025 VA examiner opined that it is less likely than not (less than a 50 percent probability) the diabetes was incurred in or caused by the claimed in-service injury, event, or illness. In the direct service connection opinion, the examiner did not address in-service prednisone use. In an opinion on whether diabetes was aggravated by asthma, the clinician noted that the Veteran was on a short course of steroids for asthma that would not likely have contributed to her developing type II diabetes mellitus. The nurse practitioner, however added that long-term use of steroids could be a factor in developing diabetes.

In a November 202
or having a family history of diabetes.

In a November 2025 medical opinion, a VA clinician opined that it is less likely than not (less than a 50 percent probability) the diabetes was incurred in or caused by the claimed in-service injury, event, or illness. In the direct service connection opinion, the examiner did not address in-service prednisone use. In an opinion on whether diabetes was caused by asthma, the nurse practitioner noted that while long-term systemic corticosteroid use can influence glucose levels, there is no evidence in the record of sustained steroid therapy sufficient to induce or worsen diabetes. In an opinion on whether diabetes was aggravated by asthma, the clinician noted that the Veteran's records do not show a prolonged use of systemic (oral or injectable) corticosteroids, which are the only asthma-related medications known to potentially cause significant and sustained elevation of blood glucose. The nurse practitioner stated that medical documentation instead reflects treatment with inhaled bronchodilators and/or inhaled corticosteroids, which have minimal systemic absorption and are not associated with chronic worsening of diabetes.

The Board notes that all of these opinions are predicated on short-term use of prednisone in service. In particular, two examiners noted that the Veteran only used prednisone for 10 days in 2001. The service treatment records, however, reflect that the Veteran used prednisone from in May 2000 and from mid-March 2001 to at least late July 2001. The December 2020 VA examiner defined long-term use as treatment for 90 days or more, and the treatment period in 2001 was more than 90 days. Given the evidence of long-term use of prednisone in service and the medical evidence relating prolonged use of prednisone to diabetes, the evidence is in equipoise as to whether the type II diabetes mellitus is related to the in-service use of prednisone for asthma. Accordingly, Hickson element (3), medical nexus, is established.

In summary, the Board is of the opinion that the Veteran has met all requirements needed to establish service connection for type II diabetes mellitus. The benefit sought on appeal is accordingly allowed.

As the Board is granting service connection for type II diabetes mellitus on a direct basis, the Board does not have to address whether diabetes was caused or aggravated by the service-connected asthma after service.

2. Entitlement to service connection for kidney stones, to include as secondary to service-connected asthma, service-connected orthopedic disabilities, and diabetes mellitus

Governing law and regulations

A disability that is proximately due to or the result of a service-connected disease or injury shall be service connected. When service connection is thus established for a secondary disorder, the secondary disorder shall be considered a part of the original condition. 38 C.F.R. § 3.310(a).

To establish service connection for a claimed disability on a secondary basis, there must be (1) medical evidence of a current disability; (2) a service-connected disability; and (3) medical evidence of a nexus between the service-connected disease or injury and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998).

The existence of a current disability is the cornerstone of a claim for VA disability compensation. Degmetich v. Brown, 104 F. 3d 1328 (1997). To be present as a current disability, the claimed condition must be present at the time of the claim for benefits, as opposed to sometime in the distant past. Gilpin v. West, 155 F. 3d 1353 (Fed. Cir. 1998). The Gilpin requirement that there be a current disability is satisfied when the disability is shown at the time of the claim or during the pendency of the claim, even though the disability subsequently resolves. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007).

Analysis

The Veteran filed her claim for service connection for a kidney disability in August 2007.

d 1328 (1997). To be present as a current disability, the claimed condition must be present at the time of the claim for benefits, as opposed to sometime in the distant past. Gilpin v. West, 155 F. 3d 1353 (Fed. Cir. 1998). The Gilpin requirement that there be a current disability is satisfied when the disability is shown at the time of the claim or during the pendency of the claim, even though the disability subsequently resolves. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007).

Analysis

The Veteran filed her claim for service connection for a kidney disability in August 2007.

Turning first to Hickson and Wallin element (1), current disability, VA treatment records reflect that in September 2002, the Veteran probably had a kidney stone that was passed. Her service treatment records reflect that a March 2003 report of medical history notes that she had a kidney stone three months, ago, which was before her 10-day period of active duty in March 2003.

Private treatment records show that in August 2011 a clinician noted that the Veteran denied any current kidney stones and that she had kidney stones in 2001. In September 2014 a clinician noted that the Veteran had a history of kidney stones in 2002.

A February 2018 VA examination report reflects that the examiner stated that the Veteran does not have and has not ever had kidney calculi.

A December 2020 VA examination report reveals that the examiner did not diagnose nephrolithiasis (kidney stones). The examiner opined that it is at least as likely as not that the Veteran has or has had kidney stones since August 2007. The clinician, however, noted that according to the medical records, the Veteran had a kidney stone that was passed in 2002 but that there is no documentation of a recurrence.

A November 2021 VA examination report shows the examiner noted that nephrolithiasis (kidney stones) was diagnosed in December 2002. A May 2025 VA examination report reveals that the examiner did not diagnose nephrolithiasis (kidney stones). The examiner noted that the Veteran was treated for kidney stones in 2002.

VA treatment records from 2002 to the present do not show that a kidney stone was diagnosed after 2002.

The Board places great weight on the VA treatment records showing no diagnosis of a kidney stone since August 2007 and the VA examination reports showing no current diagnosis of a kidney stone. While the December 2020 VA examiner opined that it is at least as likely as not that the Veteran has or has had kidney stones since August 2007, that examiner also noted that there was no documentation of a recurrence of kidney stones since 2002. Given the contradictory information in the December 2020 VA medical opinion, that opinion is of low probative value. The evidence persuasively weighs against a finding that the Veteran has or has had kidney stones during the appeal period.

In short, the Board finds that Hickson and Wallin element (1), current disability, is not satisfied as to the claim of entitlement to service connection for kidney stones. The benefit sought on appeal is accordingly denied.

3. Entitlement to service connection for nephropathy as secondary to type II diabetes mellitus

Analysis

Turning first to Wallin element (1), current disability, VA treatment records show that urinalyses from July 2002 to September 2002 were negative for protein and that an October 2002 urinalysis had a trace amount of protein. In July 2007, there were high protein levels in the urinalysis.

A July 2011 VA examination report reveals a diagnosis of proteinuria.

Private treatment records reflect that in August 201, a nephrologist diagnosed proteinuria and chronic kidney disease stage I diabetes mellitus nephropathy.

VA treatment records reveal that in April 2013 nephropathy was diagnosed.

The February 2018 VA examination report reflects that the examiner did not diagnose a kidney condition. The doctor noted that the Veteran does not have chronic kidney disease and that instead, she has proteinuria, which is a symptom and not a diagnosis.

VA treatment records reflect that in July 2018 primary membranous nephropathy was first diagnosed.

The December 2020 VA examination report reveals a diagnosis of primary membranous nephropathy. The November 2021 VA examination report reflects that primary membranous nephropathy was diagnosed in July 2018 and that proteinuria was diagnosed in 2007. The May 2025 VA examination report shows a diagnosis of primary membranous nephropathy that was diagnosed
The February 2018 VA examination report reflects that the examiner did not diagnose a kidney condition. The doctor noted that the Veteran does not have chronic kidney disease and that instead, she has proteinuria, which is a symptom and not a diagnosis.

VA treatment records reflect that in July 2018 primary membranous nephropathy was first diagnosed.

In short, the medical evidence shows a diagnosis of nephropathy. Wallin element (1), current disability, is established.

As for Wallin element (2), service-connected disability, the Board has granted service connection for type II diabetes mellitus. Thus, Wallin element (2) is shown.

With regard to Wallin element (3), medical nexus, there is conflicting medical evidence.

The July 2011 VA examiner noted that the Veteran has a renal problem and diagnosed proteinuria. The doctor stated that the renal condition is a complication of diabetes because of macro vascular complications related to diabetes.

An August 2011 private treatment record reflects that a nephrologist noted a history of analgesic abuse in the past. The doctor stated that the proteinuria could be secondary to analgesic abuse or diabetes mellitus but that diabetes mellitus is the more common etiology.

VA treatment records reveal that in April 2013 the diagnosis was diabetes with renal manifestations. In June 2020, a doctor noted a previous diagnosis of diabetic nephropathy and the more recent correct diagnosis of primary membranous nephropathy.

The December 2020 VA examiner noted that primary membranous nephropathy is idiopathic, that is, the origin is unknown.

In a November 2021 medical opinion, the November 2021 VA examiner opined that it is less likely than not (less than 50 percent probability) the primary membranous nephropathy is proximately due to the result of diabetes mellitus. The clinician noted that proteinuria was first noted in 2007 and that while there was some objective and demonstrable evidence of impaired fasting in 2007, there was no objective evidence of diabetes through 2018, well after the onset of proteinuria. In another opinion, the November 2021 VA examiner noted that primary membranous nephropathy is generally accepted to idiopathic and due to an autoimmune inflammatory response that attacks the renal system and that secondary membranous nephropathy can be the result of outside influences, including medication use. The clinician noted that the Veteran does not have laboratory findings consistent with secondary membranous nephropathy and thus eliminating medication as a cause.

In a May 2025 medical opinion, the May 2025 VA examiner opined that it is less likely than not (likelihood is less than approximately balanced or nearly equal) that primary membranous nephropathy is proximately due to or the result of diabetes mellitus. The clinician noted that primary membranous nephropathy is an autoimmune disability with an unknown cause or origin. In an aggravation opinion, the nurse practitioner noted that she could not render a positive opinion without resorting to using mere speculation because the Veteran's providers have not determined that her kidney disease is caused by diabetes.

In a November 2025 medical opinion addressing whether kidney disease was secondary to various service-connected disabilities, a VA clinician noted that the most kidney conditions arise from hypertension, diabetes, age-related decline, genetic predisposition, or post-service illness. The nurse practitioner stated that more likely non-service-related causes were present in this case and that it is less likely than not that the kidney disease is attributable to an in-service event. Later in the opinion, the clinician noted that the cause of primary membranous nephropathy is unknown in most cases.

The Board notes that a private nephrologist has related the nephropathy to diabetes mellitus. The Board further notes that the November 2021 VA medical opinion is predicated in part on no diagnosis of diabetes mellitus until 2018, over a decade after proteinuria was first noted. There is, however, medical evidence of diabetes mellitus prior to 2018. Moreover, the VA clinician in the November 2025 medical opinion noted that diabetes mellitus was a cause of the kidney disease. Given the conflicting medical evidence on the nature of the neuropathy, the evidence is in equipoise as to whether the nephropathy was caused by the type II diabetes mellitus. Therefore
most cases.

As the Board is granting service connection based on secondary causation, the Board does not have to address whether the nephropathy is directly related to active service.

MICHAEL LANE

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Cherry, David T.

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