DIABETES MELLITUS

MARJORIE A. AUER · 2026 · Case ID: 26005036

MIXED

Summary

The veteran, who served from August 1981 to November 1984, appeals the denial of service connection for diabetes mellitus, type I, and related secondary conditions. The veteran claimed diabetes onset in service due to increased thirst, urinary frequency, and weight loss, or alternatively, due to toxic exposures at Fort McClellan and Germany. The Board considered multiple VA opinions and a private medical opinion. Early VA opinions were against service connection, citing the autoimmune nature of Type I diabetes and a lack of in-service complaints or diagnosis. A later VA opinion also found less than a 50% likelihood of service connection for diabetes and TERA exposure, noting a gap in medical evidence post-service. However, a private medical opinion from Dr. R.P. provided a detailed rationale, linking Type I diabetes to in-service exposures, including ionizing radiation from a nuclear warhead leak in Germany and endocrine-disrupting chemicals (PCBs, PFAS, PBBs, dioxin-like compounds) at Fort McClellan and Kaiserlautern, Germany. Dr. R.P. opined that these exposures could initiate and accelerate autoimmune destruction of pancreatic beta cells, concluding it was at least as likely as not that the veteran's diabetes resulted from these exposures. The Board found the evidence in equipoise, resolving doubt in the veteran's favor and granting service connection for diabetes mellitus, type I. Consequently, service connection for bilateral diabetic retinopathy, cataracts, and peripheral neuropathy as secondary to diabetes was also granted. The claim for an increased rating for bilateral hearing loss was remanded for further development and review of new evidence.

Rationale

Private medical opinion from Dr. R.P. found Type I diabetes related to in-service toxic exposures (ionizing radiation, PCBs, PFAS, PBBs, dioxin-like compounds).; Dr. R.P. opined it was at least as likely as not that exposures initiated/accelerated autoimmune destruction of pancreatic beta cells.; Evidence found to be in equipoise; doubt resolved in veteran's favor per 38 U.S.C. § 5107(b).

Special Benefit

NO SPECIAL BENEFIT

Docket No.

14-06 346

Full Decision Text

Citation Nr: 26005036
Decision Date: 04/29/26 Archive Date: 04/29/26

DOCKET NO. 14-06 346
DATE: April 29, 2026

ORDER

Entitlement to service connection for diabetes mellitus, type I, is granted.

Entitlement to service connection for bilateral diabetic retinopathy and cataracts (claimed as bilateral eye condition), as secondary to diabetes mellitus, type I, is granted.

Entitlement to service connection for bilateral lower extremity diabetic peripheral neuropathy (claimed as bilateral foot condition), as secondary to diabetes mellitus, type I, is granted.

REMANDED

Entitlement to an initial compensable rating prior to October 25, 2024, and a rating in excess of 30 percent thereafter, for service-connected bilateral hearing loss, is remanded.

FINDINGS OF FACT

1. Resolving reasonable doubt in the Veteran's favor, his diabetes mellitus, type I was incurred in or caused by military service

2. The Veteran's diabetic retinopathy and cataracts and peripheral neuropathy of the bilateral lower extremities, were caused by or proximately due to his now service-connected diabetes mellitus, type I.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for diabetes mellitus, type I have been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for entitlement to service connection for diabetic retinopathy of the bilateral eyes as secondary to diabetes mellitus, type I have been met. 38 U.S.C. § 1110; 38 C.F.R. § 3.310.

3. The criteria for entitlement to service connection for diabetic peripheral neuropathy of the bilateral lower extremities as secondary to diabetes mellitus, type I have been met. 38 U.S.C. § 1110; 38 C.F.R. § 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from August 1981 to November 1984. This matter comes before the Board of Veterans' Appeals (Board) on appeal from January 2013 and January 2018 rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO).

This matter was previously before the Board in June 2015, December 2017, and April 2021. The December 2017 Board decision granted service connection for bilateral hearing loss, but denied service connection for diabetes mellitus, type I, bilateral eye disorder, and a bilateral foot disorder. The Veteran appealed the portion of the December 2017 Board decision that denied entitlement to service connection for diabetes mellitus, type I, bilateral eye disorder, and a bilateral foot disorder to the United States Court of Appeal for Veterans Claims (Court).

In a December 2019 Joint Motion for Partial Remand (JMPR), filed by the parties, the Court vacated and remanded, in part, the December 2017 decision back to the Board as the Board did not provide the Veteran with a new Board hearing as he had requested a new hearing before the Board in December 2016 and February 2017.

Most recently, in the April 2021 decision, the Board remanded the claims for additional development. The matters have been returned to the Board for adjudication.

The Veteran testified before the undersigned Veterans Law Judge during June 2014, January 2021 and December 2025 hearings. Transcripts of the hearings are associated with the Veteran's claim file.

Service Connection

Service connection will be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection may be granted for any disease diagnosed after discharge from service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

To substantiate a claim of service connection, there must be evidence of: (1) a current claimed disability; (2) incurrence or aggravation of a disease or injury in service; and (3) a nexus between the disease or injury in service and the current disability. See Shedden v. Principi, 281 F.3d 1163, 1166-67 (Fed. Cir. 2004). The determination as to whether these requirements are met is based on an analysis of all the evidence of record and an evaluation of its credibility and probative value. Baldwin v. West
to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

Secondary service connection may be established for a disability that is proximately due to, or the result of, a service-connected disease or injury. 38 C.F.R. § 3.310(a). Substantiating a secondary service connection claim requires competent evidence of: (1) a diagnosis of the disability for which service connection is being sought; (2) a service-connected disability; and (3) that the current disability was either caused or aggravated by the already service-connected disability. 38 C.F.R. § 3.310(a); Allen v. Brown, 7 Vet. App. 439 (1995) (en banc).

When there is an approximate balance in the evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

1. Entitlement to service connection for diabetes mellitus, type I

The Veteran contends that his diabetes mellitus, type I had an onset in service as he experienced increased thirst, urinary frequency, and was unable to gain weight. In the alternative, he claims that he was exposed to various toxins during his service at Fort McClellan and Germany, which caused his diabetes mellitus, type I.

A review of the Veteran's military personnel records show that he was stationed at Fort McClellan and Germany. The RO issued a December 2025 Toxic Exposure Risk Activity (TERA) Memorandum that found that based on his service at both Fort McClellan and Germany, he participated in a TERA during active military service.

A private treatment from Dr. M.B., dated November 2000, shows that the Veteran had insulin dependent diabetes mellitus of almost 10 years s/p diagnosis, thus, he was diagnosed in approximately 1990.

In August 2014, the Veteran's former representative submitted a private medical opinion from Dr. F.G. The examiner provided an opinion that it is more likely than not that environmental exposures during military service are causal to the thyroid and pancreatic condition of diabetes mellitus, type II. While the physician provided an opinion for diabetes mellitus, type II, rather than diabetes mellitus, type I, he did not that the islet cells concentrated in the tail of the pancreas are sensitive to radiation.

The Veteran was afforded a VA examination for diabetes mellitus in April 2016. He was diagnosed with diabetes mellitus, type I with the date of diagnosis from 1990. The examiner opined that in full review of the records as well as literature search, it would be resorting to mere speculation to state whether the Veteran's diabetes had its onset while in active duty. The examiner explained that Type 1A diabetes mellitus results from autoimmune destruction of the insulin-producing beta cells in the islets of Langerhans and this process occurs in genetically susceptible subjects, is probably triggered by one or more environmental agents, and usually progresses over many months or years during which the subject is asymptomatic and euglycemic. The examiner went on the state that genetic markers for type 1A diabetes are present from birth, immune markers are detectable after the onset of the autoimmune process, and metabolic markers can be detected with sensitive tests once enough beta cell damage has occurred, but before the onset of symptomatic hyperglycemia. This long latent period is a reflection of the large number of functioning beta cells that must be lost before hyperglycemia occurs. The examiner further reasoned that based on the above the Veteran had a genetic susceptibility for the condition which is not born by his military service or duties associated with military service. She noted that the question of timing of onset however would be difficult to determine.

In December 2016, the RO obtained an addendum medical opinion as the previous examiner did not address the Veteran's statements regarding complaints of increased thirst, urinary frequency, and inability to maintain weight during active
the autoimmune process, and metabolic markers can be detected with sensitive tests once enough beta cell damage has occurred, but before the onset of symptomatic hyperglycemia. This long latent period is a reflection of the large number of functioning beta cells that must be lost before hyperglycemia occurs. The examiner further reasoned that based on the above the Veteran had a genetic susceptibility for the condition which is not born by his military service or duties associated with military service. She noted that the question of timing of onset however would be difficult to determine.

In December 2016, the RO obtained an addendum medical opinion as the previous examiner did not address the Veteran's statements regarding complaints of increased thirst, urinary frequency, and inability to maintain weight during active-duty service. The examiner opined that it is less likely as not that the Veteran's type I diabetes mellitus is caused by, related to, or aggravated by the complaints of increased thirst, urinary frequency and inability to maintain weight during active-duty military service. The examiner stated that the Veteran complained of increased thirst, urinary frequency, and inability to maintain weight while in service prior to 1984. He was diagnosed with diabetes mellitus, type I, in approximately 1990. Diabetes mellitus, type I, does not have the same onset as diabetes mellitus, type II. Diabetes mellitus, type II, has a gradual onset that can span more than a decade. The examiner explained that in contrast, diabetes mellitus, type I, has an acute (immediate) onset. Soon as there is damage to the pancreas the symptoms of diabetes are immediate and permanent requiring immediate treatment with insulin. Damage to the pancreas is typically caused by autoimmune attack or viral attack on the Islets of Langerhans of the pancreas. Diabetes mellitus, type I, does not take more than 6 years to manifest, therefore, the claimed symptoms while in service were not related to the eventual diagnosis of diabetes mellitus, type I, in approximately 1990.

The Veteran was afforded another VA examination and medical opinion in October 2024. The examiner opined that the claimed condition was less likely than not (likelihood is less than approximately balanced or nearly equal) incurred in or caused by the claimed in-service injury, event, or illness. The examiner's rationale was that the Veteran's service treatment records (STRs) are silent for complaint, diagnosis, or treatment of a diabetes condition. Medical records following service document the condition in the late 1990s or early 2000s. The examiner stated that there is a significant gap in medical evidence from 1984 to 1990 showing ongoing care and treatment for a diabetes condition. The diabetes condition was not evident until well after active-duty military service. Additionally, the examiner opined that the claimed condition was less likely than not (likelihood is less than approximately balanced or nearly equal) caused by the indicated TERA, 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 medical records available do not provide TERA, ILER, or notes regarding potential exposures. The examiner noted that she is unable to opine on the conditions related to exposure without knowing what the exposure was.

In January 2026, the Veteran's representative submitted a private medical opinion regarding the Veteran's diabetes mellitus, type I from Dr. R.P. The physician indicated that she reviewed the Veteran's claim file, to include STRs, medical records, and treatment records. In her medical opinion, the physician explained that type I diabetes is fundamentally distinct from Type II diabetes and that whereas Type II is a metabolic disorder driven primarily by insulin resistance and strongly associated with age, obesity, and lifestyle factors, Type I diabetes is an immune-mediated disease in which the body's immune system mistakenly targets and destroys the insulin-producing beta cells of the pancreas, leading to lifelong insulin dependence. She noted that, importantly, Type I diabetes does not require childhood onset, nor can it be explained by genetic disposition alone. Dr. R.P. explained that over several decades, research has consistently shown that exposure to external agents- including toxic chemicals, viral infections, endocrine disruptors, and ionizing radiation- can serve as the catalysts necessary to activate autoimmunity in at-risk individuals. She stated that current medical consensus is that Type I diabetes development generally requires the convergence of three elements: genetic susceptibility, a diabetogenic environmental hit, and continued immune or toxic stress- exactly the scenario present in service members exposed to military toxicants.

The physician stated that the Veteran had a significant in-service event in which he was stationed in close proximity to a leaking nuclear warhead in Miesau, Germany. Ionizing radiation is known to cause lasting biological injury that extends far beyond carcinogenesis. She remarked on several studies that showed clinical findings noted that ionizing radiation reduces
including toxic chemicals, viral infections, endocrine disruptors, and ionizing radiation- can serve as the catalysts necessary to activate autoimmunity in at-risk individuals. She stated that current medical consensus is that Type I diabetes development generally requires the convergence of three elements: genetic susceptibility, a diabetogenic environmental hit, and continued immune or toxic stress- exactly the scenario present in service members exposed to military toxicants.

Dr. R.P. also noted that another important risk factor for the Veteran's diabetes is his in-service exposure at Kaiserlautern, Germany, and Fort McClellan, which are sites associated with documented environmental contamination involving endocrine-disrupting chemicals (EDCs). In the Veteran's cases, documented exposures to polychlorinated biphenyls (PCBs), polyfluorinated substances (PFASs), polybrominated biphenyls (PBBs), and dioxin-like compounds during his service places him squarely within the category of individuals at risk for endocrine and immune disruption from EDCs.

The physician stated that critically, EDCs do not follow the traditional toxicology principle that 'higher doses causes greater harm.' Instead, they often exert non-monotonic or U-shaped biological effects, meaning even extremely low doses can be highly disruptive. She explained that the consequence of such exposures may not be immediately observable-clinical disease can emerge years or even decades later.

Dr. R.P. specified that given that the Veteran sustained multiple service-related toxic exposures-including PCB and dioxin contamination at Fort McClellan, along with separate PFAS exposure and a documented radiological leak from a nuclear warhead in Germany-peer-reviewed medical research supports that such hazards can initiate and accelerate autoimmune destruction of pancreatic beta cells. She opined that based on this evidence, it is at least as likely as not that the Veteran's insulin-dependent Type I diabetes resulted from these in-service environmental exposures.

Here, although there are medical opinions against a finding that the Veteran's diabetes mellitus, type I is related to military service and TERA exposure, there is also a detailed medical opinion that finds in favor of the Veteran's diabetes mellitus, type I being related to his TERA exposures. The Board assigns great probative value to the independent medical review from Dr. R.P. There is no indication that the physician was not fully aware of the Veteran's past medical history or that they misstated any relevant fact. Indeed, the physician provided pertinent recitation of the record and fully supported their conclusions with specific citation to the record and research studies. The Board accords probative weight to such opinion, as the opinion provided complete rationale, relying on and citing to the records reviewed, and offered clear conclusions with supporting data as well as reasoned medical explanations connecting the two. See Nieves-Rodriquez v. Peake, 22 Vet. App. 295, 304 (2008).

Weighing the probative values of these opinions, both for and against service connection, the Board finds that the evidence is at least in equipoise. As the record appears to be in relative equipoise on the question of whether diabetes mellitus, type I, was caused by the Veteran's in-service environmental exposures, all reasonable doubt is resolved in favor of the Veteran. In reaching this conclusion, the Board has reviewed the available lay statements, medical history, and the available medical opinions.

Accordingly, the Board finds that a grant of service connection for diabetes mellitus, type I, is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

2. Entitlement to service connection for bilateral diabetic retinopathy and cataracts, as secondary to diabetes mellitus, type I

3. Entitlement to service connection for bilateral lower extremity diabetic peripheral neuropathy, as secondary to diabetes mellitus, type I

The Veteran was diagnosed with diabetic retinopathy and cataracts and bilateral lower extremity diabetic peripheral neuropathy at the April 2016 VA examination. The examiner noted that these are recognized complications of diabetes mellitus. In an October 2024 VA eye examination, the examiner noted the Veteran also had a diagnosis of cataracts.

3. Entitlement to service connection for bilateral lower extremity diabetic peripheral neuropathy, as secondary to diabetes mellitus, type I

Additionally, the January 2026 private medical opinion from Dr. R.P. also confirmed that the Veteran has medical diagnoses of diabetic peripheral neuropathy and diabetic retinopathy and cataracts. Dr. R.P. stated that the Veteran's diabetes has resulted in service and progressive complications, including bilateral diabetic neuropathy as well as diabetic retinopathy and cataracts and that it is at least as likely as not that the Veteran's bilateral lower extremity peripheral neuropathy and bilateral retinopathy with cataracts are approximately due to his type I diabetes.

Recognized complications of diabetes mellitus include diabetic retinopathy and diabetic neuropathy. Since the Veteran is now service connected for diabetes mellitus, type I, the Veteran's diabetic retinopathy and bilateral lower extremity neuropathy are subject to service connection on a secondary basis as they are conditions from the resulting complications of his diabetes mellitus, type I.

REASONS FOR REMAND

Although the Board regrets the additional delay, a remand is necessary to ensure that due process is followed and there is a complete record upon which to decide the Veteran's claim so that he is afforded every possible consideration. See 38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c).

1. Entitlement to an initial compensable rating prior to October 25, 2024, and a rating in excess of 30 percent thereafter, for service-connected bilateral hearing loss

The Veteran asserts that he is entitled to higher ratings than the currently assigned evaluations for his service-connected bilateral hearing loss.

The RO added relevant VA treatment records and a VA examination to the Veteran's electronic claims file following the April 2025 Supplemental Statement of the Case (SSOC). The RO did not review this new evidence in the first instance. Although the Veteran's representative indicated in a March 2026 Post Hearing Memorandum that they waive RO jurisdiction, it was only regarding the enclosed evidence to include a private medical opinion. Thus, the issue is being remanded for the issuance of a SSOC by the RO.

The matters are REMANDED for the following action:

Readjudicate the issues on appeal for an increased rating concerning bilateral hearing loss, to include consideration of all evidence added to the record since the April 2025 SSOC. If the benefits sought are not granted to the Veteran's satisfaction, send the Veteran and his representative a SSOC and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review.

MARJORIE A. AUER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board E. Kim, 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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