DIABETES MELLITUS

Summary

The veteran, who served in the United States Army from August 1989 to August 1992, appeals the denial of service connection for diabetes mellitus type II and a bilateral eye disability claimed as secondary to diabetes. The veteran contended that his diabetes was due to in-service exposure to environmental or toxic hazards in Southwest Asia. Medical records indicate a diagnosis of diabetes mellitus type II around 2010, approximately 18 years after service, and service records confirm deployment to Kuwait. However, a September 2023 VA examination concluded that the veteran's diabetes was not etiologically related to service, finding it "less likely than not" that a causative relationship exists, based on medical literature. The Board found this VA opinion more probative than the veteran's assertions, noting the examiner's medical expertise and reliance on scientific literature, and that the veteran's diabetes onset was significantly post-service. Consequently, the Board denied service connection for diabetes mellitus type II. The veteran also claimed diabetic retinopathy in both eyes as secondary to diabetes. While the AOJ had favorably found this secondary connection, the Board denied it because the underlying diabetes mellitus was not service-connected. The Board found the evidence weighed against both claims, rendering the benefit of the doubt doctrine inapplicable.

Rationale

Current diagnosis of diabetes mellitus type II with onset ~2010; In-service deployment to Kuwait established; VA examiner found no etiologic relationship to service exposures; Examiner's opinion based on medical literature; Veteran's assertion of exposure-related diabetes not considered probative

Full Decision Text

Citation Nr: A25087007
Decision Date: 10/08/25	Archive Date: 10/08/25

DOCKET NO. 231114-393730
DATE: October 8, 2025

ORDER

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

Entitlement to service connection for a bilateral eye disability, claimed as secondary to diabetes mellitus, is denied. 

FINDINGS OF FACT

1. The probative evidence of record weighs against finding that the Veteran's diabetes mellitus type II is caused by, due to, or otherwise related to his military service.

2. There exists no service-connected disability upon which secondary service connection for a bilateral eye disability, diagnosed as diabetic retinopathy, may be granted.

CONCLUSIONS OF LAW

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

2. The criteria for service connection for a bilateral eye disability, claimed as secondary to diabetes mellitus, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served in the United States Army from August 1989 to August 1992.

This appeal comes to the Board of Veterans' Appeals (Board) from a Department of Veterans Affairs (VA) October 2023 rating decision of the Agency of Original Jurisdiction (AOJ).

In November 2023, the Veteran submitted a VA Form 10182 Notice of Disagreement electing the Evidence Review docket. Therefore, the Board may only consider the evidence before the AOJ at the time of the rating decision on appeal, or evidence submitted by the Veteran along with, or within 90 days, of his VA Form 10182.

Generally, any evidence submitted outside the permitted window cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801. Should the Veteran have evidence that he would like VA to consider, he may file a supplemental claim. Instructions on how to do so will be included with this decision.

As a procedural matter, the Board notes that the Veteran's claim for an eye disability was specifically for a right-eye disability. See July 2023 VA Form 21-526EZ. However, the evidence of-record shows that the Veteran has diabetic retinopathy of both eyes. Therefore, the Board is expanding the Veteran's claim to encompass a bilateral eye disability pursuant to Clemons v. Shinseki. 23 Vet. App. 1 (2009). 

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; 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).

Secondary service connection is warranted if there is (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a nexus (i.e., link) between the current disability and the service-connected disability. Wallin v. West, 11 Vet. App. 509, 512 (1998). A nexus is established when medical evidence shows that the current disability was either caused or aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc); El-Amin v. Shinseki, 26 Vet. App. 136, 140 (2013).

Service connection may also be granted for a disability that is functionally worsened by a service-connected disability. See Spicer v. McDonough, 61 F.4th 1360, 1364 (Fed. Cir. 2023) (38 U.S.C. § 1110 "plainly requires compensation when a service-connected disease or injury is a but-for cause of a present day disability. This broad language applies to the natural progression of a condition not caused by a service-connected injury or disease, but that nonetheless would have been less severe were it not for the service-connected disability.
) (en banc); El-Amin v. Shinseki, 26 Vet. App. 136, 140 (2013).

Service connection may also be granted for a disability that is functionally worsened by a service-connected disability. See Spicer v. McDonough, 61 F.4th 1360, 1364 (Fed. Cir. 2023) (38 U.S.C. § 1110 "plainly requires compensation when a service-connected disease or injury is a but-for cause of a present day disability. This broad language applies to the natural progression of a condition not caused by a service-connected injury or disease, but that nonetheless would have been less severe were it not for the service-connected disability. Stated another way, § 1110 provides for compensation for a worsening of functionality - whether through an inability to treat or a more direct, etiological cause. Nothing in the statute limits § 1110 to onset or etiological causes of a worsening in functionality.").

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give benefit of the doubt to the Veteran. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

1. Entitlement to service connection for diabetes mellitus type II

The Veteran contends that his diabetes mellitus is caused by, or otherwise due to, his military service. Specifically, the Veteran puts forward the argument that his diabetes is due to his exposure to environmental or other toxic hazards while deployed to Southwest Asia. See July 2023 VA Form 21-526EZ. While the Veteran's military record establishes in-service exposure to environmental or toxic hazards, for the reasons below the Board finds that service connection is not warranted.

The Veteran's medical treatment records show a current diagnosis of diabetes mellitus type II with an onset in or around 2010, as noted in a VA examination from August 2023. Additionally, the Veteran's personnel records establish that he was deployed to Kuwait for a period of time during his service. See September 2010 DD-214. As such, the first two Shedden elements necessary to establish service connection have been met. However, as discussed below, the third and final element has not been fulfilled. 

Under the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxins Act of 2022 (PACT Act), service connection for certain diseases may be presumed should exposure to certain hazards be established. While diabetes mellitus is a disease that may be presumptively service connection in certain circumstances, the Veteran's deployment to Southwest Asia is not such a circumstance. 38 U.S.C. § 1120(a), (b); 38 C.F.R. § 3.320(a). That does not, however, preclude service connection on other theories of entitlement, such as on a direct basis.

The claims file shows that there is one medical opinion relating to the cause of the Veteran's diabetes. In September 2023 the Veteran was seen for a VA examination to determine the nature and etiology of his diabetes mellitus. At the time, the examiner determined that the Veteran's diabetes was not etiologically related to his in-service exposures. See August 2023 C&P Exam. This conclusion was based on a review of available medical literature. The examiner noted that the types of contaminants the Veteran was exposed to are not risk factors for the development of diabetes mellitus, and as such it is "less likely than not" that there is a causative relationship between the Veteran's military service and his diabetes, which was diagnosed some 18 years after he separated from service. 

The Board notes that the Veteran argues that his diabetes mellitus is related to his in-service exposures.  The Board finds that the September 2023 VA examiner's findings to be more probative than the assertions and allegations made by the Veteran and/or his representative. First, the VA examiner is a trained medical practitioner who based their conclusion on a review of the evidence in the claims file as well as a review of medical studies and other literature. Second, neither the Veteran nor his representative are medical practitioners and therefore are unable to opine on a question as medically complex as the etiology of diabetes. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). 

The Board notes that the record does not reflect, nor does the Veteran otherwise contend, that his diabetes mellitus type II onset in service or shortly thereafter, or is otherwise related to service.

In sum, the probative evidence of-record weighs against finding that there is a connection, or nexus, between the Veteran's diabetes mellitus type II and his service,
 a review of the evidence in the claims file as well as a review of medical studies and other literature. Second, neither the Veteran nor his representative are medical practitioners and therefore are unable to opine on a question as medically complex as the etiology of diabetes. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). 

The Board notes that the record does not reflect, nor does the Veteran otherwise contend, that his diabetes mellitus type II onset in service or shortly thereafter, or is otherwise related to service.

In sum, the probative evidence of-record weighs against finding that there is a connection, or nexus, between the Veteran's diabetes mellitus type II and his service, to include in-service exposures while deployed to Southwest Asia. Therefore, the third Shedden element necessary to establish service connection has not been fulfilled, and the criteria for service connection have not been met. 

As the evidence of-record weighs against the Veteran, the benefit of the doubt rule is not applicable. Lynch, 21 F.4th 776 (Fed. Cir. 2021). Accordingly, entitlement to service connection for diabetes mellitus type II is denied.

2. Entitlement to service connection for a bilateral eye disability, claimed as secondary to diabetes mellitus type II

The Veteran contends that his bilateral eye disability, which has been diagnosed as diabetic retinopathy, is secondary to his diabetes mellitus. See July 2023 VA Form 21-526EZ. As explained in further detail, because the Veteran's DM2 is not service-connected, service-connection for bilateral diabetic retinopathy on a secondary basis is not warranted.

The Veteran's medical record shows that he has a diagnosis of diabetic retinopathy in both his left and right eyes. The examiner noted that the developed cataract in both eyes as a result. This condition was such that surgical repair of the Veteran's right eye was necessary and had resulted in pseudophakia, with the left eye cataract still present on examination. See August 2023 C&P Exam. This meets the first Wallin requirement for secondary service connection. Furthermore, the AOJ has made the favorable finding that the Veteran's bilateral diabetic retinopathy is secondary to his diabetes mellitus type II. See October 2023 Rating Decision. Therefore, the Board will not disturb the favorable finding. 38 C.F.R. § 3.104(c). 

However, as discussed above, the Veteran's diabetes mellitus is not service-connected. As the Veteran's diabetic retinopathy is due to his non-service-connected diabetes mellitus, the second Wallin element necessary to establish secondary service connection cannot be fulfilled.

The Veteran does not contend, nor does the record otherwise indicate, that the Veteran retinopathy and associated complications onset in or are otherwise related to service or to another service-connected disability.

As the evidence weighs persuasively against the Veteran's claim, application of the benefit of the doubt rule is not warranted. Lynch, 21 F.4th 776 (Fed. Cir. 2021). Accordingly, service connection is not warranted, and the Veteran's claim is denied.

 

 

G. E. Wilkerson

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Neville, Mikael

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.