DIABETES MELLITUS

Summary

The Veteran, a Navy veteran who served from January 1986 to January 1989, November 2001 to November 2002, and June 2003 to December 2003, with subsequent Navy Reserve service until December 2007, appeals the denial of service connection for diabetes mellitus. The Veteran served in Egypt and Kuwait, participating in a toxic exposure risk activity (TERA) involving burn pits and other environmental hazards. The Veteran contended that diabetes was incurred due to these environmental exposures or, alternatively, was incurred or aggravated secondary to service-connected hypertension. The Board noted that the agency of original jurisdiction (AOJ) had made favorable findings regarding a current diagnosis of diabetes mellitus and the Veteran's participation in TERA. However, the Board found that service records were negative for any diabetes-related complaints or treatment during service, and the earliest diagnosis of diabetes mellitus occurred over 15 years after service in April 2020. Post-service medical records and treating physicians' notes did not indicate a link to service or provide nexus opinions. A December 2024 VA examination concluded that the Veteran's diabetes was not incurred due to active duty, attributing it instead to risk factors like obesity and poor diet, and found no medical evidence linking the exposures to diabetes. The Board found this opinion well-reasoned and weighing against direct service connection. The Board also found the Veteran incompetent to opine on the medical etiology of his condition. Regarding the secondary claim for hypertension, the Board found no competent evidence linking diabetes to hypertension, and the VA examiner also opined against this secondary connection. Consequently, the Board denied service connection for diabetes mellitus.

Rationale

Service records negative for diabetes during service.; Earliest diagnosis over 15 years post-service.; VA examiner found no link to service or exposures.; No competent medical opinion supporting service connection.

Full Decision Text

Citation Nr: A26028459
Decision Date: 03/30/26	Archive Date: 03/30/26

DOCKET NO. 250314-526705
DATE: March 30, 2026

ORDER

The claim for service connection for diabetes mellitus is denied.

FINDING OF FACT

A causal relationship does not exist between the Veteran's diabetes mellitus and an in-service disease or injury or a service-connected disability.

CONCLUSION OF LAW

The criteria for establishing service connection for diabetes mellitus are not met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty with the United States Navy from January 1986 to January 1989, from November 2001 to November 2002, and from June 2003 to December 2003 with service in the Persian Gulf and Southwest Asia theater of operations. The Veteran served in the Navy Reserve from January 1989 to December 2007. This case comes before the Board of Veterans' Appeals (Board) on appeal from a February 2025 decision issued by the Department of Veterans Affairs (VA) Regional Office (RO).

The Appeals Modernization Act (AMA) automatically applies to all claims for which VA issues notice of an initial decision on or after February 19, 2019. See 38 C.F.R. § 3.2400(a)(1). This appeal stems from a February 2025 rating decision issued by the agency of original jurisdiction (AOJ) in a response to the Veteran's October 2022 original claim for service connection; therefore, the AMA applies.

The Veteran filed a VA Form 10182 (Decision Review Request: Board Appeal) in April 1, 2025 appealing the denial of service connection for diabetes mellitus. He elected to place his appeal on the Board's Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the February 2025 rating decision on appeal. 38 C.F.R. § 20.301. 

In other words, the Board cannot consider evidence submitted after February 26, 2025, the date the AOJ provided notice to the Veteran of the rating decision on appeal.

In a December 11, 2025 letter, the Board notified the Veteran he had the right to select a different Board review option by submitting a new VA Form 10182 within a year from February 26, 2025 (the date the AOJ mailed notice of the rating decision on appeal), or within 60 days of April 1, 2025 (the date the Board received the current VA Form 10182), whichever date was later. 38 C.F.R. § 20.202(c)(2). The Veteran was informed that the Board could not adjudicate his appeal until the above period expired. He was also provided the opportunity to submit a waiver of the time remaining to request a docket switch in accordance with Williams v. McDonough, 37 Vet. App. 305 (2024). No response to the December 2025 letter was received, and the Veteran did not waive the time remaining for a docket switch. However, as the time period to request a docket switch has now expired, the Board will proceed with a decision in this case.

Entitlement to service connection for diabetes mellitus.

The Veteran contends that service connection is warranted for diabetes mellitus as it was incurred due to various environmental exposures associated with his active duty service in Egypt and Kuwait. In the alternative, the Veteran contends that his diabetes mellitus was incurred or aggravated by service-connected hypertension. 

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004).

Service connection is also provided for a disability that is proximately due to, the result of, or aggravated by a service-connected disease or injury. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439 (1995).

The February 2025 rating decision on appeal includes favorable findings relevant to the current appeal.
: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004).

Service connection is also provided for a disability that is proximately due to, the result of, or aggravated by a service-connected disease or injury. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439 (1995).

The February 2025 rating decision on appeal includes favorable findings relevant to the current appeal. First, the AOJ found that a current disability was present as records from the VA Medical Center (VAMC) document a diagnosis and treatment for diabetes mellitus. The AOJ also confirmed the Veteran's participation in a toxic exposure risk activity (TERA) based on his service in Egypt and Kuwait and exposure to various environmental hazards, including burn pits and other toxins (BPOT). The Board is bound by the AOJ's favorable findings, absent clear and unmistakable error (CUE). 38 C.F.R. § 3.104(c).

The AOJ's favorable findings therefore establish the first two elements of service connection-a current disability and an in-service injury. The remaining questions for the Board are whether the Veteran's diabetes is proximately due to, the result of, or aggravated by a service-connected disability or directly due to service. The Board will first address the Veteran's contentions regarding direct service connection before moving on to service connection as secondary to hypertension.

Service and post-service records do not indicate a link between the Veteran's diabetes mellitus and any incident of active duty. Service records are negative for any complaints or treatment related to diabetes. Laboratory tests completed throughout the Veteran's periods of active service show normal blood sugar levels, and the Veteran never sought treatment for symptoms associated with diabetes mellitus. Thus, service records do not indicate the presence of diabetes mellitus. 

The post-service medical evidence also weighs against the claim. The earliest evidence of diabetes mellitus dates from May 2020-more than 15 years after separation-when the Veteran was diagnosed with diabetes mellitus based on laboratory findings made at the VAMC. On April 30, 2020, the Veteran was seen at the VAMC emergency department with complaints of intermittent chest pain, shortness or breath, and fatigue. He was eventually diagnosed with iron deficiency anemia due to a chronic lower gastrointestinal bleed. 

The next day, on May 1, 2020, the Veteran was noted to have elevated glucose and high average blood sugar levels. He was then diagnosed with diabetes mellitus. At a meeting with his primary care doctor in June 2020, he was advised to start an oral antihyperglycemic agent, but declined, stating that he would focus on dietary changes. A year later, in July 2021, the Veteran as seen again at the VAMC emergency department, and was noted to have no improvement in his blood sugar levels. He then began treatment for diabetes with oral medication.

The Board also observes that VAMC treatment records document one earlier notation of high glucose levels in June 2017. The Veteran was not diagnosed with diabetes at that time; rather, his healthcare provider noted that the result indicated the Veteran was not fasting at the time of his blood test. The earliest evidence of diabetes mellitus therefore dates from April 2020 at the VAMC. 

The Veteran's post-service treatment records are also negative for any indication his diabetes is related to events of active service. The Veteran's treating physicians have encouraged him to treat his diabetes with modifications to his diet, exercise regime, and weight, but have not indicated any link with environmental or chemical exposures during service. Furthermore, none of the Veteran's treating physicians have provided medical opinions in support of the claim. Post-service medical records therefore do not support the claim for service connection.

Service connection is also possible for certain disabilities, including diabetes mellitus, on a presumptive basis as a chronic disease in accordance with 38 C.F.R. §§ 3.307 and 3.309. In this case, there is no competent medical evidence of diabetes for more than 15 years after service, when the condition was diagnosed at the VAMC in April 2020. As the competent evidence does not establish the presence of diabetes mellitus until years after service, service connection is not warranted on a presumptive basis. See 38 C.F.R. §§ 3.307 and 3.309 (For veterans who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities are presumed to have been incurred in service if manifest to
 basis as a chronic disease in accordance with 38 C.F.R. §§ 3.307 and 3.309. In this case, there is no competent medical evidence of diabetes for more than 15 years after service, when the condition was diagnosed at the VAMC in April 2020. As the competent evidence does not establish the presence of diabetes mellitus until years after service, service connection is not warranted on a presumptive basis. See 38 C.F.R. §§ 3.307 and 3.309 (For veterans who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities are presumed to have been incurred in service if manifest to a compensable degree within one year of discharge from service).

The Board further observes the only probative medical opinions addressing the etiology of the Veteran's diabetes weigh against the claim. In December 2024, after a full review of the claims file including service records, a VA examiner found that the Veteran's diabetes was not incurred due to active duty. Instead, the examiner attributed the Veteran's condition to various other risk factors, including obesity, low physical activity, and an unhealthy diet. The December 2024 VA examiner also noted the absence of blood sugar abnormalities in the service records, in addition to the lack of findings related to diabetes mellitus after service. Combined with the number of years that passed before a diagnosis of diabetes was noted, the examiner concluded the Veteran's diabetes was not incurred due to service. The VA examiner also reviewed the medical literature pertaining to the etiology of diabetes mellitus, to include the primary risk factors associated with the development of the condition and stated they did not indicate a link between the Veteran's condition and service. 

Additionally, the Board notes that VA has acknowledged the Veteran participated in a TERA and was exposed to environmental and chemical hazards associated with his service in Egypt and Kuwait. However, the December 2024 VA examiner also provided a medical opinion specifically against a link between the Veteran's exposures and the incurrence of diabetes. In the December 2024 VA medical opinion report, the VA clinician noted "there is no medical or scientific evidence available that provides any indication of a relationship" between the Veteran's exposures and the development of diabetes mellitus. The December 2024 medical opinion was rendered 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. It therefore weighs against the claim for direct service connection.

The Board finds that the December 2024 VA medical opinions are based on the accurate facts of record and are supported by well-reasoned rationales. The opinions therefore weigh significantly against the claim. See Nieves- Rodriguez v. Peake, 22 Vet. App. 295 (2008). Based on the above, the Board finds that the weight of all the competent medical evidence is against the claim for direct service connection.

The Board has also considered the Veteran's contentions. The Veteran contends that his diabetes mellitus was incurred due to various environmental and chemical exposures during active service deployments. The Board finds that the Veteran is competent to report his observances of symptoms, but is not competent to opine as to medical etiology or render medical opinions in that respect. Barr v. Nicholson, 21 Vet. App. 303 (2007); see Grover v. West, 12 Vet. App. 109, 112 (1999). The Board specifically finds that the Veteran is not competent to identify the cause of his diabetes mellitus and related symptoms. His opinion as to the cause of his symptoms simply cannot be accepted as competent evidence. Jandreau v. Nicholson, 492 F.3d 1372, 1376-1377 (2007); Buchanan v. Nicholson, 451 F.3d 1131, 1336 (Fed. Cir. 2006).

Service connection is also possible for certain chronic disabilities under 38 C.F.R. § 3.303(b) based on a continuity of symptomatology. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). As noted above, diabetes mellitus is a chronic disability under 38 C.F.R. § 3.309(a), but the Veteran has not reported a continuity of symptoms since service. Service connection is therefore not possible based on a continuity of symptoms.

The record therefore shows the first objective medical evidence of the Veteran's diabetes mellitus was more than 15 years after service when he was diagnosed with the condition at the VAMC in April 2020. In addition, there is no competent evidence indicating that his diabetes mellitus is associated with any event during active service, to include the Veteran's deployment and related environmental and chemical exposures. The Veteran is
 708 F.3d 1331 (Fed. Cir. 2013). As noted above, diabetes mellitus is a chronic disability under 38 C.F.R. § 3.309(a), but the Veteran has not reported a continuity of symptoms since service. Service connection is therefore not possible based on a continuity of symptoms.

The record therefore shows the first objective medical evidence of the Veteran's diabetes mellitus was more than 15 years after service when he was diagnosed with the condition at the VAMC in April 2020. In addition, there is no competent evidence indicating that his diabetes mellitus is associated with any event during active service, to include the Veteran's deployment and related environmental and chemical exposures. The Veteran is not competent to link his disability to service, and he has not reported a continuity of symptoms since service which would tend to eliminate other intervening causes. The Board therefore concludes that the evidence is against a nexus between the claimed disability and active service.

The Board will now turn to the Veteran's contentions regarding service connection on a secondary basis. The Veteran contends that service connection is warranted for his diabetes as it was incurred or aggravated secondary to service-connected hypertension. He has not provided any specific argument in support of the secondary claim. 

There is no competent medical or lay evidence in support of the secondary service connection claim. None of the Veteran's treating providers have identified a relationship between any aspect of the Veteran's service-connected diabetes and his hypertension. The December 2024 VA examiner also provided medical opinions weighing against service connection on a secondary basis, finding that the Veteran's diabetes was not incurred or aggravated due to hypertension. The examiner again identified the main risk factors for diabetes (including obesity, low physical activity and an unhealthy diet), and observed that hypertension is not among them. Additionally, while the medical literature noted some increased risk of hypertension with diabetes mellitus, "the causality between these conditions remains to be determined." The December 2024 VA medical opinion therefore weighs against the secondary service connection claim.

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As the record contains no competent lay or medical evidence in support of service connection for the Veteran's claimed disabilities on a secondary basis, the Board must conclude that the evidence significantly and substantially weighs against the claim for direct and secondary service connection, and it is denied. 38 U.S.C. § 5107(b); see also Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

 

 

M. MILLS

Veterans Law Judge

Board of Veterans' Appeals

M. Riley, Attorney for the Board of Veterans' Appeals

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.