DIABETES MELLITUS

Summary

The Veteran, who served from July 1972 to November 1979, appeals the June 2021 rating decision. The Veteran sought service connection for diabetes mellitus type II, contending it was secondary to his service-connected generalized anxiety disorder. The Board reviewed evidence of record at the time of the agency of original jurisdiction's decision, including a September 2021 medical opinion from J. E., MD. This opinion stated that the Veteran's diabetes mellitus type II developed secondary to significant weight gain related to stress eating stemming from his service-connected anxiety disorder. The Board considered the obesity-intermediate step theory of service connection, which requires evaluating if the service-connected disability caused or aggravated obesity, and if that obesity was a substantial factor in causing the current disability. After reviewing the evidence, the Board found the evidence to be in relative equipoise regarding whether diabetes mellitus type II is related to the service-connected psychiatric disability, with obesity as an intermediate step. Applying the benefit of the doubt in the Veteran's favor, service connection for diabetes mellitus type II secondary to psychiatric disability was granted.

Rationale

Evidence in relative equipoise regarding secondary service connection; Benefit of the doubt applied in Veteran's favor; Private medical opinion linked diabetes to stress eating from anxiety

Full Decision Text

Citation Nr: A26033961
Decision Date: 04/14/26	Archive Date: 04/14/26

DOCKET NO. 210702-170217
DATE: April 14, 2026

ORDER

Entitlement to service connection for diabetes mellitus type II secondary to service-connected psychiatric disability is granted.

FINDING OF FACT

Diabetes mellitus type II is secondary to the service-connected psychiatric disability.

CONCLUSION OF LAW

The criteria for entitlement to service connection for diabetes mellitus type II secondary to service-connected psychiatric disability have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran had active service from July 1972 to November 1979. 

The appeal comes to the Board of Veterans' Appeals (Board) from a June 2021 rating decision.  In the July 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held in August 2024. 

Therefore, the Board may only consider the evidence of record at the time of the agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801. 

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 

Service Connection

In general, service connection requires competent evidence showing: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). 

Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439 (1995). Service connection may be granted for a disability that is... due to, or aggravated by, service-connected disease or injury. See 38 C.F.R. § 3.310. "The statute, [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" Spicer v. McDonough, 61 F.4th 1360, 1364 (Fed. Cir. 2023).

Generally, a claimant has the responsibility to present and support a claim for benefits. All information, lay evidence and medical evidence in a case is to be considered by the Board in deciding the claim. 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 the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b); see also Lynch v. McDonough, 21 F.4th 776 (2021).

Entitlement to service connection for diabetes mellitus type II secondary to service-connected psychiatric disability is granted.

The Veteran seeks service connection for diabetes mellitus type II. The rating decision on appeal conceded the current disability.

Among other theories advanced, the
 the responsibility to present and support a claim for benefits. All information, lay evidence and medical evidence in a case is to be considered by the Board in deciding the claim. 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 the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b); see also Lynch v. McDonough, 21 F.4th 776 (2021).

Entitlement to service connection for diabetes mellitus type II secondary to service-connected psychiatric disability is granted.

The Veteran seeks service connection for diabetes mellitus type II. The rating decision on appeal conceded the current disability.

Among other theories advanced, the Veteran contends the condition is secondary to his service-connected generalized anxiety disorder. 

A September 2021 medical opinion from J. E., MD, contains the opinion that the Veteran's development of diabetes mellitus type II was secondary to his significant weight gain related to stress eating from his service-connected anxiety disorder

Under the obesity-intermediate step theory of service connection, consideration must be taken as to (1) whether the service-connected disability caused a veteran to become obese or aggravated the veteran's obesity; (2) if so, whether the obesity or aggravation of the obesity was a substantial factor in causing the current disability; and (3) whether the current disability would not have occurred but for the obesity caused or aggravated by the service-connected disability.  If these questions are answered in the affirmative, then the claimed disability may be service connected on a secondary basis.  Walsh v. Wilkie, 32 Vet. App. 300 (2020).

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After review and careful consideration, the evidence is at least in relative equipoise as to whether diabetes mellitus type II is related to the service-connected psychiatric disability, with obesity as an intermediate step.  Resolving reasonable doubt in the Veteran's favor, service connection for diabetes mellitus type II is warranted and granted. 

 

Martin T. Mitchell

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	King, Timothy (BVA)

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.