Case A26036036

Summary

The Veteran, who served from February 1978 to March 1988 and again from September 1988 to October 1998, appeals the denial of service connection for a fungal condition and diabetes mellitus type II. The Veteran's representative withdrew the appeal for the fungal condition, leading to its dismissal. For the diabetes mellitus claim, the Veteran argued it was secondary to service-connected Graves' disease or a result of weight gain from service-connected orthopedic disabilities. The Board noted the May 2021 rating decision found Graves' disease service-connected, but the Veteran's service treatment records did not indicate any in-service complaints, diagnosis, or treatment for diabetes. A March 2021 private physician's DBQ provided no nexus opinion. A subsequent April 2021 VA examination yielded a negative nexus opinion, attributing the diabetes to family history, lifestyle, age, and weight gain, noting a 13-year gap between Graves' disease and diabetes diagnoses. However, a March 2025 private opinion from an osteopathic physician reviewed the claims file and noted the Veteran's inability to exercise due to orthopedic disabilities led to weight gain, a risk factor for diabetes. Citing studies on obesity and diabetes, and a study linking Graves' disease treatment to diabetes risk, the private physician concluded the diabetes was at least as likely as not due to Graves' disease or weight gain from orthopedic issues. The Board found the evidence in approximate balance, applying the benefit of the doubt, and granted service connection for diabetes mellitus. The fungal condition appeal was dismissed due to withdrawal.

Rationale

Withdrawal of appeal by authorized representative; Requirements for withdrawal met per 38 C.F.R. § 20.205; Board lacks jurisdiction to review withdrawn issue

Full Decision Text

Citation Nr: A26036036
Decision Date: 04/17/26	Archive Date: 04/17/26

DOCKET NO. 210809-181112
DATE: April 17, 2026

ORDER

Entitlement to service connection for fungal condition is dismissed.

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

FINDINGS OF FACT

1. On April 16, 2025, prior to the promulgation of a decision in the appeal, the Board received notification from the appellant, through the authorized representative, that a withdrawal of the appeal for service connection for a fungal condition is requested.

2. Resolving reasonable doubt in the Veteran's favor, diabetes mellitus is due to service-connected orthopedic disabilities as part of a multi-causal chain.

CONCLUSIONS OF LAW

1. The criteria for withdrawal of an appeal by the Veteran via the authorized representative have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205.

2. The criteria for service connection for diabetes mellitus have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from February 1978 to March 1988 and from September 1988 to October 1998.

In the August 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. On January 27, 2025, the Veteran withdrew the hearing request.

Therefore, the Board may only consider the evidence of record at the time of the May 2021 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or his representative within 90 days following receipt of the withdrawal of the hearing request. 38 C.F.R. § 20.302(b). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to receipt of the withdrawal, or (2) more than 90 days following receipt of the withdrawal, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(b), 20.801. 

As an initial matter, the Board notes that in January 2026, the Veteran submitted a VA Form 20-10206, Freedom of Information Act (FOIA) or Privacy (PA) Request, requesting a copy of the Veteran's claims file, to include his service treatment records and disability evaluations. Generally, privacy requests should be processed prior to adjudicating a claim. 38 C.F.R. § 20.1200. However, the Board finds that there is no prejudice to the Veteran in not fulfilling the request prior to dismissing the withdrawn appeal for service connection for a fungal condition and granting service connection for diabetes mellitus.

1. Entitlement to service connection for fungal condition is dismissed.

An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 20.205. Withdrawal may be made by an appellant or an appellant's authorized representative. Id. 

A written withdrawal must include (1) the name of the Veteran, the name of the claimant or appellant if other than the Veteran, (2) the applicable VA file number, and (3) a statement that the appeal is withdrawn. If the appeal involves multiple issues, the withdrawal must specify that the appeal is withdrawn in its entirety or list the issue(s) withdrawn from the appeal. 38 C.F.R. § 20.205(b)(1); Hembree v. Wilkie, 33 Vet. App. 1 (2020). 

On April 16, 2025, the Veteran's authorized representative submitted a written brief in connection with the instant appeal. In relevant part, the authorized representative stated that the Veteran wished to withdraw his appeal for service connection for a fungal condition. All of the aforementioned requirements have been met. Accordingly, the Board does not have jurisdiction to review the appeal as to this issue and it is dismissed.

2. Entitlement to service connection for diabetes mellitus is denied.

The Veteran contends he has diabetes mellitus related to service, to include as secondary to his service-connected Graves' disease or as part of a causal chain due to weight gain associated with his service-connected orthopedic disabilities. See, e.g., April 2025 Brief.

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service.  38 U.S.C. §§ 
 part, the authorized representative stated that the Veteran wished to withdraw his appeal for service connection for a fungal condition. All of the aforementioned requirements have been met. Accordingly, the Board does not have jurisdiction to review the appeal as to this issue and it is dismissed.

2. Entitlement to service connection for diabetes mellitus is denied.

The Veteran contends he has diabetes mellitus related to service, to include as secondary to his service-connected Graves' disease or as part of a causal chain due to weight gain associated with his service-connected orthopedic disabilities. See, e.g., April 2025 Brief.

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).

In addition, service connection may be established on a presumptive basis for certain "chronic diseases"-to include diabetes mellitus-that manifest in service or to a degree of 10 percent within one year from the date of separation from service. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.303(b), 3.307(a)(3), 3.309(a); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). The term "chronic disease" refers to those diseases in 38 U.S.C. 1101(3) and 38 C.F.R. § 3.309(a). For those listed chronic diseases, a showing of continuity of symptoms affords an alternative route to service connection when the requirements for application of the presumption are not met. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

Service connection may also be established on a secondary basis. 38 C.F.R. 

§ 3.310. 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. 38 C.F.R. § 3.310 (a)-(b). 

Secondary causation exists when, but for the service-connected disability, the non-service-connected disability was caused by a service-connected disability either in a direct, etiological way or via multiple steps in a causal chain. Spicer v. McDonough, 61 F.4th 1360, 1365 (Fed. Cir. 2023) (citations omitted). Secondary aggravation exists when the non-service-connected disability not caused by a service-connected disability would be less severe and result in less functional impairment but for a service-connected disability. Id. at 1364. 

A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc). Only when the evidence persuasively favors one side, or another, is the benefit of the doubt doctrine not for application. Id.

Initially, the Board observes the May 2021 rating decision notes favorable findings that the Veteran has been diagnosed with diabetes mellitus type II and that the primary disability, Graves' disease, is service connected. The Board is bound by these favorable findings absent clear and unmistakable error. 38 C.F.R. § 3.104. 

Next, the Board notes that the Veteran's service treatment records (STRs) do not show complaints, a diagnosis, or treatment for diabetes mellitus, nor was this condition diagnosed within 1 year of separation from military service. 

The Veteran provided a Disability Benefits Questionnaire (DBQ) from his private physician in March 2021. Although the examiner provided a full examination of the Veteran, no opinion regarding the link between the Veteran's military service and the diagnosed condition was rendered.

VA obtained a medical opinion in April 2021. At that time, the examiner provided a negative nexus opinion stating that the Veteran was diagnosed with diabetes mellitus between 2000 and 2004 and was diagnosed with Graves' disease while in service
. 

Next, the Board notes that the Veteran's service treatment records (STRs) do not show complaints, a diagnosis, or treatment for diabetes mellitus, nor was this condition diagnosed within 1 year of separation from military service. 

The Veteran provided a Disability Benefits Questionnaire (DBQ) from his private physician in March 2021. Although the examiner provided a full examination of the Veteran, no opinion regarding the link between the Veteran's military service and the diagnosed condition was rendered.

VA obtained a medical opinion in April 2021. At that time, the examiner provided a negative nexus opinion stating that the Veteran was diagnosed with diabetes mellitus between 2000 and 2004 and was diagnosed with Graves' disease while in service in 1986. The examiner noted that diabetes and thyroid disease are both endocrine or hormone problems and when thyroid disease occurs in someone with diabetes, it can make controlling blood glucose more difficult. The examiners ultimately concluded that the Veteran's diabetes mellitus was not caused by his Graves' disease due to the 13-year gap between the diagnoses of Graves' disease and diabetes mellitus. The examiner indicated that the Veteran's family history of diabetes, lifestyle, age, and weight gain were significant factors for his risk and eventual diagnosis.

In April 2025, within 90 days following the hearing withdrawal, the Veteran submitted a private opinion from an osteopathic physician. The clinician reported that she reviewed the Veteran's claims file, to include the rating decision, statements, entrance and separation examinations, VA examinations, and current medical records. The clinician noted that service connection was in effect for the Veteran for a number of orthopedic disabilities, and that he was unable to exercise and lead an active lifestyle due to such. The clinician referenced several studies in the report, to include those showing a high prevalence of obesity in certain veteran populations, and connecting obesity to numerous health risks, including type 2 diabetes and cardiovascular disease. The clinician pointed to a meta-analysis of 111,851 individuals with obesity that found a significant association between obesity and sedentary behavior and physical inactivity. 

As well, the clinician noted that the Veteran has a diagnosis of Graves' disease, and that antithyroid drugs used for such can subject patients to an elevated risk of various metabolic disturbances caused by excessive thyroid hormone production. The clinician noted that the effects of thyroid hormones on glucose metabolism are well recognized and that thyroid dysfunction and diabetes mellitus can coexist in patients. A nationwide study of patients with long-standing Graves' disease following an initial 24-month course of antithyroid drug treatment had a 1.17 times risk of having diabetes mellitus. The clinician concluded that the Veteran's diabetes mellitus was at least as likely as not due to either his service-connected Graves' disease or due to weight gain caused by his various orthopedic disabilities.

The Board notes that although weight gain or obesity cannot qualify as a disease or injury or as an in-service event for VA compensation purposes, weight gain or obesity can be considered as an intermediate step between a service-connected disability and a current disability that may be service-connected on a secondary basis under 38 C.F.R. § 3.310. See Marcelino v. Shulkin, 29 Vet. App. 155 (2018) and Walsh v. Wilkie, 32 Vet. App. 300 (2020); VAOPGCPREC 1-2017 (Jan. 6, 2017).

Here, there are two opinions of record, one for and one against the claim. While the VA examiner ultimately provided a negative opinion, the examiner noted that the Veteran's weight gain was a significant risk factor for his risk of diabetes and eventual diagnosis but did not discuss the role the Veteran's service-connected disabilities may have played in the causal chain. The private clinician reported the Veteran was unable to exercise due to his service-connected orthopedic disabilities and gained weight as a result. 

Accordingly, the Board finds that the evidence is at least in approximate balance as to whether the Veteran's service-connected orthopedic disabilities were the first step in a multi-causal chain that ultimately resulted in the development of diabetes mellitus. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc). Accordingly, service connection for diabetes mellitus is warranted.

 

 

A. Dean

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Marchese, Angel N.

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. § 20.130
 that ultimately resulted in the development of diabetes mellitus. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc). Accordingly, service connection for diabetes mellitus is warranted.

 

 

A. Dean

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Marchese, Angel N.

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.