DIABETES MELLITUS

Summary

The Veteran, who served in the United States Navy from April 1985 to June 1991, appeals the denial of service connection for diabetes mellitus (DM) as secondary to service-connected posttraumatic stress disorder (PTSD), major depressive disorder, alcohol use disorder, and cannabis use disorder. The Veteran asserts that her DM developed as a result of obesity, which in turn was linked to her PTSD, a service-connected condition. The Board reviewed VA examination opinions from September, October, and November 2023. The initial and addendum opinions from the VA examiner stated that DM II was not directly related to service and was less likely than not service-connected, attributing it to genetics, impaired hormones, insulin resistance, and obesity, while noting an association between PTSD and DM risk factors. However, the October 2023 opinion stated that DM II was less likely than not aggravated beyond its natural progression by the service-connected PTSD. Resolving reasonable doubt in the Veteran's favor, the Board found the VA examiners' opinions persuasive in establishing that the Veteran's DM is secondary to her service-connected acquired psychiatric disorder via the intermediate step of obesity. Therefore, service connection for DM was granted.

Rationale

DM is secondary to service-connected acquired psychiatric disorder via intermediate step of obesity.; VA examiners' opinions found persuasive for secondary nexus.; Reasonable doubt resolved in Veteran's favor.

Full Decision Text

Citation Nr: A26036815
Decision Date: 04/21/26	Archive Date: 04/21/26

DOCKET NO. 250513-545840
DATE: April 21, 2026

ORDER

Entitlement to service connection for diabetes mellitus type 2 (DM) as secondary to service-connected posttraumatic stress disorder (PTSD) with major depressive disorder, alcohol use disorder, and cannabis use disorder is granted.

FINDING OF FACT

The Veteran's DM is secondary to service-connected acquired psychiatric disorder via an intermediate step of obesity.

CONCLUSION OF LAW

The criteria for service connection for DM as secondary to service-connected PTSD with major depressive disorder, alcohol use disorder, and cannabis use disorder have been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303; 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Navy from April 1985 to June 1991. 

The rating decision on appeal was issued in May 2024. In the May 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.

Therefore, the Board may only consider the evidence of record at the time of the January 2024 agency of original jurisdiction (AOJ) decision, which was subsequently subject to higher-level review in May 2024. 38 C.F.R. § 20.301. If evidence was submitted during the period after the AOJ issued the decision, which was subsequently subject to higher-level review, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.301, 20.801. 

Entitlement to service connection for DM to include as secondary to service-connected PTSD with major depressive disorder, alcohol use disorder, and cannabis use disorder.

The Veteran seeks entitlement to service connection for DM. The Veteran has argued both a direct theory of entitlement as well as secondary to her service-connected PTSD. She asserts that "after suffering from MST [she] was diagnosed [as] obese while in [the] military and developed diabetes."  

Service connection may be granted on a secondary basis for disability that is due to, the result of, or aggravated by a service-connected disability. 38 C.F.R. § 3.310; see Allen v. Brown, 7 Vet. App. 439, 448 (1995).

Obesity may act 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(a); VAOPGCPREC 1-2017; Adams v. Collins, No. 23-5064, 2025 WL 1879247 (July 8, 2025).

Service treatment records show that in May 1991, the Veteran was seen for "Body fat screening." She denied a dietary consult. The assessment was obesity.  

The Veteran was afforded a VA examination in September 2023. The VA examiner provided the following opinion:

"Claim condition of Type II Diabetes is not directly related to time in service. Causes of DM can be linked to Genetic, impaired hormones, Insulin resistance and Obesity. Veteran also is service connected for PTSD which has been seen with Type II Diabetes. Posttraumatic stress disorder (PTSD) is a common, debilitating mental disorder that has been associated with type 2 diabetes mellitus (T2D) and its risk factors, including obesity, in cross-sectional studies. If PTSD increases risk of incident T2D, enhanced surveillance in high-risk populations may be warranted ... Posttraumatic Stress Disorder and Incidence of Type 2 Diabetes Mellitus in a Sample of Women, 2015. Therefore, there is less likely as not a 50% probability that the claim condition of Type II Diabetes is directly related to time in-service. A nexus has not been established."

A follow-up VA examination and opinion was provided in October 2023. The VA examiner provided the following opinion:

"DM II is a chronic metabolic disorder characterized by persistent hyperglycemia. It may be due to impaired insulin secretion, resistance to peripheral actions of insulin, or both. Chronic hyperglycemia in synergy with the other metabolic aberrations in patients with diabetes mellitus can cause damage to various organ systems, leading to the development of disabling and life-threatening health complications, most prominent of which are microvascular (retinopathy, nephropathy, and neuropathy) and macrovascular complications leading to a 2-fold to 4-fold increased risk of cardiovascular diseases. While PTSD is a disabling psychiatric disorder that results from being exposed to real or threatened injury, death,
 was provided in October 2023. The VA examiner provided the following opinion:

"DM II is a chronic metabolic disorder characterized by persistent hyperglycemia. It may be due to impaired insulin secretion, resistance to peripheral actions of insulin, or both. Chronic hyperglycemia in synergy with the other metabolic aberrations in patients with diabetes mellitus can cause damage to various organ systems, leading to the development of disabling and life-threatening health complications, most prominent of which are microvascular (retinopathy, nephropathy, and neuropathy) and macrovascular complications leading to a 2-fold to 4-fold increased risk of cardiovascular diseases. While PTSD is a disabling psychiatric disorder that results from being exposed to real or threatened injury, death, and sexual assault. It is associated with functional and cognitive impairment. Therefore, the Veteran's DM II condition is less likely than not aggravated beyond its natural progression by the service connected PTSD condition."

An addendum VA opinion was provided in November 2023 to address deficiencies. The VA examiner provided the following opinion:

"Claim condition of Type II Diabetes is not directly related to time in-service. Causes of DM can be linked to Genetic, impaired hormones, Insulin resistance and Obesity. Veteran also is service connected for PTSD which has been seen with Type II Diabetes. Posttraumatic stress disorder (PTSD) is a common, debilitating mental disorder that has been associated with type 2 diabetes mellitus (T2D) and its risk factors, including obesity, in cross-sectional studies. If PTSD increases risk of incident T2D, enhanced surveillance in high-risk populations may be warranted ... Posttraumatic Stress Disorder and Incidence of Type 2 Diabetes Mellitus in a Sample of Women, 2015). Therefore, there is less likely as not a 50% probability that the claim condition of Type II Diabetes is directly related to time in-service. A nexus has not been established."

Resolving reasonable doubt in favor of the Veteran, the Board finds the VA examiners' opinions persuasive to show that the Veteran's DM is secondary to her service-connected acquired psychiatric disorder via the intermediate step of obesity. Accordingly, service connection for DM is warranted.

 

 

TANYA SMITH

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Fields, Ashley 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.