DIABETES MELLITUS

SHEREEN M. MARCUS · 2026 · Case ID: A26038330

GRANTED

Summary

The veteran, who served in the United States Army from November 1980 to July 1994, with additional active duty periods in the Army National Guard, appeals the denial of service connection for diabetes mellitus type II (DM), coronary artery disease (CAD), and various secondary conditions including diabetic neuropathy, toe amputations, peripheral vascular disease, gastroparesis, and nephropathy. The veteran claimed DM and CAD were due to herbicide exposure, specifically at Fort McClellan (FTMC), and that the other conditions were secondary to DM. The Board found that while the veteran's service at FTMC did not fall under a presumptive herbicide exposure region, the evidence, including research articles and a private environmental scientist's report, indicated herbicide use at FTMC during the veteran's service. The Board found the evidence in approximate balance regarding herbicide exposure at FTMC and resolved this doubt in the veteran's favor, establishing exposure on a facts-found basis. Consequently, DM and CAD were granted service connection as presumptive conditions related to herbicide exposure. The Board then addressed the secondary claims, finding that the veteran's diagnosed neuropathy, amputations, peripheral vascular disease, gastroparesis, and nephropathy were all caused by his now service-connected DM, based on the persuasive opinions of VA examiners. Service connection for all claimed conditions was granted.

Rationale

Exposure to herbicide agents at Fort McClellan established on facts-found basis.; DM is presumptively associated with herbicide exposure.; No clear and convincing evidence to the contrary.

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250327-527386

Full Decision Text

Citation Nr: A26038330
Decision Date: 04/23/26 Archive Date: 04/23/26

DOCKET NO. 250327-527386
DATE: April 23, 2026

ORDER

Entitlement to service connection for diabetes mellitus type II (DM), due to herbicide agent exposure, is granted.

Entitlement to service connection for coronary artery disease (CAD), due to herbicide agent exposure, is granted.

Entitlement to service connection for diabetic neuropathy of the left upper extremity, as secondary to DM is granted.

Entitlement to service connection for diabetic neuropathy of the right upper extremity as secondary to DM is granted.

Entitlement to service connection for diabetic neuropathy of the right lower extremity femoral nerve, as secondary to DM is granted.

The previous denial of service connection for diabetic neuropathy of the left lower extremity femoral nerve, as secondary to DM is granted.

Entitlement to service connection for diabetic neuropathy of the right lower extremity sciatic nerve, as secondary to DM is granted.

Entitlement to service connection for diabetic neuropathy of the left lower extremity sciatic nerve, as secondary to DM is granted.

Entitlement to service connection for amputation of the toe, right lower extremity as secondary to DM is granted.

Entitlement to service connection for amputation of toes, left lower extremity as secondary to DM is granted.

Entitlement to service connection for diabetic nephropathy as secondary to DM is granted.

Entitlement to service connection for peripheral vascular disease as secondary to DM II is granted.

Entitlement to service connection for gastroparesis as secondary to DM is granted.

FINDINGS OF FACT

1. The evidence is at least in approximate balance that the Veteran was exposed to herbicide agents during his active military service.

2. The persuasive weight of the evidence confirms the Veteran has a current diagnosis of diabetes mellitus type II (DM) and coronary artery disease.

3. The persuasive weight of the evidence indicates that the Veteran's currently diagnosed bilateral upper and lower extremity diabetic neuropathy, the amputation of his toes, peripheral vascular disease, gastroparesis, as well as his nephropathy, were caused by his now service-connected DM.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for diabetes mellitus type II (DM), due to herbicide agent exposure, have been met. 38 U.S.C. §§ 1110, 1112, 1113, 1116, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

2. The criteria for entitlement to service connection for coronary artery disease (CAD) due to herbicide exposure have been met. 38 U.S.C. §§ 1110, 1112, 1113, 1116, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

3. The criteria for entitlement to service connection for diabetic neuropathy of the left upper extremity, as secondary to DM have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

4. The criteria for entitlement to service connection for diabetic neuropathy of the right upper extremity as secondary to DM have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

5. The criteria for entitlement to service connection for diabetic neuropathy of the right lower extremity femoral nerve, as secondary to DM have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

6. The criteria for entitlement to service connection for diabetic neuropathy of the left lower extremity femoral nerve, as secondary to DM have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

7. The criteria for entitlement to service connection for diabetic neuropathy of the right lower extremity sciatic nerve, as secondary to DM have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

8. The criteria for
.

8. The criteria for entitlement to service connection for diabetic neuropathy of the left lower extremity sciatic nerve, as secondary to DM have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

9. The criteria for entitlement to service connection for amputation of the toe, right lower extremity as secondary to DM have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

10. The criteria for entitlement to service connection for amputation of toes, lower left extremity as secondary to DM have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

11. The criteria for entitlement to service connection for diabetic nephropathy as secondary to DM have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

12. The criteria for entitlement to service connection for peripheral vascular disease as secondary to DM have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

13. The criteria for entitlement to service connection for gastroparesis as secondary to DM have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from November 1980 to July 1994 with additional periods of service in the Army National Guard to include active duty for training from June 14, 2008, to June 28, 2008, and from February 13, 2009, to March 13, 2009.

This matter comes to the Board of Veterans' Appeals (Board) on appeal from a March 2025 rating decision issued by a VA Regional Office (RO).

By way of procedural background, the Veteran originally sought entitlement to service connection for the claimed issues noted above in July 2022. The claims were denied in a May 2023 rating decision. In response, the Veteran filed a November 2023 Supplemental Claim. The RO found new and relevant evidence had been received to reconsider the Veteran's claims, however, it continued to deny all claims on the merits in an April 2024 rating decision. In May 2024, the Veteran sought Higher Level Review (HLR) and in August 2024, the RO issued another rating decision noting that a duty to assist error had occurred requiring additional development to correct. Upon completion of additional development, the RO issued the March 2025 rating decision currently on appeal.

In the March 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 March 2025 agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 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 claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

The Board has limited the discussion below to the relevant evidence required to support its finding of fact and conclusion of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008).

Service Connection

Generally, 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).

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. See 38 C.F.R. § 3.310; but see Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023) (holding all that is needed is a "but for" causation or aggravation to show entitlement to secondary service connection).

Certain chronic diseases (such as DMII and CAD) will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013).

Additionally, VA regulations provide that certain diseases associated with herbicide agents may be presumed to have been incurred in service even if there is no evidence of the disease in service, provided the requirements of 38 C.F.R. § 3.307 (a)(6) are met. 38 C.F.R. § 3.309. A veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975; served in a unit that, as determined by the Department of Defense (DoD), operated in or near the Korean Demilitarized Zone (DMZ) in an area in which herbicide agents are known to have been applied between April 1, 1968, and August 31, 1971; or served in the Air Force or Air Force Reserve under circumstances in which the individual concerned regularly and repeatedly operated, maintained, or served onboard C-123 aircraft known to have been used to spray an herbicide agent during the Vietnam era, shall be presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service. 38 C.F.R. § 3.307 (a)(6). Once exposure has been established by the evidence, the presumptions found at 38 C
in an area in which herbicide agents are known to have been applied between April 1, 1968, and August 31, 1971; or served in the Air Force or Air Force Reserve under circumstances in which the individual concerned regularly and repeatedly operated, maintained, or served onboard C-123 aircraft known to have been used to spray an herbicide agent during the Vietnam era, shall be presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service. 38 C.F.R. § 3.307 (a)(6). Once exposure has been established by the evidence, the presumptions found at 38 C.F.R. § 3.309 (e) are applicable. Relevantly, DMII is a disease associated with exposure to herbicide agents.

Notwithstanding the foregoing presumption provisions, a claimant is not precluded from establishing service connection for a disability due to exposure to herbicide agents with proof of direct causation. Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994); Ramey v. Brown, 9 Vet. App. 40, 44 (1996), aff'd sub nom, Ramey v. Gober, 120 F.3d 1239 (Fed. Cir. 1997), cert. denied, 118 S. Ct. 1171 (1998).

A veteran is entitled to the benefit of the doubt when the evidence is in approximate balance or "nearly equal," and does not require that the evidence be in exact equipoise. Evidence is in approximate balance when the evidence in favor of and opposing the veteran's claim is found to be almost exactly or nearly equal. Lynch v. McDonough, 999 F.3d 1391 (Fed. Cir. 2021).

1. Entitlement to service connection for diabetes mellitus type II (DM), as due to herbicide exposure, is granted.

2. Entitlement to service connection for coronary artery disease (CAD), as due to herbicide exposure, is granted.

The Veteran contends that his DM and CAD are due to his active-duty service. Specifically, he asserts that he was exposed to herbicide agents during active-duty service while stationed at Fort McClellan (FTMC), and that he developed these disabilities as a result. See November 2023 Supplemental Claim.

By contrast, he does not contend, nor does the evidence show that his DM or CAD first began in service, within a year of service, or is otherwise attributed to some other incident of service.

Here, the evidence shows that the Veteran currently has a diagnosis of type II diabetes mellitus (DM). See October 2022 VA Examination. Further, the December 2023 VA heart conditions examination confirmed a current diagnosis of coronary artery disease (CAD).

As to herbicide exposure, the Board notes that such exposure, in this case, cannot be conceded as a matter of presumption. In this regard, it does not seem that the Veteran contends that he was stationed in any of the regions presumptively associated with herbicide exposure. Instead, he has specifically stated that he was exposed to herbicide agents while serving at Fort McClellan (FTMC) while undergoing training as a correctional specialist. See November 2023 Supporting Statement. He further reported that as part of his everyday duties and training, he came into contact with grass, soils, walkways, and fields. Id. He also reported observing on "several occasions" grounds crews spraying something of which he could smell "a chemical smell" in the air even a football field away. Lastly, he reported having been first diagnosed with DM in 2010 and has various other medical issues associated with his DM to include amputation of toes, neuropathy in both hands and feet, as well as gastroparesis. Id. He originally claimed his CAD as secondary to hypertension, but acknowledges the condition is also ordinarily presumptively associated with herbicide exposure.

The Veteran's military personnel records indicate his military occupational specialty (MOS) was a "corrections NCO" as well as a cannon crewmember in the Army. His records further show that he attended U.S. Army Military Police School at FTMC for a period of 37 days beginning on May 25, 1984.

In support of his claim, the Veteran's representative submitted in November 2023, an extensive informal hearing presentation (IHP) along with research articles and medical reports indicating the use of herbicide agents at FTMC. Notably, the research provided indicates that FTMC was a location in which some of its primary missions were to house and support the U.S. Army's Military Police and Chemical School's Training Center and the Training Brigade. An Environmental Baseline Survey "EBS", which was issued by the Federal Government in anticipation of selecting FTMC for closure in 1995 noted the use and storage of herbicide agents at Fort McClellan. Part of the EBS report included a November 1995 and January 1996 interview of a "building, grounds, and land management" employee at FTMC who reported "facility wide application of compounds used before (prior to 1991) included...Tordon". Tordon and Agent White were explained in the report to have been used in Vietnam and are "synonymous" as they contain Picloram and 2,40D, as listed in 38 C.F.R. § 3.307(a)(6) as herbicide agents.

Lastly, the Veteran's representative submitted a March 2021 report by Dr. H.M. titled "Likelihood of Exposure to Herbicide Agents used in the Vietnam War by Veterans who served on Fort McClellan (FTMC) in Anniston, AL". Within the report, Dr. H.M., an environmental scientist, noted that he reviewed all available records on the herbicides used at FTMC and ultimately concluded that:

It is my professional opinion as a weed scientist, that is more likely than not in fact, it is to a reasonable degree of certainty, that those serving and/or living at FTMC between 1962 to 1976, 1976 to 1979, 1979 to 1999 (with overlap exposure in 1985 to 1988 and 1989 to 1993) were exposed to herbicide agents, the same ones used in Vietnam via at least one or more exposure routes. They were also more likely to receive a greater exposure to the contaminants TCDD, HCV, nitrosamines, and arsenic than those with Vietnam service and the residual contamination of TCD goes on past 2050. Even more so, anyone undergoing any kind of military training conducted outdoors... were at the maximum health threatening exposure risk.

In contrast, the AOJ did not develop this contention and, instead, the claims file contains only a February 2024 VA memoranda and a January 2025 Individual Longitudinal Exposure Record (ILER) which indicate there are no conceded toxic risk exposure activities (TERAs) for the Veteran.

Given the above, and in resolving any reasonable doubt in favor of the Veteran, the Board finds that exposure to herbicide agents on a facts-found basis is warranted. The extensive argument provided by the Veteran's representative along with supporting research and medical reports indicates that, at a minimum, the evidence is in approximate balance as to whether various herbicide agents, specifically including those noted in 38 C.F.R. § 3.307(a)(6), were used at FTMC, to include during the time period in which the Veteran was stationed there in the mid-1980s. Accordingly, concession of the favorable finding of fact is appropriate.

Given said finding, service connection is warranted as both type II diabetes mellitus and CAD are presumptively associated with herbicide exposure and there exists no clear and convincing evidence to the contrary. See 38 C.F.R. § 3.309(e). Accordingly, service connection for diabetes mellitus type II (DM) and coronary artery disease (CAD) is warranted and the appeal is granted.

3. Entitlement to service connection for diabetic neuropathy of the left upper extremity, as secondary to DM, is granted.

4. Entitlement to service connection for diabetic neuropathy of the right upper extremity as secondary to DM, is granted.

5. Entitlement to service connection for diabetic neuropathy of the right lower extremity femoral nerve, as secondary to DM, is granted.

6. The previous denial of service connection for diabetic neuropathy of the left lower extremity femoral nerve, as secondary to DM, is granted.

7. Entitlement to service connection for diabetic neuropathy of the lower right extremity sciatic nerve, as secondary to DM, is granted.

8. Entitlement to service connection for diabetic neurop
itlement to service connection for diabetic neuropathy of the left upper extremity, as secondary to DM, is granted.

4. Entitlement to service connection for diabetic neuropathy of the right upper extremity as secondary to DM, is granted.

5. Entitlement to service connection for diabetic neuropathy of the right lower extremity femoral nerve, as secondary to DM, is granted.

6. The previous denial of service connection for diabetic neuropathy of the left lower extremity femoral nerve, as secondary to DM, is granted.

7. Entitlement to service connection for diabetic neuropathy of the lower right extremity sciatic nerve, as secondary to DM, is granted.

8. Entitlement to service connection for diabetic neuropathy of the left lower extremity sciatic nerve, as secondary to DM, is granted.

9. Entitlement to service connection for amputation of the toe, right lower extremity as secondary to DM, is granted.

10. Entitlement to service connection for amputation of toes, left lower extremity as secondary to DM, is granted.

11. Entitlement to service connection for diabetic nephropathy as secondary to DM, is granted.

12. Entitlement to service connection for peripheral vascular disease as secondary to DM is granted.

13. Entitlement to service connection for gastroparesis as secondary to DM is granted.

The Veteran contends that his neuropathy, nephropathy, gastroparesis, peripheral vascular disease, and amputations are secondary to his DM which was caused by exposure to herbicide agents while stationed at Fort McClellan. See November 2023 Supplemental Claim. By contrast, he does not contend, nor does the evidence show that these conditions first began in service, within a year of service, or are otherwise attributed to some other incident of service.

Again, the Board notes that 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. See 38 C.F.R. § 3.310; but see Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023) (holding all that is needed is a "but for" causation or aggravation to show entitlement to secondary service connection).

Here, there is no doubt that the Veteran has current diagnoses of bilateral upper and lower extremity diabetic neuropathy, diabetic nephropathy, gastroparesis, peripheral vascular disease, and had amputations of his right and left great toes as well as the left 5th toe. See October 2022 and February 2024 VA Examinations. In addition, as the Board has found in this case, the Veteran is now service connected for DM. Therefore, the sole remaining inquiry before the Board is whether there is a nexus between his service-connected DM and his diagnosed bilateral upper and lower extremity diabetic neuropathy, diabetic nephropathy, gastroparesis, peripheral vascular disease, and toe amputations.

At the outset, the Board finds that service connection on a direct, chronic, or presumptive basis is not merited.

Importantly, the Veteran has never asserted that these conditions are directly related to service, and his service treatment records (STRs) were negative for complaints, symptoms, treatment, or diagnoses associated with any of his claimed conditions. Moreover, the Veteran was not objectively diagnosed with any of these claimed conditions until many years after service. Based on these findings, VA examiners have consistently denied finding a direct nexus to service for said issues and associated the Veteran's claimed conditions to his DM.

Accordingly, the persuasive evidence of record is against service connection on a direct or chronic basis.

Additionally, even though the Veteran has been found to have been exposed to herbicide agents on a facts found basis, the Veteran's claimed disabilities are not presumptive conditions for those who were exposed to herbicide agents. See 38 C.F.R. § 3.309(e). Further, the Veteran has not contended, and there is no evidence of record suggesting a direct connection between his current gastroparesis, peripheral vascular disease, diabetic neuropathy, diabetic nephropathy, and toe amputations and any in-service toxic exposures. Combee v. Brown, 34 F.3d at 1042.

VA examiners have associated the Veteran's current toe amputations, neuropathy, gastroparesis, peripheral vascular disease, and nephropathy with his now service-connected DM. Specifically, the October 2022 and February 2024 VA examiners specifically reported diagnoses of diabetic neuropathy of the bilateral upper and lower extremities, gastroparesis, peripheral vascular disease, and nephropathy, as well as amputations of three toes upon in-person examinations. They also indicated that said conditions were due to the Veteran's DM and otherwise noted that these conditions were complications of the Veteran's complex DM history. Specifically, the October 2022 VA examiner reported that DM "is a chronic noncommunicable multisystem disease process which can effect microvasculature eventually leading to diabetic nephropathy, peripheral neuropathy, which can further lead to amputations due to decreased circulation to extremities". It was also reported that gastroparesis is a condition which can result from DM due to damage to the Vagas nerve which leads to irregular digestion and the inability to effectively push food from the stomach to the small intestine. It was further reported that peripheral vascular disease develops due to DM as the risk of development is increased in diabetic patients and occurs when DM is not well managed as in the case here. Lastly, the examiner reported that diabetes "affects every aspect of an individual over time and with persistent elevated blood glucose it is likely that they will endure chronic co-morbidities...after reviewing the Veteran's medical records, I noted that the Veteran has had a history of persistently elevated A1C levels which indicates persistent elevated glucose over the years...therefore the claimed conditions of peripheral vascular disease, amputations, neuropathy, and nephrology are at least as likely as not proximately due to or the result of the Veteran's [now service connected diabetes]". These reports and opinions were provided after in-person examination of the Veteran, consideration of his medical history, and based on medical literature which was specifically cited to in support thereof. See October 2022 VA Medical Opinions. The Board finds that the examination reports adequately support a determination that the currently diagnosed bilateral upper and lower extremity diabetic neuropathy, nephropathy, gastroparesis, peripheral vascular disease, and toe amputations were caused by the now service-connected DM. Furthermore, there are no medical opinions to the contrary.

Service-connection is thus warranted for bilateral upper and lower extremity diabetic neuropathy, diabetic nephropathy, gastroparesis, peripheral vascular disease, and amputations of his right and left great toes as well as the left 5th toe, as caused by his now service-connected diabetes mellitus type II (DM). The appeal is granted. See Lynch, 21 F.4th 776.

SHEREEN M. MARCUS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Minnitte, Samuel F.

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.

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