DIABETES MELLITUS

MICHAEL J. SKALTSOUNIS · 2026 · Case ID: A26039235

GRANTED

Summary

The Veteran served in the United States Navy from January 1972 to January 1978. He appealed the May 14, 2021, rating decision concerning service connection for diabetes mellitus, type II, bilateral lower extremity neuropathy, and Meniere's disease. The Veteran claimed these conditions were due to in-service herbicide exposure, specifically mentioning Agent Orange exposure at Naval Air Station Kingsville, Texas, where he washed C-123 aircraft. The Board found the Veteran's testimony credible and supported by the record, particularly his description of washing C-123 aircraft without protective equipment. The Board conceded Agent Orange exposure during service, granting service connection for diabetes mellitus, type II, and bilateral sensory-motor polyneuropathy in both lower extremities. For Meniere's disease, the Veteran claimed secondary service connection to his already service-connected bilateral hearing loss. While a VA examiner opined the Meniere's disease was less likely than not related to service-connected hearing loss, the Board found this opinion to have low probative value, noting it used a too-stringent standard and conceded hearing loss as a risk factor. The Board found a private physician's opinion, which linked the conditions, to be highly probative. Giving the Veteran the benefit of the doubt, service connection for Meniere's disease secondary to bilateral hearing loss was granted.

Rationale

Current diagnosis of diabetes mellitus, type II.; In-service event: Conceded Agent Orange exposure during service.; Nexus: At least as likely as not related to service.

Service Branch

NAVY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

210610-165183

Full Decision Text

Citation Nr: A26039235
Decision Date: 04/28/26 Archive Date: 04/28/26

DOCKET NO. 210610-165183
DATE: April 28, 2026

ORDER

Service connection for diabetes mellitus, type II, is granted.

Service connection for left lower extremity diabetic neuropathy, diagnosed as sensory-motor polyneuropathy, is granted.

Service connection for right lower extremity diabetic neuropathy, diagnosed as sensory-motor polyneuropathy, is granted.

Service connection for Meniere's disease, to include as secondary to service-connected bilateral hearing loss, is granted.

FINDINGS OF FACT

1. The most probative and persuasive evidence shows that it is at least as likely as not that the Veteran's diabetes mellitus, type II, is a result of the Veteran's service.

2. The most probative and persuasive evidence shows that it is at least as likely as not that the Veteran's left lower extremity diabetic neuropathy, diagnosed as sensory-motor polyneuropathy, is a result of the Veteran's service.

3. The most probative and persuasive evidence shows that it is at least as likely as not that the Veteran's right lower extremity diabetic neuropathy, diagnosed as sensory-motor polyneuropathy, is a result of the Veteran's service.

4. The most probative and persuasive evidence shows that it is at least as likely as not that the Veteran's Meniere's disease is a result of the Veteran's service or service-connected disability.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for diabetes mellitus, type II, have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 4.3.

2. The criteria for entitlement to service connection for left lower extremity diabetic neuropathy, diagnosed as sensory-motor polyneuropathy, have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 4.3.

3. The criteria for entitlement to service connection for right lower extremity diabetic neuropathy, diagnosed as sensory-motor polyneuropathy, have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 4.3.

4. The criteria for entitlement to service connection for Meniere's disease, to include as secondary to service-connected bilateral hearing loss, have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310, 4.3.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served in the United States Navy from January 1972 to January 1978.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 14, 2021, Appeals Modernization Act (AMA) rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO) of the Veterans Benefits Administration (VBA), which is the Agency of Original Jurisdiction (AOJ).

On June 10, 2021, the Veteran filed a VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), reflecting his decision to appeal the previously indicated rating decision via the hearing docket. Under the AMA, when a claimant seeks appellate review through the Board's hearing review docket, the Board may consider the evidence of record at the time of the AOJ decision on appeal, additional evidence submitted on the date of the Board hearing (including testimony), and additional evidence submitted within 90 days following the hearing. 38 U.S.C. § 7113(b); 38 C.F.R. §§ 20.302(a), 3.2500, 3.2501.

On January 14, 2025, the Veteran testified at a video hearing before the undersigned Veterans Law Judge (VLJ). A transcript of the hearing is associated with the claims file. The Veteran did not submit additional evidence within the 90 days following the Board hearing.

Preliminary note

The Board notes that the Veteran also appealed the issues of service connection for left lower extremity diabetic neuropathy and service connection for right lower extremity diabetic neuropathy. As such, these issues have been added to the
days following the hearing. 38 U.S.C. § 7113(b); 38 C.F.R. §§ 20.302(a), 3.2500, 3.2501.

Preliminary note

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303.

Service connection may also be granted for any disease diagnosed after discharge from service when all of the evidence, including lay evidence, establishes that the disability is due to disease or injury which was incurred in or aggravated by service. 38 C.F.R. § 3.303(d).

In order to establish service connection for a claimed disability, the following three elements must be satisfied: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship nexus) between the present disability and the disease or injury incurred or aggravated during service. Hickson v. West, 12 Vet. App. 246 (1999).

VA regulations provide that certain diseases which are associated with exposure to 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(e). A Veteran who, during active service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, 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).

The last date on which such a Veteran shall be presumed to have been exposed to an herbicide agent shall be the last date on which he or she served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975. The term "herbicide agent" means a chemical in an herbicide, including Agent Orange, used in support of the United States and allied military operations in the Republic of Vietnam during the Vietnam era. Service in the Republic of Vietnam includes service within the 12 nautical mile territorial sea of Vietnam. 38 U.S.C. §§ 1116, 1116A; 38 C.F.R. §§ 3.307 (a)(6), 3.313; Procopio v. Wilkie, 913 F.3d 1371, 1379-81 (Fed. Cir. 2019). Also, a veteran who performed service in the Air Force or Air Force Reserve under circumstances in which the individual 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. 38 C.F.R. § 3.307(a)(6)(v).

The enumerated diseases include diabetes mellitus, type II, and early onset peripheral neuropathy. 38 C.F.R. § 3.309(e). Presumptive service connection for these disorders as a result of Agent Orange exposure is warranted if the requirements of 38 C.F.R. § 3.307 (a)(6) are met, which for early onset peripheral neuropathy includes that it must become manifest to a degree of 10 percent or more within a year after the last date on which the veteran was exposed to an herbicide agent during active service. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307(a)(6)(ii), 3.309(e).

Despite the presumptive regulations, a claimant may establish service connection based on exposure to Agent Orange with proof of actual direct causation. Stefl v. Nicholson, 21 Vet. App. 120 (2007) (holding that the availability of presumptive
C.F.R. § 3.307 (a)(6) are met, which for early onset peripheral neuropathy includes that it must become manifest to a degree of 10 percent or more within a year after the last date on which the veteran was exposed to an herbicide agent during active service. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307(a)(6)(ii), 3.309(e).

Despite the presumptive regulations, a claimant may establish service connection based on exposure to Agent Orange with proof of actual direct causation. Stefl v. Nicholson, 21 Vet. App. 120 (2007) (holding that the availability of presumptive service connection for some conditions based on exposure to Agent Orange does not preclude direct service connection for other conditions based on exposure to Agent Orange). Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994).

Service connection may also be granted for a disability that is proximately due to or the result of a service-connected disability. See 38 C.F.R. § 3.310(a). When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. See 38 C.F.R.§ 3.310 (a); Harder v. Brown, 5 Vet. App. 183, 187 (1993). The governing regulation has been interpreted to permit a grant of service connection not only for a disability caused by a service-connected disability, but for the degree of disability resulting from aggravation of a non-service-connected disability by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995). In the case of Ward v. Wilkie, the United States Court of Appeals for Veterans Claims held that, for secondary service connection, "aggravation" need not be permanent in nature. 31 Vet. App. 233, 241-42 (2019).

In Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023), the United States Court of Appeals for the Federal Circuit held that secondary service connection under 38 U.S.C. § 1110 is warranted for any increase in a nonservice-connected disability that is due to a service-connected disability, including where a service-connected disability precludes treatment for a nonservice-connected disability. Id. at 1363-1365. That decision also found unlawful the VA regulation that required evidence establishing a pre-aggravation baseline before secondary service connection based on aggravation could be granted. Id. at 1366 ("We decide this case based on our interpretation of § 1110 alone. To the extent that the VA also applied 38 C.F.R. § 3.310(b) to reject Mr. Spicer's theory of compensation, that regulation is unlawful as inconsistent with 38 U.S.C. § 1110.").

In evaluating the evidence in an appeal, it is the responsibility of the Board to weigh the evidence and decide where to give credit and where to withhold the same and, in doing so, accept certain medical opinions over others. Schoolman v. West, 12 Vet. App. 307 (1999). In this regard, the Board has been charged with the duty to assess the credibility and weight given to the evidence. Jandreau v. Nicholson, 492 F.3d 1372 (2007).

Generally, the degree of probative value which may be attributed to a medical opinion issued by a VA or private treatment provider takes into account such factors as its thoroughness and degree of detail, and whether there was review of the claims file. See Prejean v. West, 13 Vet. App. 444, 448-449 (2000). Also significant is whether the examining medical provider had a sufficiently clear and well-reasoned rationale, and a basis in objective supporting clinical data. See Bloom v. West, 12 Vet. App. 185, 187 (1999); Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998). In concluding that no relationship between a current disability and military service exists, the examiner may not rely solely on an absence of medical records and not consider any available competent and credible lay statements. Dalton v. Nicholson, 21 Vet. App. 23 (2007); Buchanan v. Nicholson, 451 F.3d 1331, 1336-1336 (2006).

Competent lay evidence is any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it
, 12 Vet. App. 185, 187 (1999); Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998). In concluding that no relationship between a current disability and military service exists, the examiner may not rely solely on an absence of medical records and not consider any available competent and credible lay statements. Dalton v. Nicholson, 21 Vet. App. 23 (2007); Buchanan v. Nicholson, 451 F.3d 1331, 1336-1336 (2006).

Competent lay evidence is any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a)(2). This may include some medical matters, such as describing symptoms or relating a contemporaneous medical diagnosis. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).

In adjudicating a claim of service connection, the Board is required to evaluate evidence based on places, types, and circumstances of service, as shown by the veteran's military records and all pertinent medical and lay evidence. Hayes v. Brown, 5 Vet. App. 60, 66 (1993); see also 38 U.S.C. § 1154(a).

When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in approximate balance, with the veteran prevailing in either event. 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021); Gilbert v. Derwinski, 1 Vet. App. 49 (1990).

1. Service connection for diabetes mellitus, type II, is granted.

2. Service connection for left lower extremity diabetic neuropathy, diagnosed as sensory-motor polyneuropathy, is granted.

3. Service connection for right lower extremity diabetic neuropathy, diagnosed as sensory-motor polyneuropathy, is granted.

The Veteran claims entitlement to service connection for diabetes mellitus, type II, and bilateral lower extremity neuropathy, to include as due to in-service herbicide exposure.

Particularly, the Veteran asserts Agent Orange exposure happened at the Kingsville Naval AS, Texas, where he washed C-123 aircraft that were covered with Agent Orange. He also asserts that he underwent an Agent Orange Exam at the Nashville VAMC. See July 2020 Report of General Information.

Following a review of the evidence, the Board finds that the most probative and persuasive evidence shows that it is at least as likely as not that the Veteran's claimed disabilities are a result of the Veteran's service.

Regarding the first element of the Veteran's service-connection claim, a current disability, the Veteran has diagnoses of diabetes mellitus, type II, and bilateral sensory-motor polyneuropathy. See private treatment records, April 2016; VA treatment records, September 2019; May 14, 2021, rating decision.

Next, the Board must determine whether the Veteran was exposed to herbicide agents during service.

The Veteran's military service records show that the Veteran had shore duty from July 1972 to April 1974 at the Naval Air Station Kingsville, Texas. The Veteran had an MOS of Airframes & Hydraulics Systems Maintenance in charge of performing scheduled and unscheduled maintenance on the airframe and hydraulic systems of squadron aircraft. He had additional military duties of Assistant Squadron Duty Officer Watches. See military personnel records.

Additionally, the Veteran's service treatment records show that, in April 1973, the Veteran reported to sick bay with detergent wash in his right eye. The examiner reportedly flushed his eye, prescribed medication and an eye patch. See service treatment records, April 1973.

During the January 2025 Board hearing, the Veteran declared that his first duty station was Kingsville Naval Air Station in Kingsville, Texas. He was trained in hydraulics and as machinist and welder. When he was first assigned, he went and worked on a "flight" line before he went to work on an aircraft carrier. He was on the wash rack sometimes. He came in one morning, and the chief came out, and he and other service members saw this aircraft sitting on the "flight line." And they did not know what it was, because they were used to A-4 jets, and this thing was a cargo aircraft with two engines. They were put in charge of washing the aircraft with no personal protective equipment. And they "walked up to the aircraft, and the first thing they noticed was hanging off of the back of the wings were these little things with hoses running to them." And when they touched the side of the aircraft, it felt like they were touching the back of a sticky pad, sticky note. It was covered in this stuff that was being sprayed from that aircraft. When they looked inside, there was a series of pumps and drums of whatever they were spraying. They washed two or three of these aircraft in that year. These were aircraft he now recognizes as C-123s. Since they were washing the aircraft back then with no personal protective equipment, all their clothes were full of whatever they were washing. So, they got drenched in the stuff.

From the foregoing, and resolving reasonable doubt in the Veteran's favor, the Board finds that the second element of the Veteran's claims, an in-service event or injury, is met. While the military personnel records do not specifically confirm the Veteran had repeated contact with C-123s, they do reflect that, while performing his military duties, he was in charge of aircraft maintenance, including washing the aircraft. The Veteran's service treatment records show that he was, in fact, washing aircraft as part of his military duties. As such, the Board finds that the Veteran's statements regarding his contact with C-123s are credible and supported by the record, as it is feasible that his military duties in aircraft maintenance would result in his having physical contact with the assigned C-123s and there is no evidence that directly contradicts this contact. Thus, given the Veteran's aircraft maintenance military duties, and lay statement of contact with affected C-123s, the Board affords the Veteran the benefit of the doubt and concedes his exposure to Agent Orange during service.

Finally, VA treatment records note that, as part of an Agent Orange Registry Evaluation, the Veteran reported having been exposed to Agent Orange herbicide agent while in service. Also, a VA physician noted that the Veteran had "[d]iabetes and neuropathy that can be related to exposure to agent orange. he was involved in possible agent orange exposure in the navy." See VA treatment records, April 2017.

Therefore, service connection for the Veteran's diabetes mellitus, type II, and bilateral sensory-motor polyneuropathy, are warranted on a facts-found basis.

Accordingly, based on all the foregoing, and giving the Veteran the benefit of the doubt, service connection for diabetes mellitus, type II, is granted. Also, service connection for left lower extremity diabetic neuropathy, diagnosed as sensory-motor polyneuropathy, is granted. Further, service connection for right lower extremity diabetic neuropathy, diagnosed as sensory-motor polyneuropathy, is granted.

4. Service connection for Meniere's disease, to include as secondary to service-connected bilateral hearing loss, is granted.

The Veteran claims entitlement to service connection for Menier's disease.

At the outset, the Board notes that the Veteran is already service connected for bilateral hearing loss. See September 23, 2006, rating decision.

Also, the Veteran has been diagnosed with Meniere's disease. See private examination submitted in February 2021; April 2021 VA ear conditions examination; May 14, 2021, rating decision.

In the private examination submitted in February 2021, a private examiner explained that the Veteran had been under his care and opined that the Veteran's hearing loss was consistent with Meniere's disease; that is, they were related.

The Veteran also underwent an April 2021 VA ear conditions examination. The VA examiner opined that the Veteran's claimed disability was less likely than not
the Board notes that the Veteran is already service connected for bilateral hearing loss. See September 23, 2006, rating decision.

Also, the Veteran has been diagnosed with Meniere's disease. See private examination submitted in February 2021; April 2021 VA ear conditions examination; May 14, 2021, rating decision.

The Veteran also underwent an April 2021 VA ear conditions examination. The VA examiner opined that the Veteran's claimed disability was less likely than not proximately due to or the result of the Veteran's service-connected disability. As support for the opinion, the VA examiner explained that there was no medical evidence that the Veteran's Meniere's disease was due to or the result of or permanently aggravated by the Veteran's service-connected bilateral hearing loss. The Veteran had multiple risk factors for the development of Meniere's disease such as HTN, DM, hearing loss, tinnitus, allergies/asthma, post military MVA and exposure to Methylethylketone. As such, it was not likely that the Veteran's Meniere's disease was due to a single risk factor and more likely that it was due to his multiple risk factors.

After careful consideration, the Board finds the April 2021 VA ear conditions examination of low probative value as to the nature and etiology of the Veteran's claimed disability. Particularly, the VA examiner used a more stringent standard, that is, one seemingly based on causality, rather than the applicable "approximate balance" standard, where the Veteran would be entitled to the benefit of the doubt when the evidence was approximately balanced, that is, nearly equal, if not higher. However, the VA examiner did concede that hearing loss was one of the multiple risk factors for the development of Meniere's disease. As such, the Board finds that the VA examiner essentially conceded the possibility that the Veteran's claimed Menier's disease could be related to his service-connected bilateral hearing loss. The private examination submitted in February 2021, which was rendered by the Veteran's treating physician, and which the Board considers highly probative as to the nature and etiology of the Veteran's claimed disability, is consistent with and supports the finding of the Board.

Accordingly, giving the Veteran the benefit of the doubt, entitlement to service connection for Meniere's disease, to include as secondary to service-connected bilateral hearing loss, is also warranted.

Michael J. Skaltsounis

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Aquino Ramos, Carlos M.

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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