DIABETES MELLITUS

M. HYLAND · 2026 · Case ID: A26039607

MIXED

Summary

The veteran served from April 1984 to November 1989. The veteran appealed the denial of service connection for diabetes mellitus (DM), an acquired psychiatric disorder claimed as PTSD, obstructive sleep apnea (OSA), headaches, an old myocardial infarction, and stable angina. The Board granted service connection for DM as secondary to service-connected hypertension, finding that the evidence established it was at least as likely as not that DM resulted from hypertension, citing the American Diabetes Association's emphasis on hypertension as a risk factor. The Board remanded the claims for PTSD, OSA, and headaches, noting that the VA's duty to assist was not met as the record contained signs and symptoms but lacked adequate examinations and nexus opinions. Specifically, for OSA, the VA referred the veteran for a sleep study but there was no indication it occurred. For PTSD, the veteran claimed it due to combat stress, but the VA only noted anxiety in treatment records. For headaches, the veteran reported migraines. The Board also remanded the claims for myocardial infarction and stable angina, finding the January 2025 VA examination inadequate. The examiner's opinion was unclear, appearing to dismiss the veteran's lay statements about cardiac symptoms due to a lack of contemporaneous treatment records and using ambiguous language regarding the nexus to service. The Board emphasized that lay statements cannot be dismissed solely for lack of contemporaneous records.

Rationale

Granted as secondary to service-connected hypertension; At least as likely as not that DM is a result of hypertension; Hypertension is a significant risk factor for diabetes

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250312-536254

Full Decision Text

Citation Nr: A26039607
Decision Date: 04/28/26 Archive Date: 04/28/26

DOCKET NO. 250312-536254
DATE: April 28, 2026

ORDER

Entitlement to service connection for diabetes mellitus II (DM) is granted, as secondary to service-connected hypertension.

REMANDED

Entitlement to service connection for an acquired psychiatric disorder, claimed as posttraumatic stress disorder (PTSD) is remanded.

Entitlement to service connection for obstructive sleep apnea (OSA) is remanded.

Entitlement to service connection for headaches is remanded.

Entitlement to service connection for an old myocardial infarction is remanded.

Entitlement to service connection for stable angina is remanded.

FINDING OF FACT

The evidence establishes that it is at least as likely as not that the Veteran's DM is a result of his service-connected hypertension.

CONCLUSION OF LAW

The criteria for service connection for DM as secondary to service-connected hypertension have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from April 1984 to November 1989.

In the March 12, 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. Therefore, as to the claims of entitlement to service connection for an acquired psychiatric disorder, OSA, and headaches, the Board may only consider the evidence of record at the time of the December 2024 rating decision on appeal. 38 C.F.R. § 20.301. If evidence was submitted after the Agency of Original Jurisdiction (AOJ) issued the December 2024 rating decision, the Board did not consider it in its decision as to the claims for an acquired psychiatric disorder, OSA, and headaches. 38 C.F.R. §§ 20.300, 20.301, 20.801.

As to the claims of entitlement to service connection for DM, an old myocardial infarction, and angina, the Board may only consider the evidence of record at the time of the March 2025 rating decision on appeal. 38 C.F.R. § 20.301. If evidence was submitted after the AOJ issued the March 2025 rating decision, the Board did not consider it in its decision as to the claims for DM, an old myocardial infarction, and angina. 38 C.F.R. §§ 20.300, 20.301, 20.801.

As to the claim of entitlement to service connection for DM, 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.

As to the claims of entitlement to service connection for an acquired psychiatric disorder, OSA, headaches, an old myocardial infarction, and angina, because the Board is remanding these claims, any evidence the Board could not consider will be considered by the AOJ in the adjudication of these claims. 38 C.F.R. § 3.103(c)(2)(ii).

The Board notes that the March 12, 2025 VA Form 10182 reflects that the Veteran wished to appeal the AOJ's deferral of a decision regarding compensation for hypertension in a December 2, 2024 rating decision. However, the Board finds that this was not a final appealable decision.

The Board also notes that, in the March 12, 2025 VA Form 10182, the Veteran stated that he wished to appeal the December 27, 2024 AOJ decision granting service connection for hypertension and assigning an initial rating. However, in a February 18, 2025 VA Form 10182, the Veteran already appealed the December 27, 2024 AOJ decision as to (1) the rating assigned to his service-connected hypertension and (2) the effective date assigned for service connection for hypertension. Accordingly, these issues were addressed in a separate appeal to the Board.

Finally, the Board notes that the March 12, 2025 VA Form 10182 reflects that the Veteran wished
The Board also notes that, in the March 12, 2025 VA Form 10182, the Veteran stated that he wished to appeal the December 27, 2024 AOJ decision granting service connection for hypertension and assigning an initial rating. However, in a February 18, 2025 VA Form 10182, the Veteran already appealed the December 27, 2024 AOJ decision as to (1) the rating assigned to his service-connected hypertension and (2) the effective date assigned for service connection for hypertension. Accordingly, these issues were addressed in a separate appeal to the Board.

Finally, the Board notes that the March 12, 2025 VA Form 10182 reflects that the Veteran wished to appeal the AOJ's deferral of a decision for compensation for angina, diabetes, and a heart attack in the December 27, 2024 rating decision. The Board finds that the deferral of a decision for compensation is not a final appealable decision. However, reading the March 12, 2025 VA Form 10182 in the light most favorable to the Veteran, the Board finds that the Veteran appealed the March 11, 2025 AOJ decision denying service connection for angina, diabetes, and a heart attack. Accordingly, the Board will address these issues in this appeal.

Entitlement to service connection for DM is granted, as secondary to service-connected hypertension.

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

Establishing service connection generally requires evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Service connection may also be granted when a claimed disability is found to be due to or the result of a service-connected disability, or when any increase in severity (aggravation) of a nonservice-connected disease or injury is found to be due to or the result of a service-connected disability. 38 C.F.R. § 3.310.

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

A VA diabetes mellitus examination was obtained in January 2025. In this regard, the VA examiner provided a negative nexus opinion, stating that it was less likely than not that the Veteran's DM was due to or the result of his myocardial infarction. In providing this negative nexus opinion, the examiner stated that established risk factors for the development of DM include genetic predisposition, obesity, aging, hypertension, dyslipidemia, and sedentary lifestyle. The examiner went on to emphasize that The American Diabetes Association highlights that hypertension is a significant risk factor for the development of diabetes.

Reading this VA opinion in the light most favorable to the Veteran, the Board finds that the evidence establishes that it is at least as likely as not that the Veteran's DM is a result of his service-connected hypertension. Accordingly, service connection for diabetes mellitus is warranted.

REASONS FOR REMAND

1. Entitlement to service connection for an acquired psychiatric disorder, claimed as PTSD, is remanded.

2. Entitlement to service connection for OSA is remanded.

3. Entitlement to service connection for headaches is remanded.

As an initial matter, the Board finds that, although the Veteran filed a claim of entitlement to service connection for PTSD, because his treatment records reflect that he was seen for complaints of anxiety, the issue on appeal has been recharacterized as reflected above. Clemons v. Shinseki, 23 Vet. App. 1 (2009).

The duty to assist requires VA to provide an examination when the record contains competent evidence that the claimant has a current disability or signs and symptoms of a current disability, the record indicates that the disability or signs and symptoms of disability may be associated with military service, and the record does not contain sufficient information to make a decision on the claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4); see also McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006).

The Veteran has asserted that he has OSA, acquired psychiatric disorder, and headaches which are related to his time in service.
1 (2009).

The Veteran has asserted that he has OSA, acquired psychiatric disorder, and headaches which are related to his time in service. Specifically, the Veteran asserted that his OSA and headaches are due to the stress and hardship he experienced due to his time in service. In addition, the Veteran asserted PTSD due to feared hostile military or terrorist activity.

The Veteran's VA treatment records reflect that he had suspected OSA and was referred to the Community Choice program for a sleep study. Community Choice records reflect that the Veteran was to be scheduled for a sleep study, but there is no indication that the sleep study occurred or that the Veteran was diagnosed with OSA. However, the treatment records reflect signs and symptoms of OSA. As to the Veteran's claim for an acquired psychiatric disorder, as stated above, his VA treatment records reflect that he was seen for anxiety. Finally, as to the Veteran's claim of entitlement to service connection for headaches, the Veteran stated on his claim for entitlement to service connection that he would get migraines that caused him to get dizzy and need to be in the dark.

Based on the above, the Board finds that the record is sufficient to trigger VA's duty to assist by providing examinations and obtaining etiology opinions regarding the Veteran's claims for OSA, an acquired psychiatric disorder, and headaches, but no such examinations and opinions were obtained. As such, remand is warranted to obtain VA opinions to comply with VA's duty to assist.

4. Entitlement to service connection for an old myocardial infarction is remanded.

5. Entitlement to service connection for stable angina is remanded.

Once VA undertakes the effort to provide an examination or opinion, it must provide an adequate one. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Failure to obtain an adequate examination constitutes a pre-decisional duty to assist error requiring a remand.

Here, a VA heart conditions examination was obtained in January 2025 which reflects diagnoses of (1) acute, subacute, or old myocardial infarction, and (2) stable angina. The Veteran reported an onset of symptoms in 1990, specifically stating that, after separating from service, he injured his hand, underwent surgery, and was told that he had a heart murmur. The examiner provided a negative nexus opinion as to both diagnoses. First, the VA examiner opined that "without evidence of chronic diagnosis, chronic disability pattern or chronicity of care regarding [the] claimed heart attack (myocardial infarction) condition during military service it is not secure to say that the current diagnosis of old myocardial infarction is a condition which was incurred in or caused by military service." Second, the VA examiner opined that "without evidence of chronic diagnosis, chronic disability pattern or chronicity of care regarding [the] claimed Angina condition during military service it is not secure to say that the current diagnosis of Stable angina is a condition which was incurred in or caused by military service."

The Board finds the January 2025 VA heart conditions examination to be inadequate for the following reasons. First, the VA examiner appears to have impermissibly dismissed the Veteran's lay statements regarding cardiac symptomatology solely based on the lack of contemporaneous medical treatment records. Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006) (holding that "[w]hile the lack of contemporaneous medical records may be a fact that the Board can consider and weigh against a veteran's lay evidence, the lack of such records does not, in and of itself, render lay evidence not credible.")

Second, although the VA examiner states that it is less likely than not that the Veteran's old myocardial infarction and stable angina are due to his service, in providing a rationale, the VA examiner also stated that "it is not secure to say that the" Veteran's disabilities were incurred in or caused by military service. Thus, the Board finds that the opinion is unclear as to whether the proper standard to establish service connection was used by the examiner.

Because the Board finds the January 2025 VA heart condition examination to be inadequate, remand
may be a fact that the Board can consider and weigh against a veteran's lay evidence, the lack of such records does not, in and of itself, render lay evidence not credible.")

Because the Board finds the January 2025 VA heart condition examination to be inadequate, remand is warranted to obtain new opinions to comply with VA's duty to assist.

The matters are REMANDED for the following action:

1. Schedule the Veteran for an examination with a qualified clinician regarding his claims for service connection for obstructive sleep apnea and headaches.

After review of the claims file and examination of the Veteran the clinician should opine whether it is at least as likely as not (at least an approximate balance of the positive and negative evidence) that the disability began in or is otherwise caused by the Veteran's active service.

For the purposes of the opinion, the examiner should assume the Veteran's statements about his symptoms are credible, unless they are inconsistent with the medical evidence or with medical principles concerning his condition. The Board emphasizes that this does not constitute a positive credibility determination, as the Board will weigh the evidence if the appeal returns.

If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. In doing so, the examiner may identify any discrepancies, inconsistencies, or contradictions contained in the evidence of record, and may state whether or not the Veteran's lay statements are supported by medical or other evidence. The examiner may not dismiss the Veteran's statements about his symptoms solely because they are not documented in contemporaneous treatment records.

All findings must be reported in detail and all opinions must be accompanied by a clear rationale. If any of the above issues cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided.

2. Schedule the Veteran for an examination with a qualified clinician regarding his claim for service connection for an acquired psychiatric disorder.

After review of the claims file and examination of the Veteran the clinician should identify all acquired psychiatric disorders found at any point in time during the appeal period, even if now asymptomatic or resolved. For each acquired psychiatric disorder identified during the course of the appeal, even if now asymptomatic or resolved, the clinician should opine whether it is at least as likely as not (at least an approximate balance of the positive and negative evidence) that the disability began in or is otherwise caused by the Veteran's active service. If PTSD is diagnosed, the clinician must identify the stressor or stressors upon which the diagnosis is made.

3. Obtain an opinion from a qualified clinician regarding the Veteran's claims of entitlement to service connection for a myocardial infarction and angina. If the selected clinician determines that an examination is necessary to respond to this request, such examination should be scheduled.

After review of the claims file, and examination of the Veteran if deemed necessary, the clinician should opine whether it is at least as likely as not (at least an approximate balance of the positive and negative evidence) that the disability began in or is otherwise caused by the Veteran's active service.

M. HYLAND

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Elias, 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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