DIABETES MELLITUS

Summary

The veteran, who served in the United States Army across multiple periods between December 1978 and August 2014, appeals the February 2025 rating decision denying service connection for diabetes mellitus. The veteran's claims are based on alleged toxic exposures in Southwest Asia, including fine particulate matter and burn pits in Afghanistan, and alternatively, on service-connected hypertension. The Board noted that diabetes is not a presumptive condition under the relevant regulations, and the veteran's service treatment records did not indicate any diagnoses, treatment, or complaints related to diabetes during service or within a year of separation. However, the Board found that a September 2014 VA pharmacy note indicated a link between the veteran's hypertension medication and an increased risk of diabetes. A January 2025 VA diabetes examination noted the diabetes diagnosis and prescribed medication, and also diagnosed diabetic peripheral neuropathy. The examiner opined that the diabetes was less likely than not due to toxic exposures, citing other risk factors, but identified the hypertension medication as a more likely cause. While the VA examination was considered flawed, the Board found the evidence regarding the link between hypertension medication and diabetes to be in equipoise. Applying the benefit of the doubt, the Board granted service connection for diabetes mellitus.

Rationale

Evidence in equipoise regarding diabetes causation by hypertension medication; Benefit of the doubt applied to grant service connection; No evidence of diabetes in service treatment records

Full Decision Text

Citation Nr: A26039980
Decision Date: 04/29/26	Archive Date: 04/29/26

DOCKET NO. 260115-612375
DATE: April 29, 2026

ORDER

Service connection for diabetes mellitus type II (diabetes) is granted.

FINDING OF FACT

Currently diagnosed diabetes is caused by service connected hypertension.

CONCLUSION OF LAW

The criteria for service connection for diabetes have been met. 38 U.S.C. §§ 1110, 1112, 1113, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Army from December 1978 to May 1982, June 2010 to June 2011, August 2012 to June 2013, and August 2013 to August 2014. He was also a member of the National Guard. This matter is before the Board of Veterans' Appeal (Board) on appeal from a February 2025 rating decision of the agency of original jurisdiction (AOJ) of the United States Department of Veterans Affairs (VA).

In January 2026, the Veteran submitted a timely VA Form 10182 (Decision Review Request: Board Appeal (Notice of Disagreement) (NOD)). The Veteran selected the Direct Review docket; the Board may only review evidence of record at the time of the February 2025 decision. 38 C.F.R. § 20.301. No additional evidence was submitted.

Service connection will be granted if it is shown that the veteran suffers from a disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty, during active military service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303.  Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d); see also Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994).

In order to establish service connection on a direct basis, the record must contain competent evidence of: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

A disability which is proximately due to, or the result of, a service-connected disease or injury shall be service connected. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. 38 C.F.R. § 3.310.  

Some chronic diseases may be presumed to have been incurred in service, including diabetes, if they become manifest to a degree of ten percent or more within the applicable presumptive period. 38 U.S.C. §§ 1101(3), 1112(a); 38 C.F.R. §§ 3.307(a), 3.309(a). For those listed chronic conditions, a showing of continuity of symptoms affords an alternative route to service connection. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). The applicable presumptive period is one year from separation.

With specific regard to National Guard service, the presumptions of soundness, aggravation, and service connection for chronic diseases do not apply to claimants, even those with Veteran status from prior periods of service, for claims based on periods of ACDUTRA. 38 U.S.C. §§ 101 (24), 1137; Smith v. Shinseki, 24 Vet. App. 40 (2010).

The Veteran contends that his currently diagnosed diabetes is related to his established toxic exposures while serving in Southwest Asia, or alternatively his service connected hypertension. The Veteran's established exposures include fine particulate matter and burn pits in Afghanistan. However, diabetes is not one of the presumptive conditions, so the presumption does not apply. 38 C.F.R. § 3.320.

VA medical records reflect a diagnosis of diabetes and use of oral medications for control. It is unclear when the Veteran was first diagnosed with diabetes, though
 for claims based on periods of ACDUTRA. 38 U.S.C. §§ 101 (24), 1137; Smith v. Shinseki, 24 Vet. App. 40 (2010).

The Veteran contends that his currently diagnosed diabetes is related to his established toxic exposures while serving in Southwest Asia, or alternatively his service connected hypertension. The Veteran's established exposures include fine particulate matter and burn pits in Afghanistan. However, diabetes is not one of the presumptive conditions, so the presumption does not apply. 38 C.F.R. § 3.320.

VA medical records reflect a diagnosis of diabetes and use of oral medications for control. It is unclear when the Veteran was first diagnosed with diabetes, though records indicate early 2024.

The Veteran's service treatment records (STRs) do not contain any diagnoses, treatment, or complaints related to diabetes. Indeed, a September 2014 record states the Veteran has no diabetes or endocrine disorders. VA medical records confirm the Veteran did not have any diagnoses, treatment, or complaints related to diabetes within a year of his August 2014 post-separation from active duty, which is the last year for which the presumption of service connection for a chronic disease is applicable. 

A September 2014 VA pharmacy note states that the Veteran's hypertension medication was being changed to Lipitor, and the Veteran should be counseled that Lipitor is associated with an increased risk of increasing blood glucose concentrations and diabetes.

In a January 2025 VA diabetes examination, the examiner noted the Veteran had been diagnosed with diabetes, which was managed by a restricted diet and prescribed oral hypoglycemic. The examiner also noted the Veteran had diabetic peripheral neuropathy. When issuing their opinion on whether the Veteran's diabetes and neuropathy was related to service, including his established toxic exposures, the examiner opined that it was less likely than not that his diabetes was due to his toxic exposures because his other risk factors outside military service "far outweigh" such factors. The examiner specifically identified the Veteran's medication for hypertension as the more likely cause of his diabetes, citing to an article on the side effects of hypertension medication. The examiner also gave a positive opinion as to the Veteran's lower and upper neuropathy, but contributed his neuropathy to pain in his limbs in service and did not address their earlier diagnoses of neuropathy as secondary to diabetes. 

While there is no evidence of neuropathy pain while the Veteran was on active duty service, the January 2025 rating decision did grant service connection for upper and lower diabetic neuropathy, even though it denied service connection for diabetes.

While the January 2025 VA medical opinion is flawed, it does cite to an article that supports the earlier counseling the Veteran received in September 2014 about his hypertension medication being linked to diabetes. Thus, the Board finds that the evidence is at least in equipoise regarding whether the Veteran's diabetes was caused by service-connected hypertension. The Board will give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Service connection for diabetes is warranted.

 

 

WILLIAM H. DONNELLY

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	L.M. Barletta

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.