DIABETES MELLITUS

Summary

The veteran, who served from September 1988 to June 1990, appeals the denial of service connection for diabetes mellitus. The veteran has a current diagnosis of diabetes mellitus, noted in a July 2020 VA medical record, but his service treatment records contain no complaints or treatment for this condition, and he reported no diabetes during service. The earliest mention of diabetes in the record is from June 2019, with no medical opinion linking it to his military service. The Board found no evidence of diabetes onset within one year of separation or any presumptive basis for service connection. The veteran argued for secondary service connection, claiming his diabetes arose secondary to obesity, which was in turn caused or aggravated by his service-connected conditions (depression, anxiety, lumbosacral strain, radiculopathy, hearing loss, tinnitus). He testified that his service-connected pain made it difficult to exercise and maintain a proper diet. However, the Board found that no medical professional had linked his obesity to a service-connected disability or opined that his diabetes would not have occurred but for service-connected obesity. The Board found the veteran's lay testimony insufficient to establish this complex medical nexus. The Board also noted that the secondary theory was raised after the RO decision, precluding a remand for duty to assist error. The evidence was found persuasively against the claim, and the benefit-of-the-doubt doctrine was not applicable. Service connection for diabetes mellitus is denied.

Rationale

No in-service complaints or treatment for diabetes.; No presumptive basis for service connection.; No medical opinion linking diabetes to service.; Lay testimony insufficient to establish secondary connection via obesity.

Full Decision Text

Citation Nr: A26040263
Decision Date: 04/29/26	Archive Date: 04/29/26

DOCKET NO. 200731-100097
DATE: April 29, 2026

ORDER

Entitlement to service connection for diabetes mellitus is denied.

FINDING OF FACT

The Veteran's diabetes mellitus did not manifest during service or to a compensable degree within one year of separation from service, and the evidence weighs persuasively against finding that the Veteran has diabetes mellitus that was caused or aggravated by service or a service-connected disability, to include as caused or aggravated by obesity that was caused or aggravated by a service-connected disability.

CONCLUSION OF LAW

The criteria for entitlement to service connection for diabetes mellitus have not been met.  38 U.S.C. §§ 1110, 1112, 1113, 1131, 1168, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310, 3.317.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from September 1988 to June 1990.  This matter comes before the Board on appeal from a July 2020 Regional Office (RO) rating decision.  The Veteran was notified of this decision in a letter dated July 13, 2020.

In July 2020, the Veteran submitted a VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), on which he listed the issue that is currently on appeal.  He requested that his case be placed on the Hearing Docket.  On June 17, 2024, the Veteran testified at a hearing before a Veterans Law Judge. 

The Board may only consider the evidence of record at the time of the notification letter of the appealed rating decision, as well as any evidence submitted by the Veteran or his representative at the hearing or within 90 days following the hearing.  38 C.F.R. § 20.302(a).  

Thus, the Board may only consider the evidence of record at the time of the July 13, 2020, rating decision notification letter, as well as evidence submitted at the time of the June 17, 2024, Board hearing through September 16, 2024.  If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision.  38 C.F.R. §§ 20.300, 20.302(a), 20.801.

1. Entitlement to service connection for diabetes mellitus ia denied.

Service connection is warranted where the evidence of record establishes that an injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby.  38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a).

Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service.  38 C.F.R. § 3.303(d).

To establish a right to compensation for a present disability, a veteran must show (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, or nexus, 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).

Service connection may also be granted for listed chronic diseases, such as diabetes mellitus, if such were shown as chronic in service; manifested to a compensable degree within a presumptive period (usually one year) after separation from service; or were noted in service with continuity of symptomatology since service.  38 U.S.C. §§ 1112, 1113; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013); 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a).  

A disability that is proximately due to, or results from, a service-connected disease or injury shall be considered a part of the original condition.  38 C.F.R. § 3.310(a).  Secondary service connection on the basis of aggravation is permitted.  38 C.F.R. § 3.310
 from service; or were noted in service with continuity of symptomatology since service.  38 U.S.C. §§ 1112, 1113; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013); 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a).  

A disability that is proximately due to, or results from, a service-connected disease or injury shall be considered a part of the original condition.  38 C.F.R. § 3.310(a).  Secondary service connection on the basis of aggravation is permitted.  38 C.F.R. § 3.310(b).  Compensation is payable for that degree of aggravation of a non-service-connected disability caused by a service-connected disability.  Allen v. Brown, 7 Vet. App. 439 (1995).

Obesity may serve as an intermediate step when considering secondary service connection under 38 C.F.R. § 3.310.  See VAOPGCPREC 1-2017.  In Walsh v. Wilkie, 32 Vet. App. 300, 307 (2020), the United States Court of Appeals for Veterans Claims (Court) held that proper interpretation of G.C. Prec. Op. 1-2017 requires consideration of both proximate causation and aggravation in its analytical framework: (1) whether the service-connected disability caused the veteran to become obese/aggravated the veteran's obesity; (2) if so, whether the obesity/aggravation of obesity as a result of the service-connected disability was a substantial factor in causing/aggravating the current disability; and (3) whether the current disability would not have occurred but for obesity caused/aggravated by the service-connected disability.  

The Veteran has claimed entitlement to service connection for diabetes mellitus.  The July 2020 rating decision contains the favorable finding that he has been diagnosed with a current disability, noting that "A review of your VA Medical Center treatment reports show you were diagnosed with diabetes mellitus on June 10, 2019."  

The Veteran's service treatment records contain no complaints of or treatment for diabetes mellitus, and the Veteran himself reported at his Board hearing that he did not have diabetes in service.  (See Board hearing transcript, page 3.)

The record does not demonstrate an onset of diabetes within one year of the Veteran's separation from service, or for many years thereafter.

A July 2013 VA medical record notes that the Veteran "has been identified as 'at risk' for obesity related conditions.  Patient was educated on health risks of obesity such as coronary heart disease, high blood pressure, stroke, dyslipidemia, diabetes, gallstones, sleep apnea, osteoarthritis and some types of cancer."  

A November 2013 VA medical record notes that the Veteran is not diabetic.

The earliest mention of diabetes mellitus of record appears in a June 2019 VA medical record, which notes that the Veteran was prescribed Metformin "for diabetes."  There is no medical opinion of record linking the Veteran's diabetes directly to his military service, and there is no suggestion of such a relationship.  

In light of the above, the Board finds that entitlement to service connection for diabetes mellitus must be denied on a direct basis.

In the absence of evidence of diabetes mellitus within one year of the Veteran's separation from service, service connection on a presumptive basis based on a chronic disability is not warranted.

Rather, the Veteran contends that his diabetes mellitus arose secondary to his service-connected disabilities with obesity as an intermediate step.  Service connection is in effect for depression and anxiety; lumbosacral strain with degenerative arthritis; radiculopathy of the left lower extremity; radiculopathy of the right lower extremity; bilateral hearing loss; and tinnitus.  He agreed with his representative that "these conditions make it difficult to remain active or physically conditioned."  He also agreed that "going to the gym and going to go work out is not really a viable option" and that "maintaining a routine of eating and proper diet is difficult because you're in pain."  (See Board hearing transcript, page 4.)  He reported that he currently weighs much more than he did during service.  (See Board hearing transcript, pages 5-6.)  

With respect to the cause of his diabetes, he testified that "what my doctor told me was, she said it could be the food that I was eating.  Well, that's, that's all I, I was told."  (See Board hearing transcript, page 5.)  

As noted above, obesity may serve as an intermediate step when considering secondary service connection under 38 C.F.R. § 3.310
 viable option" and that "maintaining a routine of eating and proper diet is difficult because you're in pain."  (See Board hearing transcript, page 4.)  He reported that he currently weighs much more than he did during service.  (See Board hearing transcript, pages 5-6.)  

With respect to the cause of his diabetes, he testified that "what my doctor told me was, she said it could be the food that I was eating.  Well, that's, that's all I, I was told."  (See Board hearing transcript, page 5.)  

As noted above, obesity may serve as an intermediate step when considering secondary service connection under 38 C.F.R. § 3.310.  See VAOPGCPREC 1-2017.  The Veteran has been informed that he is at risk for obesity related conditions, such as diabetes mellitus.  However, no medical professional has linked the Veteran's obesity to a service-connected disability or disabilities, based either on causation or aggravation.  Nor has a competent medical professional asserted that the Veteran's obesity was a substantial factor in causing or aggravating the Veteran's diabetes.  Finally, no competent medical professional has opined that his diabetes would not have occurred but for obesity that was caused or aggravated by a service-connected disability.  

The only opinion on this matter comes from the Veteran himself.  The Board recognizes that there are instances in which a layperson may be competent to offer testimony on medical matters, such as describing symptoms observable to the naked eye or even diagnosing simple conditions.  See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).  The Board finds, however, that the questions posed by this claim are of such complexity as to require that individuals who provide competent medical evidence on this matter possess a level of expertise that a layperson simply does not possess.  The Board therefore cannot accept the Veteran's own lay testimony that he is obese due to his service-connected disabilities and, that the obesity caused or aggravated his diabetes.  

The Board notes that the Veteran's accredited representative believes "There is a potential duty to assist error.  I don't think they ever looked at it as a secondary condition."  The Board notes that it may only remand to correct pre-decisional errors in the duty to assist.  See 38 C.F.R. § 20.802(a).  This secondary theory of entitlement was first raised at the Veteran's Board hearing, after the issuance of the rating decision on appeal.  Thus, the Board cannot remand based on evidence or argument that was initially presented after the July 13, 2020, rating decision notification letter, to include during the June 2024 Board hearing.  

In short, there is no medical evidence linking the Veteran's service connected disabilities to his obesity; identifying obesity as a substantial factor in causing or aggravating his diabetes; and asserting that the Veteran's diabetes would not have occurred but for the obesity caused or aggravated by his service-connected disabilities.  Therefore, the criteria for entitlement to service connection for diabetes on a secondary basis, with obesity as an intermediate step, have not been met.

Accordingly, the evidence is persuasively against the claim.  As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable, and the claim must be denied.  See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

 

 

TANYA SMITH

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Elizabeth Jalley, Counsel

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.