DIABETES MELLITUS

LESLEY A. REIN · 2026 · Case ID: A26040483

MIXED

Summary

The Veteran served in the United States Marine Corps from November 1968 to June 1971. The Veteran appeals the denial of service connection for diabetes mellitus type II (DMII) and the remand of service connection for bilateral varicose veins. Regarding DMII, the Veteran claimed a link to contaminated water exposure at Camp Lejeune, which was conceded by the RO as a toxic exposure risk activity (TERA). However, DMII is not a presumptive condition under Camp Lejeune regulations. The Veteran's service treatment records showed no in-service complaints or treatment for DMII. While private and VA treatment notes documented a diabetes diagnosis in 2019 and subsequent uncontrolled diabetes, the Board found the June 2025 VA medical opinion to be the most probative. This opinion concluded DMII was less likely than not caused by TERA, citing morbid obesity as the likely cause and noting a lack of scientific evidence linking DMII to TERA. The Board found the April 2024 VA opinion inadequate due to conclusory findings and lack of individual analysis. The Board denied DMII, finding the evidence weighed against the claim and the benefit-of-the-doubt rule inapplicable. For bilateral varicose veins, the Veteran claimed service connection. Service treatment records were absent of any related complaints or treatment. However, treatment notes from 2006-2007 indicated varicose veins, possible links to Vasotec, and antihypertensive medication use. The Board found the VA medical opinions inadequate because they were conclusory, failed to address individual circumstances, and did not fully account for potential medication links or the Veteran's lay statements. The case is remanded for a new VA examination to determine the nature and etiology of the varicose veins, specifically addressing medication links and continuity of symptoms.

Rationale

No in-service complaints or diagnosis in STRs; DMII not presumptive for Camp Lejeune TERA; June 2025 VA opinion found DMII less likely than not caused by TERA; Morbid obesity assessed as likely cause of DMII

Service Branch

MARINE CORPS

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250806-573685

Full Decision Text

Citation Nr: A26040483
Decision Date: 04/30/26 Archive Date: 04/30/26

DOCKET NO. 250806-573685
DATE: April 30, 2026

ORDER

Entitlement to service connection for diabetes mellitus type II (DMII) is denied.

REMANDED

Entitlement to service connection for bilateral varicose veins is remanded.

FINDING OF FACT

The Veteran's DMII did not have its onset during his active service and is not otherwise etiologically related to such service, to include exposure to contaminated water while at Camp LeJeune, nor was it present to a compensable degree within a year of the Veteran's separation from active service.

CONCLUSION OF LAW

The criteria for service connection for DMII have not been met. 38 U.S.C. §§ 1110, 1137, 5107 (2024); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2025).

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran had active service in the United States Marine Corps from November 1968 to June 1971.

This case comes before the Board of Veterans' Appeals (Board) on appeal of a June 2025 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO).

In the August 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on January 12, 2026. A transcript of that hearing is of record in the claims file. Therefore, the Board may only consider the evidence of record at the time of the June 2025 agency of original jurisdiction (AOJ) decision on appeal, 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). 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 is in its decision. 38 C.F.R. 20.300, 20.302(a), 20.801.

The Board acknowledges that the undersigned did not preside over the January 2026 Board hearing; however, under the modernized review system, the Veterans Law Judge who conducts a Board hearing is not required to decide the appeal. 38 U.S.C. § 7107(c); Frantzis v. McDonough, 35 Vet. App. 354 (2022).

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.

However, because the Board is remanding the claim of entitlement to service connection for bilateral varicose veins, any evidence the Board could not consider will be considered by the AOJ in the adjudication of that claim. 38 C.F.R. § 3.103(c)(2)(ii).

Service Connection - DMII

The Veteran asserts that his DMII is related to exposure to contaminated water at Camp Lejeune.

The Board initially notes that the evidence of record reveals that the Veteran served at Camp Lejeune from January 1969 to May 1969 (i.e., greater than 30 days). The Board also notes that the Veteran's June 2025 rating decision noted the AOJ's favorable finding that the Veteran's participation in a toxic exposure risk activity (TERA) was conceded. The Board is bound by that favorable finding. 38 C.F.R. § 3.104(c). However, diabetes is not listed among the diseases presumed to be associated with the contaminated water at Camp Lejeune. As such, presumptive service connection is not applicable in this case. 38 C.F.R. § 3.309(f).

Nonetheless, unavailability of presumptive service connection does not preclude a veteran from establishing proof of direct causation. See Stefl v. Nicholson, 21 Vet. App. 120 (2007); see also Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994) (stating that the
) was conceded. The Board is bound by that favorable finding. 38 C.F.R. § 3.104(c). However, diabetes is not listed among the diseases presumed to be associated with the contaminated water at Camp Lejeune. As such, presumptive service connection is not applicable in this case. 38 C.F.R. § 3.309(f).

The Veteran's service treatment records (STRs) reveal no complaints of, treatment for, or diagnosis of DMII or any resultant symptoms thereof.

An April 2019 treatment note revealed that the Veteran's lab results were consistent with diabetes.

An April 2020 treatment note revealed that the Veteran was assessed to have a new onset of uncontrolled diabetes and diabetic ketoacidosis.

During a July 2022 VA examination, the Veteran reported that he had been consuming a 750 milliliter bottle, or more, of liquor daily but that he stopped drinking alcohol when he was diagnosed with diabetes.

During an April 2024 VA examination, the VA examiner reported that the Veteran had a diagnosis of DMII since 2019. However, in a May 2024 VA opinion, the examiner opined that the Veteran's DMII was less likely caused by his indicated TERA. At that time, the VA examiner failed to provide a specific rationale for the conclusion reached. The VA examiner did provide a significant amount of information related to the development of diabetes, both type I and type II.

During a June 2025 VA examination, a VA examiner assessed that the Veteran had a diagnosis of DMII. At that time, the VA examiner opined that the Veteran's DMII was less likely than not caused by his indicated TERAs. The VA examiner noted that an ILER was not available in the current claims file to support other toxic or environmental exposures. The VA examiner also reasoned that there was no medical or scientific evidence available that provided any indication of a causal relationship between the development of DMII and the Veteran's TERA. The VA examiner also assessed that morbid obesity was the likely cause of the Veteran's DMII and noted that a May 2023 primary care provider (PCP) note documented that the Veteran had a diagnosis of morbid obesity.

The Board initially finds that the April 2024 VA medical opinion is inadequate for adjudication purposes. In this regard, the VA examiner's opinion was conclusory as they failed to provide sufficient underlying rationale related to why the Veteran's DMII was not linked to his TERA. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21. Vet. App. 120 (2007). The Board also finds that the examiner's medical opinion was solely based on general medical literature without a discussion of the Veteran's individual circumstances. See Bailey v. O-Rourke, 30 Vet. App. 54, 60 (2018).

In contrast, the Board finds that the June 2025 VA medical opinion is the most probative evidence of record. In this regard, the VA examiner reviewed the evidence of record, to include evidence in the Veteran's STRs, and supported their conclusion with relevant medical evidence, both general and specific to the Veteran. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008).

Accordingly, the Board finds that the benefit-of-the-doubt rule is not applicable as the evidence weighs persuasively against the claim and is not in approximate balance. Therefore, entitlement to service connection for DMII is not warranted. 38 U.S.C. § 5107(b) (2018); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

REASONS FOR REMAND

Service Connection - Bilateral Varicose Veins

The Veteran asserts that his bilateral varicose veins are the result of his active service.

The Veteran's STRs are absent of any complaint of, treatment for, or diagnosis of varicose veins or any resultant symptoms thereof.

A July 2006 treatment note revealed that the Veteran had a repair of a varicose vein in the left leg. At that time, the treatment note also documented that it was thought that Vasotec caused the Veteran's varicose vein.

An August 2006 treatment note documented
2018); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

REASONS FOR REMAND

Service Connection - Bilateral Varicose Veins

The Veteran asserts that his bilateral varicose veins are the result of his active service.

The Veteran's STRs are absent of any complaint of, treatment for, or diagnosis of varicose veins or any resultant symptoms thereof.

An August 2006 treatment note documented that the Veteran was started on antihypertensive medications due to lower extremity edema and varicose vein rupture.

A January 2007 treatment note documented that the Veteran had superficial varicose veins in the lower extremities bilaterally.

A January 2007 treatment note documented the Veteran's complaint that he had varicose veins for four years.

During an April 2024 VA examination, the Veteran reported that the onset of his varicose veins was in 1980 and that they started to develop for no apparent reason. At that time, the VA examiner reported that the Veteran had a diagnosis of varicose veins from July 2006. In a May 2024 VA opinion, the VA examiner opined that the Veteran's varicose veins were less likely than not caused by his indicated TERA. The VA examiner noted the causes and main risk factors for varicose veins.

During a June 2025 VA examination, the VA examiner reported that the Veteran had a diagnosis of varicose veins. At that time, the VA examiner opined that the Veteran's varicose veins were less likely caused by his indicated TERA. The VA examiner noted the risk factors for varicose veins and assessed that obesity was the likely cause of the Veteran's varicose veins.

In this case, the Board finds that the VA medical opinions of record are inadequate for adjudication purposes. In this regard, the May 2024 VA examiner's opinion was conclusory and merely listed general risk factors for the development of varicose veins without linking any of those risk factors to the Veteran. As indicated above, a medical opinion based solely on general medical literature without discussion of the Veteran's individual circumstances is inadequate. Bailey v. O'Rourke, 30 Vet. App. 54, 60 (2018); see also Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Additionally, the June 2025 VA examiner only accounted for the Veteran's obesity as the cause of his varicose veins without addressing the additional objective medical evidence that showed specific medications as a potential cause of his varicose veins. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008).

Based on the above, the Board finds that the AOJ's failure to obtain an adequate medical opinion constitutes a pre-decisional duty to assist error that warrants a remand for corrective action. See 38 C.F.R. § 20.802(a); see also Barr v. Nicholson, 21 Vet. App. 303 (2007).

The matters are REMANDED for the following action:

Forward the claims file to an examiner with sufficient expertise to determine the nature and etiology of the Veteran's claimed varicose veins. The claims file must be made available to and reviewed by the examiner.

Based on a thorough review of the record, the examiner must provide an opinion as to whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's varicose veins had their onset during his active service or are otherwise etiologically related to such service.

In forming this opinion, the examiner must specifically address the medical evidence from 2006 which indicated a possible relation between Vasotec and the Veteran's varicose veins as well as the Veteran's use of antihypertensive medication due to varicose vein rupture. Additionally, the examiner must specifically address the Veteran's lay statements related to the onset and continuity of his claimed varicose veins.

LESLEY A. REIN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board A. Randall

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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