DIABETES MELLITUS

D. JOHNSON · 2026 · Case ID: A26040688

MIXED

Summary

The Veteran, an Air Force Veteran who served from January 1961 to December 1964, appeals the denial of service connection for tinnitus and the grant of service connection for diabetes mellitus, type II, left arm tremors, and right hand tremors. The Veteran claimed these conditions were due to in-service toxic exposure risk activity (TERA), specifically mentioning exposure to fuels, oils, cleaning solvents, and potentially Agent Orange and insecticides. The Board found the evidence persuasively favored service connection for diabetes and tremors. While VA examinations opined these conditions were less likely than not related to service, citing a lack of chronicity during service and a lack of nexus in medical literature, a private medical opinion from Dr. E. found it more likely than not that the Veteran's diabetes and tremors were due to TERA, citing extensive literature and providing a detailed rationale. The Board found Dr. E.'s opinion more persuasive due to its thoroughness and detailed discussion of scientific literature, leading to the grant of service connection for diabetes mellitus, type II, left arm tremors, and right hand tremors. For tinnitus, the Board denied service connection, finding the evidence weighed against the claim. While the Veteran reported intermittent tinnitus and noise exposure, VA examinations and opinions concluded the symptoms were transient ear noise, not recurrent tinnitus, and lacked functional impairment or a nexus to service or TERA. The Board found the VA examiners' opinions, which noted the absence of a tinnitus diagnosis and the transient nature of the symptoms, to be more probative than the Veteran's testimony or earlier less specific VA notes.

Rationale

Current diagnosis of diabetes mellitus, type II.; Private medical opinion found it more likely than not related to TERA.; Board found private opinion more persuasive than VA opinion.

Service Branch

AIR FORCE

Special Benefit

NO SPECIAL BENEFIT

Docket No.

260105-609541

Full Decision Text

Citation Nr: A26040688
Decision Date: 04/30/26 Archive Date: 04/30/26

DOCKET NO. 260105-609541
DATE: April 30, 2026

ORDER

Entitlement to service connection for diabetes mellitus, type II, is granted.

Entitlement to service connection for left arm tremors is granted.

Entitlement to service connection for right hand tremors is granted.

Entitlement to service connection for tinnitus is denied.

FINDINGS OF FACT

1. The most probative medical evidence shows the Veteran's diabetes mellitus, type II, and bilateral hand tremors are at least as likely as not related to in-service toxic exposure risk activities (TERA).

2. The competent and probative medical evidence persuasively weighs against a finding that the Veteran has had tinnitus at any time during the pendency or in close proximity to filing the service connection claim, to include symptoms that cause functional impairment of earning capacity.

CONCLUSIONS OF LAW

1. The criteria for service connection for diabetes mellitus, type II, are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for service connection for left arm tremors are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for service connection for right hand tremors are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

4. The criteria for entitlement to service connection for tinnitus have not been met. 38 U.S.C. §§ 1101, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Air Force from January 1961 to December 1964.

In an April 2024 decision, the Board remanded the issues for further development. In December 2024, the agency of original jurisdiction (AOJ) issued the supplemental claim decision on appeal, which again denied service connection for the issues of diabetes mellitus, left arm tremors, right hand tremors, and tinnitus.

In May 2025, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of a December 2024 decision. In May 2025, the agency of original jurisdiction (AOJ) issued the HLR decision on appeal, which considered the evidence of record at the time of the prior December 2024 decision. Therefore, the Board may only consider the evidence of record at the time of the December 2024 decision and any evidence submitted during an applicable evidentiary window.

In the January 5, 2026 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket.

Therefore, the Board may only consider the evidence of record at the time of the December 2024 agency of original jurisdiction (AOJ) decision, which was subsequently subject to higher-level review, as well as any evidence submitted by the Veteran or representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decision, which was subsequently subject to higher-level review and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801.

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 claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

Service Connection

1. Entitlement to service connection for diabetes mellitus, type II, is granted.

2. Entitlement to service
.R. §§ 20.300, 20.303, 20.801.

Service Connection

1. Entitlement to service connection for diabetes mellitus, type II, is granted.

2. Entitlement to service connection for left arm tremors is granted.

3. Entitlement to service connection for right hand tremors is granted.

The Veteran asserts that his diabetes, left arm tremors and right hand tremors are due to in-service toxic exposure risk activity (TERA). See September 2022 VA 21-4138 Statement in Support of Claim.

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004).

The Board concludes that the Veteran has current disabilities that are related to in-service TERA. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a).

In a June 2000 VA treatment record, the Veteran first complained of tremors. An October 2003 VA treatment record show the Veteran to have a diagnosis diabetes. June 2024 VA examinations show the Veteran has current diagnoses of diabetes and essential tremors. Thus, the question becomes whether the current disabilities are related to service. On this question there are probative opinions in favor of and against the claims.

In an October 2023 VA TERA memorandum, the document shows the Veteran to have experienced TERA as an aircraft mechanic with exposure to fuel and oils.

At the November 2023 Board hearing, the Veteran testified that he cleaned aircraft that may have been in Vietnam and there may have been Agent Orange on the aircrafts' surfaces. Board Hearing Transcript (T.) at 4. The Veteran also stated that at the airbase, he was exposed to an insecticide that was sprayed on the base. T. at 5. The Veteran stated that exposure to fuels, cleaning solvents, gasoline, smoke, and disease had the potential to cause his disabilities. T. at 9.

The evidence against the claim includes VA examinations and opinions finding that the Veteran's diabetes and tremors are not the result of service, to include in-service TERA.

On the June 2024 VA diabetes examination, the examiner indicated that the Veteran has a diagnosis of diabetes mellitus, type II. The examiner opined that it is less likely than not that the Veteran's diabetes is the result of service. The examiner reasoned that there is a lack of substantiating evidence supporting a nexus between the current diagnosis and service. The examiner stated that without chronicity during service or after service, a post-service evidence, illness, or injury is considered to be a more likely etiology. The examiner stated that the service treatment records are silent for diabetes issues, however post-service records contain extensive medical notes about diabetes management from early 2000s to current. There was no documentation of diabetes from separation in 1964 until the early 2000s.

The June 2024 VA diabetes examiner also opined that it is less likely than not that the Veteran's diabetes was caused by the indicated TERAs, after considering the total potential exposure through all appliable military deployments of the Veteran and the synergistic, combined effect of all TERAs of the Veteran. The examiner reasoned that the service treatment records are silent for diabetes. The examiner noted that the claims file contains TERA which documents fuels, oils, and cleaning solvents. The examiner acknowledged the Veteran's claimed exposure to agent orange via planes that came back from Vietnam and insecticide spray, however, the examiner found this speculative. The examiner stated that the medical research and literature does not support a nexus between the
the early 2000s.

On the June 2024 VA central nervous system examination, the examiner indicated that the Veteran has a diagnosis of essential tremor. The Veteran stated that the symptoms began in 2000. The Veteran stated that the symptoms began gradually and noted tremor in the bilateral hands, especially with writing. The Veteran stated he sought treatment and was diagnosed with essential tremor.

The June 2024 VA examiner opined that the Veteran's left arm tremors and right hand tremors were less likely than not the result of service. The examiner reasoned that there is a lack of substantiating evidence supporting a nexus between the current diagnosis of the right arm essential tremor and military service. Without chronicity during service or after service, a post-service event, illness, or injury is considered to be a more likely etiology. The examiner stated that the service treatment records were silent for tremor issues, however, treatment records after separation from service contain extensive medical notes about tremor management from early 2000s to current. The examiner found that the Veteran had no issues related to the claimed left arm tremor and right arm tremor conditions prior to military service and there was no documentation of tremors in service treatment records or the separation exam. Also, there was no documentation of tremors from separation in 1964 until the early 2000s. Therefore, the examiner concluded that neither nexus nor chronicity can be established.

The June 2024 VA examiner opined that the Veteran's left arm tremors and right hand tremors were less likely than not caused by the indicated TERAs, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all TERAs of the Veteran. The examiner reasoned that the Veteran's service treatment records are silent for tremor issues. After separation from service, the examiner found extensive medical notes about tremor management from the early 2000s to current. The claims file contains TERA which documents fuels, oils, and cleaning solvents. The examiner stated that there is no documentation of exposure to insecticide or agent orange. The examiner acknowledged that the Veteran claims exposure to agent orange via exposures to planes that came back from Vietnam and insecticide spray, however the examiner found this to be speculative. After review of medical research and literature, the examiner did not find support for a nexus between the Veteran's left arm essential tremor and right arm essential tremor and the combined effect of all TERAs documented in the claims file.

The evidence in favor of the claim includes private medical opinions that found the Veteran's diabetes and tremors to be the result of in-service TERA.

In a January 2026 private medical opinion, the medical provider opined that it is more likely than not that the Veteran's diabetes and tremors are the result of in-service TERA. The medical provider listed the chemicals contained in fuels, oils and lubricants. The medical provider researched literature related to the specific chemicals found in the listed TERA. As a result, the medical provider found that the medical literature confirms the sum of environmental exposures are causative factors in the development of diabetes. The medical provider also found that the medical literature confirms a pathophysiological relationship between the Veteran's in-service TERA and the development of neurological tremors.

Upon review of the record, the Board finds the competent medical evidence is persuasively in favor of the claim. Both the VA and private medical opinions are competent as they were provided by clinicians who reviewed the claims file. However, the Board finds the nexus opinions from Dr. E. to be the most persuasive.

Dr. E. is a physician with over 20 years of experience. She indicated that she previously worked for VA as a medical opinions specialist and also as a compensation and pension examiner. Significantly, Dr. E. provided an extensive rationale for her opinions and discussed the relevant scientific literature in great detail. In contrast, the VA examiner's rationale was perfunctory and did not discuss the few medical treatises supported in support of the unfavorable opinion. Thus, they are less persuasive.
evidence is persuasively in favor of the claim. Both the VA and private medical opinions are competent as they were provided by clinicians who reviewed the claims file. However, the Board finds the nexus opinions from Dr. E. to be the most persuasive.

Dr. E. is a physician with over 20 years of experience. She indicated that she previously worked for VA as a medical opinions specialist and also as a compensation and pension examiner. Significantly, Dr. E. provided an extensive rationale for her opinions and discussed the relevant scientific literature in great detail. In contrast, the VA examiner's rationale was perfunctory and did not discuss the few medical treatises supported in support of the unfavorable opinion. Thus, they are less persuasive. Only when the evidence persuasively favors one side or another is the benefit of the doubt doctrine not for application. See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). Accordingly, the benefit of the doubt doctrine is not for application here. Service connection for diabetes, bilateral hand tremors is granted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

4. Entitlement to service connection for tinnitus is denied.

Service treatment records are absent complaints or findings related to tinnitus. The Veteran denied ear trouble on his November 1964 Report of Medical History.

The post-service VA medical records in the claims file prior to the claim on appeal were reviewed. A March 2001 VA primary care record shows the Veteran denied tinnitus. A post-service VA medical record for a cardiology initial consult dated in January 2004 shows the Veteran reported some ringing in his ears- but the record reflects this was not a regular symptom. The clinician indicated that the Veteran was decrease his "ASA" medication to see whether it helped to reduce the ringing. Tinnitus was not diagnosed. A June 2012 primary care record shows the Veteran reported ringing/buzzing in his ears five days ago; and on/off for quite a while. A June 2012 primary care record shows the Veteran reported ringing in his ears comes and goes and was becoming more frequent. Tinnitus was not diagnosed. Records dated in June 2018 and in March 2022 show the Veteran denied tinnitus. The Veteran appeared for an initial VA audiological evaluation in August 2022. He reported intermittent bilateral tinnitus for the past several years and that it had no effect on his life. The examining audiologist did not include a diagnosis of tinnitus in the medical record.

The Veteran filed his service connection claim for tinnitus in September 2022.

During an April 2023 VA audio examination, an examiner indicated that the Veteran does not have a diagnosis of recurrent tinnitus. She explained that the Veteran's symptoms are consistent with transient auditory events. The episodes occur once or twice a month, lasting one to two minutes with random onset and resolve spontaneously.

At the November 2023 Board hearing, the Veteran testified that he experiences frequent ringing in his ears. Board Hearing Transcript (T.) at 10. He stated that the ringing started over a period of time. T. at 11. He stated that the ringing began in the 1980s or 1990s. Id. The Veteran that he was exposed to noise as an aircraft mechanic. T. at 11-12.

In a May 2024 VA medical opinion, a different examiner reviewed the claims file and opined that the Veteran does not have tinnitus. She explained that the Veteran's description is in line with transient ear noise and cited Dauman and Tyler (2000) as well as the Tinnitus Handbook (Tyler). She further explained that based on the April 2023 VA examination report, the Veteran reports transient ear noise that occurs in the general population without auditory damage or pathology. She further explained that because tinnitus is not present, it cannot be aggravated by hearing loss. The examiner concluded that the Veteran's claimed tinnitus is not caused or aggravated by his service-connected hearing loss.

The examiner further opined that the Veteran's claimed tinnitus was less likely than not caused by the indicated TERAs, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all of his TERAs. She again explained that what the Veteran reports is transient ear noise that occurs in the general population without auditory damage or pathology. She further explained that transient ear noise is not caused by the indicated TERAs and she again noted that the Veteran does not currently have a diagnosis of tinnitus. She cited medical literature in support of her opinion.

The Board finds the combined VA medical opinions to be probative evidence that persuasively weighs against a finding that the Veteran has current tinnitus, to include symptoms that cause functional impairment that impacts earning capacity. The VA
innitus was less likely than not caused by the indicated TERAs, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all of his TERAs. She again explained that what the Veteran reports is transient ear noise that occurs in the general population without auditory damage or pathology. She further explained that transient ear noise is not caused by the indicated TERAs and she again noted that the Veteran does not currently have a diagnosis of tinnitus. She cited medical literature in support of her opinion.

The Board finds the combined VA medical opinions to be probative evidence that persuasively weighs against a finding that the Veteran has current tinnitus, to include symptoms that cause functional impairment that impacts earning capacity. The VA examiners, both of whom were audiologists, possessed the necessary education, training, and expertise to provide the requested findings and opinions. See Grottveit v. Brown, 5 Vet. App. 91, 93 (1993).

The April 2023 examiner performed the necessary testing and determined that based on the Veteran's self-report symptoms and history, review of the record, and applicable medical principles, the Veteran did not have signs or symptoms of recurrent tinnitus. The May 2024 examiner reviewed that examination report and the claims file and came to the same conclusion.

The examiners provided an explanation as to why the Veteran's symptoms did not meet the criteria for a tinnitus diagnosis and why such a diagnosis was not warranted. The opinions are supported by cogent rationale, which was based on a review of the claims file (including the service treatment records, post-service VA treatment records, lay statements from the Veteran, an in-person examination), medical principles, and supporting medical treatise evidence. The VA examiners' opinions are considered probative. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). There is no medical opinion to the contrary.

The Board acknowledges that the August 2022 VA audiology record shows the Veteran reported having tinnitus. However, the Board notes that the clinician did not include tinnitus as a diagnosis. To the extent that tinnitus was noted in that record, the Board finds the VA examiner's medical opinions, which were provided after full review of the claims file and specifically address whether the symptoms reported are in fact indicative of tinnitus, to be more probative. Further, the Veteran reported to the August 2022 clinician that his subjective symptoms had no effect on his life. Thus, it cannot be said that they caused functional impairment of earning capacity to warrant a finding of a disability pursuant to Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018).

The Veteran reported to the April 2023 VA examiner that his transient ear noise episodes occur once or twice a month, lasting for 1-2 minutes, have random onset, and resolve spontaneously. The Board finds that this transient ear noise which occurs with such limited severity and duration, i.e., at most four minutes each month, does not reach the level of a functional impairment with regard to earning capacity. Diagnostic Code (DC) 6260 provides for a compensable 10 percent rating for "recurrent" tinnitus. "Recurrent" means happening time after time. See https://www.merriam-webster.com/dictionary/recurrent. In this case, the Veteran's transient ear noise does not rise to the recurrent level that would equate to functional impairment.

Accordingly, the Board finds that the evidence is neither evenly balanced nor approximately so with regard to whether entitlement to service connection for tinnitus is warranted. Rather, the evidence persuasively weighs against the claim for service connection. The benefit of the doubt doctrine, see 38 U.S.C. § 5107(b), is therefore not for application. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc). Service connection for tinnitus is denied.

D. JOHNSON

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board M. Thompson, 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.

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