DIABETES MELLITUS

MARCUS N. FULTON · 2026 · Case ID: A26040901

GRANTED

Summary

The veteran, who served in the Marine Corps from October 1994 to October 2002 and the Army from February 2009 to February 2010, appeals the denial of service connection for diabetes type II (DM II) and seeks an increased rating for his posttraumatic stress disorder (PTSD). The Board reviewed evidence of record up to 90 days after a January 2025 virtual hearing. For DM II, the veteran testified that it was secondary to service-connected sleep apnea with sarcoidosis or related medication. A private medical opinion from Dr. P. in April 2025 opined that DM II was at least as likely as not secondary to sarcoidosis treatment, citing studies linking corticosteroid treatment for sarcoidosis to an increased risk of DM II. The Board found this opinion well-reasoned and afforded it significant probative weight, noting no contrary opinion. Given the equipoise between the evidence, the Board resolved doubt in the veteran's favor, granting service connection for DM II on a secondary basis. For PTSD, the veteran sought an increased rating beyond the 30 percent assigned. The May 2021 VA examiner noted mild symptoms, but the veteran testified to more severe symptoms, including frequent panic attacks and sleep disturbances. A July 2022 private PTSD DBQ from Dr. H. documented significant impairment, including deficiencies in most areas of work and social functioning, daily panic attacks, and feelings of hopelessness. The Board found Dr. H.'s opinion persuasive, noting symptoms like difficulty adapting to stress, impaired impulse control, and interpersonal conflict, which approximated the criteria for a 70 percent rating. However, the Board found the evidence did not support a 100 percent rating, as the veteran did not exhibit total occupational and social impairment, such as gross impairment in thought processes or persistent danger to self or others. Service connection for DM II is granted, and the PTSD rating is increased to 70 percent.

Rationale

Dr. P. opinion found persuasive; Positive nexus established; Benefit of the doubt applied

Service Branch

MARINE CORPS

Special Benefit

NO SPECIAL BENEFIT

Docket No.

210727-174995

Full Decision Text

Citation Nr: A26040901
Decision Date: 04/30/26 Archive Date: 04/30/26

DOCKET NO. 210727-174995
DATE: April 30, 2026

ORDER

Entitlement to service connection for diabetes type II (DM II), secondary to service-connected disability, is granted.

Entitlement to an initial 70 percent rating for posttraumatic stress disorder (PTSD) is granted, subject to the regulations governing the award of monetary benefits.

FINDINGS OF FACT

1. The persuasive evidence reflects that the Veteran's DM II is related to service-connected disability.

2. The evidence is at least evenly balanced as to whether the Veteran's PTSD symptomatology more nearly approximated deficiencies in most areas, but not total occupational and social impairment.

CONCLUSIONS OF LAW

1. Resolving doubt in favor of the Veteran, the criteria for service connection for DM II, secondary to service-connected disability, have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310.

2. Resolving doubt in favor of the Veteran, the criteria for an initial 70 percent rating, but not higher, for PTSD, have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.130, Diagnostic Code (DC) 9411.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the Marine Corps from October 1994 to October 2002 and the Army from February 2009 to February 2010.

These matters come before the Board of Veterans' Appeals (Board) on appeal from a May 2021 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO).

In a July 2021 Decision Review Request: Board Appeal (Notice of Disagreement) (VA Form 10182), the Veteran timely appealed the May 2021 rating decision to the Board and requested a Hearing Review, indicating he would submit additional evidence he wished considered in support of his appeal within 90 days after his hearing.

In January 2025, the Veteran appeared at a virtual Board hearing before the undersigned Veterans Law Judge (VLJ). A copy of the transcript is of record.

The Board will thus review the claim based on the evidence of record at the time of the May 2021 rating decision and within 90 days of the January 2025 Board hearing. 38 C.F.R. §§ 20.202(b)(2); 20.303.

1. Entitlement to service connection for DM II

Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted for a disease first diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in-service. 38 C.F.R. § 3.303(d).

Service connection may also be established on a secondary basis for a disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a).

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

The Board is bound by the favorable findings identified by the RO in its May 2021 rating decision. Favorable findings included the diagnosis of DM II.

The Veteran's service treatment records (STRs) do not document complaints, treatment, or diagnoses related to diabetes.

At his Board hearing, the Veteran testified that his DM II was secondary to service-connected sleep apnea with sarcoidosis and/or medication related to taking it. See Board hearing transcript, p. 3.

In April 2025, within the 90-day period for evidence submission, a medical opinion from Dr. P. was obtained. She opined that the Veteran's DM II was at least as likely as not secondary to sarcoidosis and its treatment for this condition. As rationale, the physician noted that she had reviewed the claims file, to include the Veteran's service and medical records. Dr. P. noted the Veteran's diagnosed sarcoidosis (in 2012), which preceded his 2018 diabetes diagnosis. She stated that medical studies showed that corticosteroid treatment (taken for treatment of sarcoidosis) is known to induce insulin. Notably, the study showed that "[i]n a large population-based cohort study, sarcoidosis was associated with an increased risk for T2D [DM II] which was highest in corticosteroid-treated sarcoidosis patients." Thus, Dr. P. posited that the Veteran's service-connected condition/medication to treat service-connected sarcoidosis likely contributed to his DM II.

Upon review of the pertinent evidence of record, the Board finds that entitlement to service connection for DM II is warranted. Specifically, the Board notes that Dr. P. provided a thorough rationale to support her opinion based on an accurate characterization of the evidence of record, to include review of the lay evidence and medical literature indicating a positive medical relationship between medication taken for the Veteran's service-connected sleep apnea with sarcoidosis and the development of DM II. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (most of the probative value of a medical opinion comes from its reasoning). Therefore, Dr. P.'s opinion is afforded significant probative weight. Notably, there is no contrary opinion of record.

Thus, the above evidence is at least evenly balanced as to whether the Veteran's DM II is secondary to service-connected disability. As the reasonable doubt created by this relative equipoise in the evidence must be resolved in favor of the Veteran, entitlement to service connection for DM II on a secondary basis is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

2. Entitlement to a higher initial rating for PTSD

The Veteran asserted that his PTSD is more severe than approximated by his 30 percent assigned rating.

Disability evaluations are determined by the application of the Schedule for Rating Disabilities, which assigns ratings based on the average impairment of earning capacity resulting from a service-connected disability. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. It is the defined and consistently applied policy of VA to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. Any reasonable doubt regarding the degree of disability is resolved in favor of the Veteran. See 38 C.F.R. § 4.3.

Where the appeal arises from the original assignment of a disability evaluation following an award of service connection, the severity of the disability at issue is to be considered during the entire period from the initial assignment of the disability rating to the present time. See Fenderson v. West, 12 Vet. App. 119 (1999).

In view of the number of atypical instances it is not expected, especially with the more fully described grades of disabilities, that all cases will show all the findings specified. Findings sufficiently characteristic to identify the disease and the disability therefrom, and above all, coordination of rating with impairment of function will, however, be expected in all instances. 38 C.F.R. § 4.21. In order to evaluate the level of disability and any changes in condition, it is necessary to consider the complete medical history of a veteran's condition. Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991).

A 30 percent is warranted when there is evidence demonstrating occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names,
. 38 C.F.R. § 4.21. In order to evaluate the level of disability and any changes in condition, it is necessary to consider the complete medical history of a veteran's condition. Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991).

A 50 percent rating is warranted when there is evidence demonstrating occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory, for example, retention of only highly learned material, forgetting to complete tasks; impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships.

A 70 percent rating is assigned when there is objective evidence demonstrating occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities, speech intermittently illogical, obscure, or irrelevant; near continuous panic or depression affecting the ability to function independently, appropriately, or effectively; impaired impulse control, such as unprovoked irritability with periods of violence; spatial disorientation, neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances, including work or a work-like setting; inability to establish and maintain effective relationships.

A 100 percent rating is warranted when there is total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene; disorientation to time and place, memory loss for names of close relatives, own occupation, or own name.

Symptoms listed in the VA's general rating formula for mental disorders serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating, and are not intended to constitute an exhaustive list. See Mauerhan v. Principi, 16 Vet. App. 436, 442-44 (2002). The United States Court of Appeals for the Federal Circuit (Federal Circuit) has emphasized that the list of symptoms under a given rating is a non-exhaustive list, as indicated by the words "such as" that precede each list of symptoms. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 115 (Fed. Cir. 2013). In Vazquez-Claudio, the Federal Circuit held "that a veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage or others of similar severity, frequency, and duration." Id. at 117. Other language in the decision indicates that the phrase "others of similar severity, frequency, and duration," can be thought of as symptoms of like kind to those listed in the regulation for a given disability rating. Id. at 116.

Turning to the relevant evidence of record, the Veteran underwent VA PTSD examination in May 2021. The examiner opined that the Veteran's PTSD caused occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by medication. The examiner remarked that the Veteran has "exaggerated startle, avoids fireworks, crowds, parades, checks and re-checks locks. He has intense anger at times, can be w[ith]drawn and leaves the room when others visit at times. He can only concentrate if a task is very difficult. He feels excessive guilt. He has initial insomnia and freq[uent] waking with daily fatigue and excessive caffeine use. At virtual work, he turns off his camera to avoid being seen."

PTSD symptoms include anxiety, suspiciousness, chronic sleep impairment, and mild memory loss, such as forgetting names, directions or recent events. Regarding behavioral observations, the Veteran was properly groomed, alert oriented, pleasant, and cooperative with good eye-contact; psychomotor activity was elevated with a high rate of speech. His mood was "neutral to angry, affect euthymic." Thought content was free of obvious hallucinations and delusions, thought process logical and
the room when others visit at times. He can only concentrate if a task is very difficult. He feels excessive guilt. He has initial insomnia and freq[uent] waking with daily fatigue and excessive caffeine use. At virtual work, he turns off his camera to avoid being seen."

PTSD symptoms include anxiety, suspiciousness, chronic sleep impairment, and mild memory loss, such as forgetting names, directions or recent events. Regarding behavioral observations, the Veteran was properly groomed, alert oriented, pleasant, and cooperative with good eye-contact; psychomotor activity was elevated with a high rate of speech. His mood was "neutral to angry, affect euthymic." Thought content was free of obvious hallucinations and delusions, thought process logical and goal-directed. Judgement, insight, impulse, control, attention, memory, and calculation were noted as good. His abstraction was intact with no acute distress. The Veteran denied non-suicidal self-injury (NSSI) and Suicidal Ideation/Intent/Plans (SIIP). He could manage his financial affairs.

At his Board hearing, the Veteran testified that his PTSD symptoms were more severe than noted by the May 2021 VA examiner. He stated that he stopped going to church and the return to office has created more anxiety attacks. The Veteran reported that he does not have any interest in socialization. He noted problems with impulse control, and can isolate from friends and family. See Board hearing, pp. 8-9. He also reported having panic attacks two to three times a week and increased nightmares and sleep disturbances over the past number of years. Id. at 9-10.

In March 2025, within the 90-day period for evidence submission, a July 2022 PTSD disability questionnaire (DBQ) from Dr. H., a private psychologist, was submitted. Dr. H. opined that the Veteran's PTSD caused occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgement, thinking, and/or mood. The Veteran stated that he had been distancing himself from people and stopped attending church. He gets irritated with people and has "zero patience." The Veteran also reported that he had a sense of hopelessness and "feels it will never get better no matter what he does," stating that he is "scared to death of it." The Veteran reported that he is not doing well at his job since he must interact with more people. Moreover, he was facing a suspension from work for not following supervisor instructions. Dr. H. noted the Veteran has panic attacks more than once daily (especially in the morning before work and at the end of the night before bed). His intrusive thoughts effect his sleep, and he only gets about two to three hours of uninterrupted sleep.

Symptoms included depressed mood, anxiety, suspiciousness, panic attacks occurring more than once per week, near continuous panic or depression affecting the ability to function independently, appropriately and effectively, chronic sleep impairment, mild memory loss, such as forgetting names, directions, or recent events, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances, including work or a work-like setting, and impaired impulse control, such as unprovoked irritability with periods violence.

In this case, the evidence of record indicates that the Veteran's psychiatric disorder has been manifested by symptoms and impairment that more nearly approximate the criteria for a 70 percent rating, but no higher.

In particular, Dr. H.'s July 2022 PTSD DBQ (submitted in March 2025) documented that the Veteran's PTSD symptoms resulted in difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances, including work or a work-like setting, and impaired impulse control, such as unprovoked irritability with periods violence. Notably, Dr. H. noted the Veteran's interpersonal conflict, difficulties with his work environment , daily panic attacks, and feelings of hopelessness and being "scared to death" that his situation will not improve.

Thus, the above symptoms caused the Veteran's social and occupational impairments- such as difficulty in adapting to stressful circumstances, including work and worklike setting, as well as deficiencies in his social/familial relations-including the inability to maintain effective relationships, as generally specified for a 70 percent initial rating.

The Veteran is not, however, entitled to a higher, 100 percent disability rating. The evidence of record did not show that the Veteran experienced symptoms such as an impairment in thought processes or communication, persistent danger of hurting self or others, or grossly inappropriate behavior. Likewise, his thought content did not appear delusional, or impaired to reality, and he did not experience memory loss for names of close relatives, own occupation, or own name. Moreover, he did not have psychiatric hospitalizations or hallucinations and could manage his finances
stressful circumstances, including work and worklike setting, as well as deficiencies in his social/familial relations-including the inability to maintain effective relationships, as generally specified for a 70 percent initial rating.

The Veteran is not, however, entitled to a higher, 100 percent disability rating. The evidence of record did not show that the Veteran experienced symptoms such as an impairment in thought processes or communication, persistent danger of hurting self or others, or grossly inappropriate behavior. Likewise, his thought content did not appear delusional, or impaired to reality, and he did not experience memory loss for names of close relatives, own occupation, or own name. Moreover, he did not have psychiatric hospitalizations or hallucinations and could manage his finances. Thus, overall, this reflects that the impairment caused by the Veteran's symptoms did not more nearly approximate the total occupational and social impairment required for a 100 percent disability rating.

In reaching the above conclusions, the Board is mindful that the symptoms listed in the rating schedule are essentially examples of the type and degree of symptoms indicative of the level of impairment required for each such rating, and that the Veteran need not demonstrate those exact symptoms to warrant a higher disability rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002).

As explained above, the Board has found that that the evidence of record shows that the Veteran has manifested sufficient symptoms of the type and extent, frequency, or severity (as appropriate) to result in the occupational and social impairment with deficiencies in most areas required for an initial disability rating of 70 percent. 38 C.F.R. § 4.130. However, he did not show symptoms of the type and extent, frequency, or severity (as appropriate) to result in total social impairment required for an initial rating of 100 percent as he had some social interactions and relationships and was able to work, despite the noted impairments, reflecting that his overall level of impairment did not more nearly approximate total social impairment. Id.

Marcus N. Fulton

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Kovacs, Mayer

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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