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

Citation Nr: 26001461 Decision Date: 01/30/26 Archive Date: 01/30/26 DOCKET NO. 15-19 858 DATE: January 30, 2026 ORDER Entitlement to service connection for diabetes mellitus type II is denied. FINDINGS OF FACT 1. The evidence persuasively weighs against finding that the Veteran was exposed to herbicide agents during his active service. 2. The evidence of record persuasively weighs against finding that the Veteran's diabetes mellitus type II began during active service or is otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for entitlement to service connection for diabetes mellitus type II have not been met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran had active service from March 1963 to April 1967, and from September 1990 to August 1991. The Veteran died in March 2024. The appellant is his surviving spouse. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a July 2011 rating decision from a Department of Veterans Affairs (VA) agency of original jurisdiction (AOJ). A hearing was held before the undersigned Veterans Law Judge in December 2017. A transcript of the hearing has been associated with the claims file. The Board previously remanded the issue for additional development in June 2018, June 2021, December 2024, and May 2025. It returns for further appellate review in the instant matter. Entitlement to service connection for diabetes mellitus type II The appellant contends the Veteran's diabetes mellitus type II (heretofore "diabetes") was caused by his service. The appellant contends that the Veteran's diabetes was due to his exposure to herbicide agents while in Vietnam. The appellant further contends that the Veteran's diabetes was due to his exposure to gas in Saudi Arabia. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 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). Additionally, if a Veteran was exposed to an "herbicide agent," such as Agent Orange, used in support of the United States and allied military operations in the Republic of Vietnam from January 9, 1962, to May 7, 1975, then, absent affirmative evidence to the contrary, certain diseases, including type 2 diabetes, will be presumptively service connected even if there is no record of the disease in service. 38 U.S.C. §§ 1110, 1116; 38 C.F.R. §§ 3.307(a)(6), (d), 3.309(e). "Service in the Republic of Vietnam" includes service in the waters offshore and service in other locations if the conditions of service involved duty or visitation in the Republic of Vietnam. 38 C.F.R. § 3.307(a)(6)(iii). Moreover, service within the 12 nautical mile territorial sea offshore the Vietnam landmass entitles veterans to a presumption of herbicide exposure. 38 U.S.C. § 1116A; See Procopio v. Wilkie, 913 F.3d 1371 (Fed. Cir. 2019). In addition, a veteran who, during active military, naval, or air service, served between April 1, 1968, and August 31, 1971, in a unit that, as determined by the Department of Defense, operated in or near the Korean demilitarized zone (DMZ) in an area in which herbicides are known to have been applied during that period, shall be presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service. 38 C.F.R. §§ 3.307(a)(6)(iv). Furthermore, members of the Air Force and Air Force Reserve who regularly and repeatedly operated, maintained, or served onboard C-123 aircraft known to have been used to spray an herbicide agent during the Vietnam Era are presumed to have been exposed to an herbicide agent. 38 C.F.R. § 3.307(a)(6)(v). "Regularly and repeatedly operated, maintained, or served onboard C-123 aircraft" means that the individual was assigned to an Air Force or Air Force Reserve squadron when the squadron was permanently assigned one of the affected aircraft and the individual had an Air Force Specialty Code indicating duties as a flight, ground maintenance, or medical crew member on such aircraft. Id. The presumption of in-service herbicide agent exposure was further expanded to include the following active military, naval, air, or space service: performed in Thailand at any United States or Royal Thai base during the period beginning on January 9, 1962, and ending on June 30, 1976, without regard to where on the base the veteran was located or what military job specialty the veteran performed; performed in Laos during the period beginning on December 1, 1965, and ending on September 30, 1969; performed in Cambodia at Mimot or Krek Kampong Cham Province during the period beginning on April 16, 1969, and ending on April 30, 1969; or performed on Guam or American Samoa, or in the territorial waters thereof, during the period beginning on January 9, 1962, and ending on July 31, 1980, or served on Johnston Atoll or on a ship that called at Johnston Atoll during the period beginning on January 1, 1972, and ending on September 30, 14 1977." 38 U.S.C. § 1116(d). Initially, the Veteran's private treatment records show that the Veteran had diabetes during the pendency of the claim. See, for example, December 2019 private treatment record. As such, the evidence demonstrates that the Veteran had a current disability during the pendency of his claim. During the December 2017 Board hearing, the Veteran reported that while he was stationed in Okinawa, he traveled to Vietnam to deliver supplies. While the Veteran's personnel records show the Veteran was stationed at Naha Air Base in Okinawa, Japan from January 1965 until his reassignment in August 1966, there is no evidence of his reported travel to Vietnam in his service records. The Veteran's service records include his performance evaluations for the periods of December 1964 to December 1965, and from December 1965 to December 1966, both of which show the Veteran's duties as a vehicle operator and dispatcher. They do not, however, indicate any travel to Vietnam to transport supplies as the Veteran reported. It appears instead that the nature of the Veteran's duties during 1964 and 1965 were not consistent with his report that he traveled to Vietnam to transport supplies. In that regard, the Veteran's duties as a vehicle dispatcher were described as " responsible for dispatching of all types of vehicles, meets scheduled commitments by dispatching suitable vehicles regularly or at determined times. Initiates and checks transportation forms end maintains equipment status. Vehicle operator." The Veteran had additional duties as a General Purpose, Special Purpose, and Material Handling Vehicle Operator. Those duties were described as "[c]ouples and uncouples full and semi-trailers by use of fifth wheel devices, cleans and services automotive equipment Handles cargo and material. Improvises and employs field and mechanical expedients." Further, the Veteran's performance review for 1966 shows the Veteran delivered munitions to the Advanced Ballistic Re-Entry System (ABRES) and became well-versed in the loading and transporting of Aerospace Ground Equipment (AGE); however, it appears that these duties were performed at the 6595th Aerospace Test Wing located at Vandenberg Air Force Base, California, rather than when the Veteran was deployed in Okinawa. Regrettably, as the Veteran's report that he traveled to Vietnam while he was stationed in Okinawa is inconsistent with the circumstances of his service, the Board cannot rely on the Veteran's report and finds it not credible. See Caluza v. Brown, 7 Vet. App. 498, 511 (1995) (finding that in weighing credibility, VA may consider inconsistent statements, internal inconsistency, and consistency with other evidence of record). Although the Veteran was deployed during the Vietnam era, the evidence shows he was stationed in Okinawa, Japan at that time. The law does not recognize a presumption of exposure to herbicide agents based on the Veteran's service. As there is no indication otherwise that the Veteran was exposed to Agent Orange or another herbicide agent, the Board finds the evidence weighs against finding that the Veteran had actual exposure to herbicide agents. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). Turning to the theory of entitlement to service connection for diabetes on a direct basis, the Board finds that there is no evidence of in-service onset of the Veteran's diabetes. In that regard, the Veteran's service treatment records reflect periodic testing for sugar or glucose with negative results. See, for example, January 1967, November 1983, and July 1991 service treatment records. The date of onset of the Veteran's diabetes is unclear but it cannot be found to have been onset during the Veteran's service. Instead it appears that the Veteran reported diabetes in an October 2003 questionnaire as to his medical history, to have denied it while re-establishing VA treatment in March 2009, at which time the Veteran's glucose level was assessed as normal, but subsequently reported diabetes during April 2010 VA mental health treatment. In October 2020, the Veteran underwent a VA examination for diabetes that confirmed the Veteran had diabetes controlled by restricted diet, and noted fasting plasma glucose tests in February 2004 and March 2005 that showed elevated glucose levels. The Board cannot conclude the date of onset based on the record, but concludes that the Veteran's diabetes did not have its onset during service. Additionally, as the appellant has asserted that the Veteran's diabetes was due to his exposure to gas during his deployment to Saudi Arabia, VA obtained two opinions as to the etiology of the Veteran's diabetes in February and March 2025. In February 2025, an examiner opined that the Veteran's diabetes was less as likely as not causally related to service. The examiner reasoned that: It is unlikely that a person diagnosed with Type 2 Diabetes (DM2) in 2009 had developed the condition decades earlier (between 1990-1991 or 1963-1967), especially if their blood sugar in 2009 was 85 mg/dL (which is within the normal range for fasting blood sugar). Type 2 diabetes typically develops gradually over time, and early stages often show insulin resistance before noticeable symptoms or elevated blood sugar levels. If the person had undiagnosed diabetes or prediabetes in the past, there would likely be some signs of glucose dysregulation even years earlier, such as higher fasting glucose or HbA1c. It is more likely that the condition developed in the years closer to the diagnosis in 2009, with gradual onset and potentially undetected symptoms prior to that time. In March 2025, another examiner also opined that the Veteran's diabetes was less likely than not (likelihood is less than approximately balanced or nearly equal) incurred in or caused by his service. The examiner reasoned that: In the Hearing testimony, vet reported concern about diabetes developing in service based on symptoms of hair loss in his associates. Vet reported that while in "Saudi Arabia, we were gassed twice" and "I had a couple females that worked for me. When we got back home, they started having hair loss. I don't know if it from that or what, but they start having hair loss." Hair loss is not a typical presenting symptom of diabetes. The symptoms that can occur with the development of diabetes such as fatigue, frequent urination, unintentional weight loss, blurred vision, numbness/tingling of the extremities, increased hunger/thirst, frequent infections, slow healing wounds, etc. are not specific for diabetes. These symptoms can occur with so many other conditions. Thus, a medical diagnosis of diabetes cannot be made based on a history of symptoms. A medical diagnosis of diabetes absolutely requires lab testing that supports the diagnosis. This is based on medical guidelines. Furthermore, the vet's lab results in service do not support a diagnosis of diabetes at that time. Specifically, the veteran's labs in the STRs show no medical evidence for a diagnosis of DM. The STRs show that vet had 2 blood glucose tests done during his military service reported as 92 and 95. These are normal glucose test results and not consistent with a diagnosis of DM. Vet also had urine testing on military separation exam. Urine testing on separation reported negative glucose. This also rules against a diagnosis of diabetes at time of separation. Vet did not have a diagnosis of diabetes during military service. Vet's diabetes developed after service. Diabetes is extremely common in the general population. Although the onset of the Veteran's diabetes is not clear, these opinions, together, and in light of the evidence of record, are adequate to proceed to adjudication, as they reflect consideration of the Veteran's service and reports, as well as the relevant evidence. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Moreover, while a private examination was submitted in January 2020, there is no opinion that the Board can rely upon to conclude that the Veteran's diabetes was caused by his service. (Continued on the next page) ? While the Veteran believed that his disability was incurred in and/or related to service, he was not competent to provide a nexus opinion regarding this issue. The issue is medically complex. Therefore, it is outside the competence of the Veteran because the record does not show that he had the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the VA examination, which was rendered by a medical professional. As such, the evidence weighs persuasively against concluding that the Veteran's diabetes was caused by his service. As the evidence of record is not in approximate balance, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021). Accordingly, the claim of entitlement to service connection for diabetes mellitus type II must be denied. L. CHU Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Shorafa 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.