Citation Nr: 0003710 Decision Date: 02/11/00 Archive Date: 02/15/00 DOCKET NO. 97-15 017 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUE Entitlement to service connection for diabetes mellitus. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD A. P. Simpson, Associate Counsel INTRODUCTION The appellant served on active duty from May 1969 to September 1989. This case comes before the Board of Veterans' Appeals (the Board) on appeal from a September 1990 rating decision of the St. Petersburg, Florida, Department of Veterans Affairs (VA) Regional Office (RO). In that decision, the RO denied service connection for diabetes mellitus. The Board remanded this claim in June 1998. The requested development has been accomplished, to the extent possible, and the case has been returned to the Board for further appellate review. FINDING OF FACT Diabetes mellitus did not manifest during service or within one year following service. CONCLUSION OF LAW Diabetes mellitus was not incurred or aggravated in active service or manifested to a compensable degree within one year following service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107 (West 1991); 38 C.F.R. §§ 3.303 (1999). REASONS AND BASES FOR FINDING AND CONCLUSION Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. §§ 1110. 1131 (West 1991). Service connection for diabetes mellitus may be granted if manifest to a compensable degree within one year of separation from service. Service connection may be granted for any disease diagnosed after service when all the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (1999). In making a claim for service connection, the appellant has the burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim is well grounded. 38 U.S.C.A. § 5107(a). A well-grounded claim is a plausible claim, one which is meritorious on its own or capable of substantiation. Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). A well-grounded claim for service connection generally requires medical evidence of a current disability; evidence of incurrence or aggravation of a disease or injury in service as provided by either lay or medical evidence, as the situation dictates; and, a nexus, or link, between the inservice disease or injury and the current disability as provided by competent medical evidence. Cohen v. Brown, 10 Vet. App. 128, 137 (1997); Caluza v. Brown, 7 Vet. App. 498 (1995) aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996) (table); see also 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303 (1999); Layno v. Brown, 6 Vet. App. 465 (1994); Espiritu v. Derwinski, 2 Vet. App. 492 (1992). Alternatively, the nexus between service and the current disability can be satisfied by evidence of continuity of symptomatology and medical or, in certain circumstances, lay evidence of a nexus between the present disability and the symptomatology. See Savage v. Gober, 10 Vet. App. 488, 495 (1997). Establishing direct service connection for a disability that was not clearly present in service requires the existence of a current disability and a relationship or connection between that disability and a disease contracted or an injury sustained during service. Cuevas v. Principi, 3 Vet. App. 542 (1992); Rabideau v. Derwinski, 2 Vet. App. 141 (1992). With a "chronic disease," such as diabetes mellitus, service connection may be warranted when the disease is manifested to a compensable degree within one year following service. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137 (West 1991); 38 C.F.R. §§ 3.307, 3.309(a) (1999). The appellant has not claimed that diabetes mellitus arose under combat situation. Thus, entitlement to application of 38 U.S.C.A. § 1154(b) (West 1991) is not warranted. The Board notes that it views the issue of well-groundedness in a vacuum. The appellant has submitted a May 1997 letter from Dr. Frederic J. Guerrier in which he stated the following: "After reviewing [the appellant's] records, it was found that patient showed tendency toward diabetes since 1988 . . . ." When determining whether a claim is well grounded, the evidence submitted in support of the claim must be accepted as true; however, once well-groundedness is established, the weight and credibility of the evidence must be assessed. Robinette v. Brown, 8 Vet. App. 69, 75-76 (1995). The Board finds that Dr. Guerrier's statement is sufficient to establish a well-grounded claim for service connection for diabetes mellitus. 38 U.S.C.A. § 5107(a). However, there is another standard that must be addressed; the benefit of the doubt. When all the evidence is assembled, the Secretary, is then responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). In reaching the merits determination, truthfulness and credibility are no longer assumed. The Board notes that the appellant's diagnosis of diabetes mellitus is not in dispute. The issue before the Board is whether diabetes mellitus is related to the appellant's active service. Service medical records are silent for a diagnosis of diabetes mellitus. In April 1980 and May 1983, clinical evaluations of the endocrine system were normal. Urinalyses taken at those times were negative for sugar. In November 1988, a test revealed a glucose level of 111 milligrams (mg)/deciliter (dl) and was noted to be abnormal. A second test taken at that time revealed a glucose level of 126 mg/dl. January 1989, March 1989, and April 1989 urinalyses were negative for glucose. In May 1989, clinical evaluation of the endocrine system was normal. A urinalysis taken at that time was within normal limits for sugar. A June 1989 report noted a fasting blood sugar of 114 mg/dl. The appellant underwent a VA examination in November 1989. Physical examination of the endocrine system was normal. A urinalysis taken at that time revealed a glucose level of 97 mg/dl (the reference range was noted to be between 65 and 110). The appellant was diagnosed with new onset of diabetes mellitus in September 1991. The appellant had reported feeling weak for the past week with increased urination and thirst. He stated that he had difficulty focusing his eyes. The September 1991 hospitalization report indicated that he went to the emergency room and had a blood sugar count of 861, which test was repeated again and the same results occurred. Dr. Robinson noted that the appellant had no past history of diabetes. In a May 1997 letter, Dr. Guerrier stated that the appellant's records revealed that he "showed tendency toward diabetes since 1988" when his "fasting blood sugar then was 126 (normal up to 110)." Dr. Guerrier stated that the appellant was currently on insulin. The Board remanded this claim in June 1998. The Board asked that a VA examiner review the November 1988 laboratory report which showed a glucose level of 126 mg/dl and address the significance of that reading as to the appellant's diabetes mellitus. Additionally, the VA examiner was asked to review the inservice glucose levels of 111 and 114 and determine if there was any relationship between the current diagnosis of diabetes mellitus and the inservice findings. The appellant underwent a VA examination in October 1998. The VA examiner noted that he had reviewed the appellant's claims file and clinical records. The VA examiner stated that the appellant was found to be diabetic in September 1991. The VA examiner noted that he had reviewed the Board's June 1998 request and made the following determination: It is certainly felt by reviewing the veteran's chart that he had no symptoms referable to diabetes mellitus, no polyuria, no polydyspnea, no polyphagia and it was not until nearly 2 1/2 years after his discharge from the military that he developed signs of diabetes and is being treated. It is the opinion of this examiner that there was no relationship to the borderline abnormal blood sugar of November 14, 1988 [which was 126], to his current diagnosis [of] diabetes mellitus. Additionally, the VA examiner stated that the glucose levels of 111 and 114 were normal. After having reviewed the evidence of record, the Board concludes a preponderance of the evidence is against the claim for service connection for diabetes mellitus. The Board finds the preponderance of the evidence is against the appellant's claim that diabetes mellitus is related to his military service. The evidence in favor of the appellant's claim is Dr. Guerrier's statement that the appellant "showed tendency" toward diabetes in 1988 when his glucose level was 126. Dr. Guerrier noted that a normal glucose level went up to 110. However, the Board finds that the preponderance of the evidence is against the appellant's claim. In an October 1998 examination report, the VA examiner stated that the inservice glucose levels of 111 and 114 were normal and that the inservice glucose level in November 1988 of 126 was "borderline abnormal." He added that the November 1988 glucose level of 126 had "no relationship" to the current diagnosis of diabetes mellitus. The Board finds that the VA examiner's medical opinion is more probative than Dr. Guerrier's statement that the appellant "showed tendency" toward diabetes in 1988. The Board finds that Dr. Guerrier's statement that the appellant had a tendency toward diabetes is not clear or definitive, whereas the VA examiner made a clear and definitive finding that the inservice glucose level of 126 had no relationship to the appellant's current diagnosis of diabetes mellitus. Dr. Guerrier did not state that diabetes mellitus was diagnosed during service or within one year of separation from service. Additionally, he did not state that the current diagnosis of diabetes mellitus was related to the inservice "tendency." The VA examiner added that there were no symptoms in service such as polyuria, polydyspnea, or polyphagia which would be referable to diabetes mellitus. He stated that the appellant's diagnosis of diabetes mellitus did not show until 2 1/2 years following the appellant's discharge from service. Dr. Guerrier made a statement and substantiated it only with a glucose level reading of 126. He did not state how a glucose level of 126 was indicative of diabetes mellitus- only that it showed a tendency toward diabetes mellitus. However, the VA examiner made a definitive determination and substantiated it with both clinical findings shown in the record and noted that the appellant did not have symptoms during service which were indicative of diabetes mellitus. For these reasons, the Board accords more probative value to the VA examiner's substantiated, definitive medical opinion than Dr. Guerrier's cursory statement that the appellant showed a "tendency toward" diabetes mellitus in 1988, which the Board is not clear what that means. The Board has substantiated why it finds that the preponderance of the evidence is against the appellant's claim for service connection for diabetes mellitus. The Court has recognized that the Board is not compelled to accept medical opinions; rather, if the Board reaches a contrary conclusion, it must state its reasons and bases and be able to point to a medical opinion other than the Board's own, unsubstantiated opinion. Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991). The Board has based its decision on the VA examiner's October 1998 medical opinion who determined that the inservice glucose level of 126 had no relationship to the appellant's post service diagnosis of diabetes mellitus and that the inservice glucose levels of 111 and 114 were normal. Finally, the appellant has alleged that his diabetes mellitus was shown in service; however, he is not competent to provide a nexus between the diagnosis of schizophrenia to service, as that requires a medical opinion. Espiritu v. Derwinski, 2 Vet. App. 492, 494 (1992). The preponderance of evidence is against the appellant's claim for service connection for diabetes mellitus, and there is no doubt to be resolved. 38 U.S.C.A. § 5107(b). ORDER Service connection for diabetes mellitus is denied. H. N. SCHWARTZ Member, Board of Veterans' Appeals