Citation Nr: 0001703 Decision Date: 01/20/00 Archive Date: 01/28/00 DOCKET NO. 98-14 338 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUE Entitlement to service connection for diabetes mellitus. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESSES AT HEARING ON APPEAL Appellant and spouse ATTORNEY FOR THE BOARD Stephen L. Higgs, Associate Counsel INTRODUCTION The veteran served on active duty from June 1965 to April 1969 and from June 1969 to June 1975. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a rating decision dated in July 1998 by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the RO. 2. The claim for service connection for diabetes mellitus is not plausible. CONCLUSION OF LAW The claim for service connection for diabetes mellitus is not well grounded. 38 U.S.C.A. §§ 1110, 1131, 5107(a) (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSION Factual Background The veteran's service medical records, to include an August 1972 examination conducted at Quantico, Virginia, and the veteran's May 1975 service discharge examination, are negative for complaints or diagnosis of diabetes mellitus. A June 1987 letter from a VA physician to the veteran recommends that the veteran have his blood sugar tested, based on abnormal blood sugar upon urinalysis in May 1987. Private medical records dated in November 1987 reflect that the veteran was diagnosed with diabetes based on blood sugar level testing. His condition was described as a mild, non- insulin dependent, diabetic condition which would be controlled with oral medication and would not require the use of insulin. VA records of treatment in August 1990 reflect a positive history for diabetes. VA records of treatment from March 1991 forward reflect diagnosis of and ongoing treatment for diabetes. During his November 1998 RO hearing, the veteran contended that he was treated during service for symptoms of diabetes, to include hypoglycemia. He indicated he had the first hypoglycemic episode in Okinawa, Japan, in the late 1960s. He indicated that he was treated for diabetes symptoms in Quantico, Virginia, in 1971 and 1972. He stated that he was denied reenlistment in 1975 because of diabetes symptoms, to include blackout spells. He said that he had not been diagnosed with diabetes at this point but had been noted to have diabetes traits and diabetes symptoms. He described progressive problems from 1975 forward. He indicated that he was found to have high blood sugar four times in service and that he had three blackout spells in service. He said that he was never told during service that his condition would limit deployment or assignment. The veteran's spouse testified as to the veteran's blackout spells and said that the veteran had been advised to stay on a diet restricted in fatty foods, sodium and carbohydrates. She said that in the 1970s or 1980s, the veteran was seen for a diabetic coma in Manhattan, Kansas. Upon further questioning, the veteran and his spouse were uncertain as to the date and location of the described diabetic coma. Analysis Service connection for diabetes mellitus was denied by the RO in February 1992. The denial was not appealed and became final. The RO has concluded, and the Board concurs, that since that time evidence in the form of hearing testimony and records of treatment have been received which were not previously submitted to agency decisionmakers which bear directly and substantially upon the matter under consideration, which is neither cumulative or redundant, and which by itself or in connection with evidence previously assembled is so significant that it must be considered to fairly decide the merits of the claim. Accordingly, the claim for service connection for diabetes mellitus is reopened. 38 C.F.R. § 3.156(a). The Board makes this determination with an emphasis on completeness of the record rather than whether the outcome of the claim would be different in light of the new evidence. Hodge v. West, 155 F. 3d 1356 (Fed. Cir. 1998). The threshold question that must be resolved with regard to a claim is whether the veteran has presented evidence of a well-grounded claim. See 38 U.S.C.A. § 5107(a); Murphy v. Derwinski, 1 Vet. App. 78, 81 (1991). A well-grounded claim is a plausible claim that is meritorious on its own or capable of substantiation. See Murphy, 1 Vet. App. at 81. An allegation of a disorder that is service connected is not sufficient; the veteran must submit medical evidence in support of a claim that would "justify a belief by a fair and impartial individual that the claim is plausible." 38 U.S.C.A. § 5107(a); Tirpak v. Derwinski, 2 Vet. App. 609, 611 (1992). The quality and quantity of evidence required to meet this statutory burden of necessity will depend upon the issue presented by the claim. Grottveit v. Brown, 5 Vet. App. 91, 92-93 (1993). If the veteran has not presented a well-grounded claim, his appeal must fail, and there is no duty to assist him further in the development of the claim. 38 U.S.C.A. § 5107(a). See Epps v. Gober, 126 F.3d 1464 (Fed. Cir. 1997). In order for a claim for service connection to be well- grounded, there must be competent evidence of a current disability (a medical diagnosis); of incurrence or aggravation of a disease or injury in service (lay or medical evidence); and of a nexus between the inservice injury or disease and the current disability (medical evidence). Caluza v. Brown, 7 Vet. App. 498 (1995); 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. Where the determinant issue involves a question of medical diagnosis or medical causation, competent medical evidence to the effect that the claim is plausible or possible is required to establish a well-grounded claim. Grottveit v. Brown, 5 Vet. App. at 93. Lay assertions of medical causation cannot constitute evidence to render a claim well grounded under 38 U.S.C.A. § 5107(a); if no cognizable evidence is submitted to support a claim, the claim cannot be well-grounded. Id. Service connection may be established for a disability resulting from personal injury suffered or disease contracted in the line of duty or for aggravation of a preexisting injury suffered or disease contracted in the line of duty. 38 U.S.C.A. § 1110. Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Diabetes mellitus will be considered to have been incurred in service if manifest to a compensable degree within one year of separation from service, even though there is no evidence of such disease during the period of service. 38 C.F.R. §§ 3.307, 3.309. A disorder may be service connected if the evidence of record, regardless of its date, shows that the veteran had a chronic disorder in service, or during an applicable presumptive period, and that the veteran still has such a disorder. 38 C.F.R. § 3.303(b); Savage v. Gober, 10 Vet. App. 488 (1997). Such evidence must be medical unless it relates to a disorder that may be competently demonstrated by lay observation. Savage. If the disorder is not chronic, it may still be service connected if the disorder is observed in service or an applicable presumptive period, continuity of symptomatology is demonstrated thereafter, and competent evidence relates the present disorder to that symptomatology. Id. Although urinalyses in service in September and October 1967 were positive for sugar, only nonspecific urethritis was then diagnosed; diabetes mellitus was not diagnosed. Moreover, urinalyses both before and after these findings were uniformly negative for any showing of sugar in the veteran's urine. The mere presence on two occasions of glucose in the urine, especially while the veteran was being treated for a genitourinary disorder, is insufficient to identify the disease entity in service as diabetes mellitus. See 38 C.F.R. § 3.303(b). The claim for service connection for diabetes mellitus is not well grounded because diabetes mellitus was not diagnosed during service, or shown to a degree of at least ten percent within one year of the veteran's discharge from service, and there is no medical "nexus" evidence of a link between his currently diagnosed diabetes mellitus and any findings possibly indicative of diabetes mellitus in service. Caluza; Epps. The earliest actual diagnosis of diabetes mellitus is not shown until November 1987, more than a dozen years following the veteran's separation from active service. Accordingly, the claim for service connection for diabetes mellitus must be denied. Id. The Board acknowledges the veteran's assertion in an August 1991 written statement that his diabetes mellitus is a lifelong condition that was permanently aggravated by inadequate treatment of inservice episodes of high blood sugar. A competent medical opinion to this effect would be required to well ground the veteran's claim. The veteran, as a lay person, is not competent to provide medical opinions, and his assertions as to medical diagnosis or causation cannot constitute evidence of a well-grounded claim. See Espiritu v. Derwinski, 2 Vet. App. 492 (1992); Grottveit. The Board also acknowledges the veteran's assertion in a written statement received in July 1998 that a VA physician told him that inservice problems with high blood sugar were an indication of underlying problems. The Board notes, however, that a statement about what a doctor told a lay claimant does not constitute the required medical evidence for a well-grounded claim. See Franzen v. Brown, 9 Vet. App. 235, 238 (1996). The Board further acknowledges the veteran's contention that there should be service medical records which reflect treatment for high blood sugar. The Board notes that the RO made multiple attempts to obtain all of the veteran's service medical records. At one point in 1987, the service medical records for the period from June 1965 to June 1969 had not been associated with the claims file. However, after several attempts, the RO was successful in obtaining these records. The Board finds that further attempts to locate additional service medical records would likely be futile and that a remand for this purpose is not warranted. ORDER Service connection for diabetes mellitus is denied. WILLIAM W. BERG Acting Member, Board of Veterans' Appeals