Veterans Disability Info Blog

In-Service Metabolic Syndrone as a Basis for Later Diagnosed Diabetes and Heart Disease

I recently received a favorable decision from the Board of Veterans Appeals in a service-connection for the cause of death case. My client was the surviving spouse of the veteran and she had a DIC claim. My client’s husband died of a heart attack at a young age with the death certificate noting diabetes and obesity as risk factors. The claim was repeatedly denied at various levels of the Agency and was eventually denied by the Board of Veterans Appeals. The case went up to the U.S. Court of Appeals for Veterans Claims wherein we were successful in getting the case overturned on appeal. In fact, the case was slated for oral argument before a panel at the Court based on the issue of whether or not obesity could serve as an in-service predicate for the later development of disease that is not diagnosed until after service. Historically, VA tends to characterize any claim that is based on obesity as being illegitimate on the grounds that service-connection is not available for obesity. Generally, it is true that obesity is not something for which VA will grant service-connection by itself per se, but we argued in this particular case that obesity onsetting during service is a medical event that can serve as a basis for the development of diseases that may not be diagnosed until years after service.

In this particular case, my client’s husband gained significant weight during his time on active duty such that he was placed in a weight reduction program. His waist circumference increased during active duty and he gained approximately 50 pounds from the time he enlisted until the time he separated from service. Within about 5 years after service, he was diagnosed with Type II diabetes. His wife offered testimony that he was on Lipitor to lower his cholesterol. He eventually died of a heart attack at age 42.

After getting the case successfully overturned on remand from the Court, something we do all the time as veterans disability lawyers, we hired two medical experts. Both medical experts essentially gave the opinion that the in-service onset to obesity represented the onset of metabolic syndrome which is a pre-cursor to Type II Diabetes and heart disease. One of the medical experts also cited research indicating a correlation between waist circumference and the development of metabolic syndrome and Type II Diabetes. The Board of Veterans Appeals came back with a favorable decision agreeing that the obesity did constitute an in-service event for which service-connection could be based. In other words, the development of obesity is a medically significant event in the same way that a car accident could be to the development of a low back disability. Therefore, it is important for any Veteran who is pursuing a service-connection claim for Type II Diabetes or cardiovascular disease, to consider whether or not he or she experienced a significant gain in weight during service or an elevation in blood pressure or cholesterol levels. Naturally, of course, if the Veteran was in Vietnam then the normal presumptive service-connection rules would apply with respect to ischemic heart disease and Type II Diabetes. However, if we are talking about cases where there is no Agent Orange exposure and the claim is for Type II Diabetes, then the Veteran and his advocate should look very carefully at the service medical records to ascertain the existence of weight gain and other factors that could be characterized as the tell-tale signs of the beginnings of metabolic syndrome. If you are in the middle of an appeal for service-connection for the cause of death and it is based upon Type II Diabetes or ischemic heart disease, please do not hesitate to contact our office to discuss the same. As veterans disability lawyers, we welcome any inquiry from a veteran or a surviving spouse in cases involving complex medical issues, such as the VA denial of heart disease, diabetes, stroke, cancer, or sleep apnea.

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