Citation Nr: 0018339 Decision Date: 07/13/00 Archive Date: 07/14/00 DOCKET NO. 98-10 030 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Albuquerque, New Mexico THE ISSUE Entitlement to service connection for diabetes mellitus. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESSES AT HEARING ON APPEAL Appellant and his spouse ATTORNEY FOR THE BOARD T. Mainelli, Associate Counsel INTRODUCTION The appellant had active service from May 1976 to May 1982. This case comes before the Board of Veterans' Appeals (the Board) on appeal from an April 1998 rating decision, in which the Albuquerque, New Mexico, Regional Office (RO) of the Department of Veterans Affairs (VA) denied service connection for diabetes mellitus. In June 1996, the appellant submitted medical evidence which had not previously been considered by the RO as well as a waiver of RO consideration of this evidence in the first instance. The Board will proceed accordingly. See 38 C.F.R. § 20.1304(c) (1999). The Board notes that, during his appearance before the undersigned in March 2000, the appellant raised the issue of service connection for a transient ischemic attack as secondary to his diabetes mellitus. This issue is referred to the RO for appropriate action. FINDINGS OF FACT 1. The appellant has presented competent medical evidence of the onset of diabetes mellitus in service. 2. The appellant has presented a plausible claim for service connection for diabetes mellitus, and VA has a further duty to assist him in the development of his claim. CONCLUSION OF LAW The claim for service connection for diabetes mellitus is well grounded, and there is a further statutory duty to assist the appellant in developing facts pertinent to his claim. 38 U.S.C.A. § 5107(a) (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSION The appellant contends that his diabetes mellitus was first manifested in service. In support of his claim, he appeared before the undersigned in March 2000 and testified to his belief that his diabetes mellitus was first manifested by his in- service history of high blood sugar levels. He further testified that he was diagnosed with diabetes mellitus within one year from his separation from service. At that time, he recalled being prescribed Metformin and Glyburide while being treated at Cannon Air Force Base (AFB) in New Mexico. He also identified other pertinent medical records since his separation in May 1982 which included yearly physical examinations by the State of New Mexico and treatment at VA clinics in Clovis and Amarillo. His wife corroborated his testimony of diagnosis of, and treatment for, diabetes mellitus within one year from his separation from service. The appellant's induction examination, dated in January 1976, was essentially unremarkable with a urinalysis which was negative for albumin or sugar. His service medical records are negative for diagnosis of diabetes mellitus, but there is documentation of an abnormally high glucose reading of 124 mg%, as opposed to a stated normal range from 065 mg% to 110 mg%, on a blood test dated in December 1980. In January 1982, a blood test revealed a glucose reading of 116 mg%, but a urinalysis taken at that time was negative for glucose. On his retirement examination, dated in February 1982, he denied a history of "sugar or albumin in urine." The examiner noted diagnoses of obesity and elevated fasting blood sugars (FBS), but his physical examination was negative for a diagnosis of diabetes mellitus. Post- service, the first available medical record consists of a VA examination report, dated in July 1982, which is essentially unremarkable with a urinalysis negative for glucose. A May 1985 blood test conducted at Cannon AFB first reveals an abnormally high glucose reading of 170 mg/dl. In July 1985, the appellant reported a history of "borderline" diabetes. A May 1988 blood test study revealed an abnormally high glucose reading of 116 mg/dl. Thereafter, his VA clinical records first reveal a diagnosis of non- insulin dependent diabetes mellitus (NIDDM) in May 1996. At that time, he reported a history of NIDDM of "1.5 y[ears]" duration. His subsequent VA and private clinical records reveal treatment for diabetes mellitus with Metformin and Glyburide. In a letter dated in May 2000, George E. Evetts, M.D., indicated that he had been treating the appellant for arthritis and NIDDM for approximately one year. Dr. Evetts indicated that his review of the appellant's service medical records revealed elevated abnormal blood sugars. Dr. Evetts further provided opinion that it would "probably be clear" that the appellant was developing NIDDM in service, and that the appellant "certainly had probably treatable elevated blood sugars during the time he was in the military." The Board finds that the opinion offered by Dr. Evetts is sufficient to well ground the appellant's claim for diabetes mellitus. See Caluza v. Brown, 7 Vet.App. 498 (1995). As addressed in the remand below, the Board is of the opinion that further development of this claim is warranted prior to any further adjudication. ORDER The claim of entitlement to service connection for diabetes mellitus is well grounded. To this extent only, the appeal is granted. REMAND As the claim of claim of entitlement to service connection for diabetes mellitus is well grounded, VA may undertake development to assist the appellant in developing facts pertinent to his claim. See Morton, 12 Vet.App. at 486 (1999). As noted above, the appellant has identified additional treatment records which may be pertinent to his claim on appeal. As such, the RO should attempt to obtain the appellant's clinical records from Cannon AFB, the State of New Mexico and VA clinics in Clovis and Amarillo since May 1982 prior to any further adjudication. Thereafter, the appellant should be afforded VA examination, by an endocrinologist, in order to determine the date of onset of his diabetes mellitus. Accordingly, this case is REMANDED for the following action: 1. The RO should obtain the appellant's clinical records, to include yearly physical examination reports, from Cannon AFB and the State of New Mexico since May 1982, and associate those records with the claims folder. 2. The RO should obtain the appellant's clinical records, both inpatient and outpatient, from the VA clinics in Clovis and Amarillo since May 1982, and associate those records with the claims folder. 3. The appellant is hereby advised that he has the right to submit additional evidence and argument on the matter in question while this case is in remand status. Kutscherousky v. West, 12 Vet. App. 369 (1999). 4. Thereafter, the appellant's claims file should be reviewed by a VA endocrinologist for the purpose of determining the approximate date of onset of his diabetes mellitus. In this regard, the examiner should express opinion as to whether it is least likely as not that the appellant's diabetes mellitus was first manifested during his period of active service and/or to a degree of 10 percent or more within one year from his discharge from service? The reasoning which forms the basis of the opinion should be set forth. The claims folder and a copy of this remand should be made available to the examiner. 4. After completion of the above, the RO should readjudicate the issue of service connection for diabetes mellitus with consideration given to all of the evidence of record, including any additional evidence obtained by the RO pursuant to this remand. If any benefit sought on appeal, for which a notice of disagreement has been filed, remains denied, the appellant and his representative should be furnished a Supplemental Statement of the Case and given the opportunity to respond thereto. Thereafter, the case should be returned to the Board, if in order. The Board intimates no opinion as to the ultimate outcome of this case. The appellant need take no action unless otherwise notified. This claim must be afforded expeditious treatment by the RO. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See The Veterans' Benefits Improvements Act of 1994, Pub. L. No. 103-446, § 302, 108 Stat. 4645, 4658 (1994), 38 U.S.C.A. § 5101 (West Supp. 1999) (Historical and Statutory Notes). In addition, VBA's Adjudication Procedure Manual, M21-1, Part IV, directs the ROs to provide expeditious handling of all cases that have been remanded by the Board and the Court. See M21-1, Part IV, paras. 8.44- 8.45 and 38.02-38.03. NANCY I. PHILLIPS Member, Board of Veterans' Appeals