Citation Nr: 1003256 Decision Date: 01/22/10 Archive Date: 02/01/10 DOCKET NO. 06-34 424 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Atlanta, Georgia THE ISSUES 1. Entitlement to service connection for renal glycosuria. 2. Entitlement to service connection diabetes mellitus, type II, including as secondary to renal glycosuria. 3. Entitlement to a disability rating in excess of 30 percent for hypertensive heart disease. 4. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities. REPRESENTATION Appellant represented by: Georgia Department of Veterans Services WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD A. Lindio, Associate Counsel INTRODUCTION The Veteran had active duty service from February 1972 until November 1988. This matter comes before the Board of Veterans' Appeals (BVA or Board) on appeal from an April 2005 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO) in Atlanta, Georgia. The Veteran appeared before the undersigned Veterans Law Judge at a Board hearing held at the RO in October 2009. The Board notes that the Veteran raised additional claims for increased ratings in August 2007, which were adjudicated by the RO in an August 2008 rating decision. The Veteran subsequently provided a Notice of Disagreement in February 2009 in regards to the claims for hypertensive heart disease and unemployability. However, a September 2009 letter from the RO appeared to continue the Veteran's claims to include for increased ratings for hypertension, hemorrhoids, the bilateral knees, and the right ankle. The RO/AMC should contact the Veteran and determine whether he still wishes to pursue these claims. These matters are not before the Board because they have not been prepared for appellate review. Accordingly, these matters are REFERRED to the RO for appropriate action. The appeal is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the appellant if further action is required. REMAND The Veteran seeks service connection for renal glycosuria, essentially contending that it is a disability that he has had since service. He further claims that his current diabetes mellitus, type II, developed secondary to his renal glycosuria. He has also raised claims for an increased rating for his service-connected hypertensive heart disease and for entitlement to TDIU. The Board observes that Glycosuria is "the presence of glucose in the urine, especially excretion of an abnormally large amount in the urine." Renal glycosuria is "glycosuria occurring when there is only the normal amount of sugar in the blood, due to inability of the renal tubules to reabsorb glucose completely." It is also called non- diabetic or normoglycemic glycosuria and renal diabetes. Dorland's Illustrated Medical Dictionary 787 (30th ed. 2003). The Board further notes that renal tubular disorders, such as renal glycosuria, is a ratable disorder for which service connection may be granted under 38 C.F.R. § 4.115b, Diagnostic Code 7532 (2009). The Veteran's service treatment records generally indicate numerous findings of his having renal glycosuria, as indicated in a July 1975 examination. A June 1975 STR found the Veteran to have a non-diabetic disorder. An October 1981 STR noted that the Veteran had a past medical history, including glycosuria, which was negative for diabetes mellitus and thought to be a low renal threshold. His September 1988 examination prior to separation noted that the Veteran had moderate glucose in his urine and referred him for an internal medicine consult. The October 1988 consult found him to have essential hypertension, uncontrolled, at present related to medication non-compliance and chondromalacia. A November 1988 internal medicine clinic record, following laboratory reports, found him to have glycosuria of unknown etiology. Although the Veteran did have glycosuria in service, the medical records are silent as to any findings of glycosuria in the years following his service. The record indicates repeated treatments for hypertension, as well as several laboratory tests. However, the records do not note any current findings of or tests specifically for glycosuria. The record does indicate that the Veteran has been diagnosed with diabetes, due to his sugars, in April 2004. It does not appear that the Veteran has been afforded a VA examination in regards to his claimed renal glycosuria or diabetes mellitus, type II, including as secondary to his renal glycosuria. A VA examination should be provided to determine the nature, extent, onset, and etiology of the claimed renal glycosuria disorder and whether it is a chronic disorder that still afflicts the Veteran, and if so if it has resulted in the Veteran's current diabetes mellitus, type II; or whether the currently diagnosed diabetes is otherwise related to service. Assistance by VA includes obtaining a medical opinion when such an opinion is necessary to make a decision on a claim. 38 U.S.C.A. § 5103A(d) (West 2002 & Supp. 2009); 38 C.F.R. § 3.159(c)(4) (2009). Under the circumstances, because of the Veteran's documented history of renal glycosuria and currently diagnosed diabetes, the Board finds that this assistance is necessary in order to fulfill the mandate of the VCAA. Additionally, the Veteran filed a Notice of Disagreement in regards to the August 2008 rating decision denying claims for an increased rating for hypertensive heart disease and entitlement to TDIU. In his October 2009 hearing testimony, the Veteran indicated that he was continuing his appeal of those claims. In an February 2009 Notice of Disagreement, the Veteran reported that he had been awarded disability benefits from the Social Security Administration (SSA) due to his service- connected hypertensive heart disease. Given the Veteran's current claim, these records appear to be especially relevant. As such, VA is obliged to attempt to obtain and consider those SSA records. 38 U.S.C.A. § 5103A(c)(3) (West 2002); 38 C.F.R. § 3.159(c)(2) (2006); see also Diorio v. Nicholson, 20 Vet. App. 193, 199-200 (2006); Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002). To date, the Veteran has not been issued a Statement of the Case (SOC) for those issues and under the circumstances the Board has no discretion and must remand this matter for issuance of an SOC. See Manlicon v. West, 12 Vet. App. 238 (1999); Fenderson v. West, 12 Vet. App. 119, 131-132 (1999). Accordingly, the case is REMANDED for the following actions: 1. The RO/AMC should request, directly from the SSA, complete copies of any disability determination(s) it has made concerning the Veteran, as well as copies of the medical records that served as the basis for any such decision(s). All attempts to fulfill this development must be documented in the claims file. If the search for any such records yields negative results, that fact should be clearly noted and the Veteran must be informed in writing. 2. A Statement of the Case should be issued to the Veteran concerning the claims for an increased rating for hypertensive heart disorder and entitlement to TDIU. The Veteran should be advised of the necessity of filing a timely substantive appeal if he wants the Board to consider these issues. 3. After the requested medical records are associated with the claims file, the RO/AMC should arrange for the Veteran to undergo an appropriate VA examination to determine the nature, extent, onset, and etiology of any renal glycosuria and/or diabetes mellitus, if found to be currently present. The claims folder should be made available to and be reviewed by the examiner. All indicated studies should be performed, and all findings should be reported in detail. In conjunction with the examination, the examiner shall render the following opinions: A) In regard to renal glycosuria, the examiner shall opine as to whether it is at least as likely as not (that is, at least a 50 percent or more degree of probability) that any renal glycosuria found to be present was incurred in, or aggravated by, service. The opinion should include a discussion of whether the Veteran's claimed renal glycosuria disorder is a chronic disorder that has continued since service. B) In regard to diabetes mellitus, the examiner shall opine as to whether it is at least as likely as not (that is, at least a 50 percent or more degree of probability) that any diabetes mellitus found to be present was incurred in, or aggravated by, service. This shall include and opinion as to whether it is at least as likely as not that any current diabetes mellitus is due to his in-service and or current renal glycosuria. In discussing his/her opinions, the examiner should acknowledge the Veteran's lay statements of record relating to the onset of the Veteran's disorder, as well as the medical evidence of record, including service medical records. The rationale for all opinions expressed should be provided in a legible report. 4. When the development requested has been completed, the case should again be reviewed by the RO/AMC on the basis of the additional evidence. If the benefit sought is not granted, the Veteran should be furnished a Supplemental Statement of the Case, and be afforded a reasonable opportunity to respond before the record is returned to the Board for further review. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. 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 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2009). _________________________________________________ JONATHAN B. KRAMER Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (2006).