Citation Nr: 18141480 Decision Date: 10/10/18 Archive Date: 10/10/18 DOCKET NO. 15-34 804 DATE: October 10, 2018 REMANDED Entitlement to service connection for type 2 diabetes mellitus is remanded. Entitlement to service connection for bilateral upper extremity neuropathy of the 4th and 5th fingers, to include as due to coronary artery disease and/or type 2 diabetes mellitus is remanded. Entitlement to service connection for bilateral lower extremity peripheral neuropathy, to include as due to type 2 diabetes mellitus is remanded. Entitlement to service connection for erectile dysfunction, to include as due to type 2 diabetes mellitus, coronary artery disease, and a vascular condition is remanded. Entitlement to service connection for a vascular condition of the bilateral lower extremities, to include as due to coronary artery disease and/or type 2 diabetes mellitus, is granted. Whether new and material evidence has been received to reopen the claim of entitlement to service connection for bilateral hearing loss is remanded. Entitlement to automobile or other conveyance and adaptive equipment or adaptive equipment only is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1985 to September 1991. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2015 rating decision by the Department of Veterans Affairs (VA). The Board has combined and expanded the Veteran’s claims on appeal to encompass all similar disorders. See Clemons v. Shinseki, 23 Vet. App. 1 (2009) (the scope of a disability claim includes any disability that may reasonably be encompassed by the claimant’s description of the claim, reported symptoms, and the other information of record). Initially, the Board acknowledges the representative’s argument in a November 2015 statement that VA owes the Veteran a heightened duty to explain its findings and conclusions as it has been unable to obtain the Veteran’s service treatment records. However, the Veteran’s service treatment records were submitted to VA by the Veteran himself in September 2011. There is no indication that the records, which include his entrance and separation examinations, are not complete. 1. Entitlement to service connection for type 2 diabetes mellitus is remanded. 2. Entitlement to service connection for bilateral upper extremity neuropathy of the 4th and 5th fingers, to include as due to coronary artery disease and/or type 2 diabetes mellitus is remanded. 3. Entitlement to service connection for bilateral lower extremity peripheral neuropathy, to include as due to type 2 diabetes mellitus is remanded. In a June 2015 statement, the Veteran’s representative asserts that the claims file is missing highly pertinent medical record. Specifically, although the Veteran has reported being a diabetic since 1992, within a year of discharge from service, VA never obtained records from the Grand Island Nebraska VA Medical Center from this era. Instead, VA only obtained medical records from 1996 to 2000. As these medical records may be critical to demonstrating that the Veteran’s type 2 diabetes mellitus and any accompanying secondary conditions are related to service, VA should obtain these records upon remand. 4. Entitlement to service connection for erectile dysfunction, to include as due to type 2 diabetes mellitus, coronary artery disease, and a vascular condition is remanded. In addition to the reasons for a remand stated above, the Veteran’s erectile dysfunction claim requires an addendum medical opinion. The Veteran is seeking service connection for erectile dysfunction, to include as due to his other service-connected conditions. In a March 2015 opinion, a VA examiner stated that his erectile dysfunction was less likely than not proximately due to or the result of Lipitor, a medication for his coronary artery disease. Instead, it was “more than likely due to his other medical conditions.” Additionally, an examiner stated in a September 2015 addendum opinion that the erectile dysfunction is less likely than not aggravated beyond its natural progression by coronary artery disease or medications taken for the condition. The examiner further stated that there was no clinical evidence of any aggravation beyond the natural progression of the Veteran’s erectile dysfunction by the coronary artery disease. In this case, it appears the VA examiner did not ask whether the erectile dysfunction was simply caused by the Veteran’s coronary artery disease. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. See 38 U.S.C. 5103(d); Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Therefore, the Board will remand the claim for an addendum medical opinion. 5. Entitlement to service connection for a vascular condition of the bilateral lower extremities, to include as due to coronary artery disease and/or type 2 diabetes mellitus In addition to the reasons for a remand stated above, the Veteran’s vascular condition claim requires an addendum medical opinion. He is seeking service connection for a vascular condition, to include as due to coronary artery disease and/or type 2 diabetes mellitus. He underwent a VA examination in December 2014. The examiner noted that the Veteran reported high cholesterol levels during and after service. The examiner then concluded that the Veteran’s heart condition was at least as likely as not caused by his high cholesterol levels during service. With regards to his vascular condition, the examiner stated that it was most likely due to his very high cholesterol levels, smoking history, and type 2 diabetes mellitus. In a March 2015 addendum opinion, a VA examiner appears to try to clarify that the Veteran’s smoking history and diabetes contributed to a greater degree than his high cholesterol. In this case, it appears the VA examiner did not specify whether the Veteran’s vascular condition was etiologically related to his high cholesterol levels during and/or after service. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. See 38 U.S.C. 5103(d); Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Therefore, the Board will remand the claim for an addendum medical opinion. 6. Whether new and material evidence has been received to reopen the claim of entitlement to service connection for bilateral hearing loss is remanded. The missing treatment records from the Grand Island Nebraska VA Medical Center could potentially have bearing on the Veteran’s claim for bilateral hearing loss. Therefore, the Board must also remand this claim to obtain the outstanding treatment records. 7. Entitlement to automobile or other conveyance and adaptive equipment or adaptive equipment only is remanded. This issue is inextricably intertwined with the other issues currently on appeal, and must be deferred pending the outcome of these other claims. The matters are REMANDED for the following action: 1. Obtain and associate with the claims file any outstanding VA treatment records and private treatment records pertaining to the appeal. VA must attempt to obtain treatment records from the Grand Island Nebraska VA Medical Center as early as 1992. If the records cannot be located, a memorandum should be submitted into the record documenting all attempts to find the treatment records. 2. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s erectile dysfunction is at least as likely as not related to his service-connected coronary artery disease. 3. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s vascular condition is at least as likely as not related to his high cholesterol. The examiner should specify whether it was due to his high cholesterol during and/or after service. 4. Conduct any additional development deemed appropriate. Then, readjudicate all of the claims on appeal and issue a Supplemental Statement of the Case if appropriate. L. B. CRYAN Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Borman, Associate Counsel