Citation Nr: 18144875
Decision Date: 10/25/18	Archive Date: 10/25/18

DOCKET NO. 10-17 456
DATE:	October 25, 2018
REMANDED
Service connection for diabetes mellitus type II is remanded.
REASONS FOR REMAND
The Veteran served honorably from February 1968 to April 1979. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2008 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The claim has been remanded by the Board in November 2013 and June 2016 for further development. Unfortunately, there has not been substantial compliance with the Board’s previous remand directives regarding the issue of diabetes mellitus type II.  Another remand is required when the previously ordered exam is inadequate.  Stegall v. West, 11 Vet. App. 268, 271 (1998).  
The Veteran contends that his diabetes mellitus type II is service connected. He claims the present disability is residual from his service connected knee and back disabilities. The Veteran claims that his service connected injuries cause his inactivity which lead to his diabetes. The Veteran further claims that, while in service, he suffered from symptoms of polyuria and polydipsia, which were indications of his diabetes.
The September 2016 VA examination is inadequite. The examiner stated generally that diabetes is controlled in many patients by oral intake, and thus, is not residual to inactivity caused by the Veteran’s service connected knee and back disabilities. However, the examiner failed to specify whether inactivity, at least in part, contributed to the Veteran’s diabetes and, if so, whether that inactivity was in whole or in part related to service connected disability. 
Regarding the claim of polyuria and polydipsia as indicators of diabetes, the examiner failed to opine that, assuming the Veteran did have polyuria and polydipsia in service, his diabetes could be residual of those disabilities, or the symptoms associated with the named disabilities were an indication that the Veteran had diabetes. The examiner, per the December 2014 VA examination, found no record in the Veteran’s medical records of a diagnosis or complaints of symptoms related to polyuria or polydipsia. However, the Board finds the Veteran competant to observe symptoms associated with polyuria and polydipsia. Jandreau v. Nicholson, 492 F. 3d 1372, 1377 (2009).  Thus, the Board accepts that the Veteran did infact possess symptoms of polyuria and polydipsia, and the examiner failed to determine if those disabilities could have been an indication of his present diabetes. 
The matter is REMANDED for the following action:
If available to provide still further comment, obtain an addendum opinion from the examiner who rendered the September 2016 VA opinion. Otherwise the opinion must be rendered by someone with the necessary qualifications or competence to comment. The opinion must determine whether is at least as likely as not that diabetes mellitus is proximately due to, the result of, or aggravated by (beyond the natural progression of the disease) the service-connected knee and lumbar spine disabilities, to include symptoms caused by inactivity caused by these disorders. Further, the opinion must determine whether this Veteran’s diabetes mellitus can be controlled by oral intake alone, and is not affected by the Veteran’s inactivity. The examiner must also address whether the Veteran had signs or symptoms of diabetes mellitus in service to include polyuria and/or polydipsia, and if those signs or symptoms could have been an indication of diabetes mellitus. 
Explanatory rationale must be provided, regardless, citing to specific evidence in the file supporting conclusions. If the requested opinion cannot be provided without resorting to mere speculation, the examiner must state this and specifically explain why an opinion cannot be provided without resorting to mere speculation.
 
M. H. HAWLEY
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	Drew Kelly, Associate Counsel