Citation Nr: 18145803 Decision Date: 10/30/18 Archive Date: 10/30/18 DOCKET NO. 15-21 222 DATE: October 30, 2018 REMANDED Entitlement to service connection for diabetes mellitus, type II, is remanded. Entitlement to service connection for sleep apnea, to include as secondary to diabetes mellitus, type II, and/or service-connected thoracolumbar scoliosis with degenerative disc disease, is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1979 to July 2005. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued in October 2013 by a Department of Veterans Affairs (VA) Regional Office. In January 2018, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. At such time, he waived Agency of Original Jurisdiction (AOJ) consideration of the evidence associated with the record since the issuance of the May 2015 statement of the case. 38 C.F.R. § 20.1304(c). Therefore, the Board may properly consider such evidence. The undersigned also held the record open for 60 days for the submission of additional evidence, which was received in February 2018. 38 U.S.C. § 7105(e)(1). Thereafter, additional evidence consisting of updated VA treatment records was associated with the record in March 2018. The Veteran has not waived AOJ consideration of such evidence. 38 C.F.R. § 20.1304(c). However, as the Veteran’s claims are being remanded, the AOJ will have an opportunity to review the newly received evidence such that no prejudice results to him in the Board considering such evidence for the limited purpose of issuing a comprehensive and thorough remand. 1. Entitlement to service connection for diabetes mellitus, type II. The Veteran contends that he developed diabetes mellitus, type II, during service as evidenced by high glucose readings and symptoms of erectile dysfunction and groin itching, and/or as a result of exposure to pharmaceutical chemicals such as acetone, acids, and powders while serving as a pharmacy specialist. In this regard, while the Veteran’s service treatment records are negative for any complaints, treatment, or diagnosis referable to erectile dysfunction, such reflect treatment on numerous occasions for a rash that was assessed as tinea cruris and urticaria in 1989 and 1990, and treatment for jock itch in August 1992. Additionally, in September 1993, the Veteran’s glucose was elevated at 112 mg/dL. Additional testing done during service reflect that his glucose was negative and/or within the normal range, but on the higher end, to include 105 mg/dL at his December 2004 retirement examination. The Veteran’s service personnel records reflect his military occupational specialty as a pharmacy specialist. Further, post-service treatment records reflect a diagnosis of glucose intolerance in November 2006 and diabetes mellitus, type II, in December 2012. Therefore, in light of the foregoing, the Board finds that a remand is necessary in order to afford the Veteran a VA examination so as to determine the nature and etiology of his diabetes mellitus, type II. 2. Entitlement to service connection for sleep apnea, to include as secondary to diabetes mellitus, type II, and/or service-connected thoracolumbar scoliosis with degenerative disc disease. The Veteran contends that he has sleep apnea as a result of his schedule during service that required him to be awake at odd hours or, in the alterative, as secondary to diabetes mellitus, type II, and/or his service-connected thoracolumbar scoliosis with degenerative disc disease. The Veteran’s service treatment records are negative for any complaints, treatment, or diagnosis referable to sleep apnea. However, he was diagnosed with such disorder in December 2012, and testified that he experienced symptoms related to sleep apnea, to include jerking awake, fatigue, and night sweats, during and since service. Additionally, in a February 2018 statement, his spouse alleged that, due to his diabetes mellitus, type II, he has developed many health conditions, to include sleep apnea. Finally, he is currently service-connected for thoracolumbar scoliosis with degenerative disc disease and has claimed that such disability prevents him from sleeping in non-apnea sleep positions. Therefore, in light of the foregoing, the Board finds that a remand is necessary in order to afford the Veteran a VA examination so as to determine the nature and etiology of his sleep apnea. The matters are REMANDED for the following action: 1. The Veteran should be afforded an appropriate VA examination in order to determine the nature and etiology of his diabetes mellitus, type II. The record, to include a copy of this Remand, must be made available to the examiner, and all indicated tests should be conducted. The examiner should address the following inquiries: (A) Is it at least as likely as not (i.e., a probability of 50 percent or greater) that the Veteran’s diabetes mellitus, type II, had its onset during, or is otherwise related to, his military service, to include his elevated glucose readings and/or exposure to pharmaceutical chemicals such as acetone, acids, and powders consistent with his duties pharmacy specialist. (B) Did the Veteran’s diabetes mellitus, type II, manifest within one year of his separation from service in July 2005, i.e., by July 2006? If so, please describe the manifestations. In offering the foregoing opinions, the examiner should consider whether the Veteran’s in-service complaints referable to tinea cruris, urticaria, and jock itch reflected the presence of diabetes mellitus, type II; his elevated glucose readings during service; and the diagnosis of glucose intolerance in November 2006 (approximately 16 months after his separation from service in July 2005). A complete rationale for any opinion offered should be provided. 2. The Veteran should be afforded an appropriate VA examination in order to determine the nature and etiology of his sleep apnea. The record, to include a copy of this Remand, must be made available to the examiner, and all indicated tests should be conducted. The examiner should address the following inquiries: (A) Is it at least as likely as not (i.e., a probability of 50 percent or greater) that the Veteran’s sleep apnea had its onset during, or is otherwise related to, his military service, to include his schedule that required him to be awake at odd hours and/or his reports of symptoms of jerking awake, fatigue, and night sweats. The examiner is advised that the sole basis of a negative opinion cannot be the fact that the Veteran’s service treatment records are silent as to any complaints, treatment, or diagnosis of sleep apnea. (B) Is it at least as likely as not (i.e., a probability of 50 percent or greater) that the Veteran’s sleep apnea is caused or aggravated by his thoracolumbar scoliosis with degenerative disc disease. For any aggravation found, the examiner should state, to the best of his or her ability, the baseline of symptomatology and the amount, quantified if possible, of aggravation beyond the baseline symptomatology by the aggravation. In offering such opinion, the examiner should consider the Veteran’s report that such disability prevents him from sleeping in non-apnea sleep positions. (C) Is it at least as likely as not (i.e., a probability of 50 percent or greater) that the Veteran’s sleep apnea is caused or aggravated by his diabetes mellitus, type II. For any aggravation found, the examiner should state, to the best of his or her ability, the baseline of symptomatology and the amount, quantified if possible, of aggravation beyond the baseline symptomatology by the aggravation. In offering such opinion, the examiner should consider the spouse’s statement that the Veteran developed many health conditions, to include sleep apnea, as a result of his diabetes mellitus. A complete rationale for any opinion offered should be provided. A. JAEGER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Tiffany Alston, Associate Counsel