Citation Nr: 18145838 Decision Date: 10/30/18 Archive Date: 10/30/18 DOCKET NO. 16-24 699A DATE: October 30, 2018 ORDER Entitlement to service connection for Parkinson's disease is granted. REMANDED Entitlement to service connection for diabetes mellitus, type II, is remanded. FINDINGS OF FACT 1. The Veteran served in the Republic of Vietnam and is therefore presumed to have been exposed to herbicide agents such as Agent Orange. 2. The Veteran has a current diagnosis of Parkinson’s disease. CONCLUSION OF LAW The criteria for entitlement to service connection for Parkinson's disease have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1155, 5107; 38 C.F.R. §§ 3.102, 3.303; 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty in the United States Army from June 1969 to June 1975, including service in the Republic of Vietnam. 1. Entitlement to service connection for Parkinson's disease The Veteran seeks to establish service connection for Parkinson’s disease, which he has alleged is due to exposure to herbicide agents while serving in the Republic of Vietnam. Pertinent VA law and regulations provide that service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110 (2012); 38 C.F.R. § 3.303 (2018). Generally, this requires (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); 38 C.F.R. § 3.303(d). Alternatively, service connection may be established either by showing that a chronic disability or disease was incurred during service and later manifestations of such chronic disability or disease are not due to intercurrent cause(s) or that a disorder or disease was incurred during service and there is evidence of continuity of symptomatology which supports a finding of chronicity since service. 38 C.F.R. § 3.303(b). When a chronic disease becomes manifest to a degree of 10 percent within one year of a veteran’s discharge from service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the veteran’s period of service. 38 U.S.C. § 1112 (2012); 38 C.F.R. §§ 3.307, 3.309 (2018). VA laws and regulations provide that, if a Veteran was exposed to Agent Orange during service, certain listed diseases are presumptively service-connected if they manifest to a compensable degree at any time after service. 38 U.S.C. § 1116(a)(1); 38 C.F.R. § 3.307(a). Parkinson’s disease is listed among the diseases presumed to be associated with Agent Orange exposure. 38 U.S.C. § 1116(a)(2)(H); 38 C.F.R. § 3.309(e). Here, in the September 2015 VA examination, the examiner indicated that the Veteran is not and has never been diagnosed with Parkinson’s disease. However, more recent private treatment records show that the Veteran has a current diagnosis of Parkinson’s disease. Specifically, in February 2016, May 2016, and February 2017, two separate private treatment providers indicated that the Veteran is now diagnosed with Parkinson’s disease. Based on the Veteran’s conceded in-service exposure to herbicides, the Board finds that Parkinson’s disease is presumed to have been incurred in service. 38 C.F.R. §§ 3.307, 3.309 (2018). Service connection for Parkinson’s disease therefore has been established. 38 U.S.C. § 5107 (b) (2012); 38 C.F.R. § 3.102 (2018). REASONS FOR REMAND Remand is necessary to obtain a new VA examination. When VA undertakes to obtain an opinion, it must ensure that the opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). A medical opinion is considered adequate “where it is based on consideration of the veteran’s prior medical history and examinations and also describes the disability, if any, in sufficient detail so that the Board’s evaluation of the claimed disability will be a fully informed one.” Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). 1. Entitlement to service connection for diabetes mellitus, type II, is remanded. Here, in the September 2015 VA diabetes examination, the examiner found that the Veteran did not have a current diagnosis of diabetes mellitus. The examiner indicated that the Veteran had an impaired fasting glucose in 2012 that was managed by restricted diet. The examiner noted that the Veteran was treated by a diabetic care provider less than two times per month. The examiner remarked that the Veteran did not meet the diagnostic criteria for diabetes mellitus at that time. However, the examiner did not offer an opinion regarding the Veteran’s May 2015 diagnosis of diabetes mellitus from a private treatment provider or an opinion on the etiology of the Veteran’s impaired fasting glucose. Therefore, a remand is required to obtain an additional VA examination to determine whether the Veteran is currently diagnosed with diabetes mellitus, type II. The matters are REMANDED for the following action: 1. Obtain any outstanding VA and private treatment records and associate them with the claims file. Any efforts to obtain the records must be clearly documented in the claim file. 2. Obtain a VA examination from an appropriate clinician to determine the nature and etiology of the Veteran’s diabetes mellitus, type II, and/or his impaired fasting glucose. The examiner must clarify whether the Veteran is currently diagnosed with diabetes mellitus, type II, or whether he has been so diagnosed at any point during the appeal period. If the Veteran is not found to have diabetes mellitus, type II, the examiner must opine as to whether it is at least as likely as not that any impaired fasting glucose is related to the Veteran’s service, including his service in the Republic of Vietnam and his conceded exposure to Agent Orange. The examiner must discuss the 2012 findings of impaired fasting glucose, as well as the May 2015 private diagnosis of diabetes mellitus, in the context of any opinion that diabetes mellitus is not present. CAROLINE B. FLEMING Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Thompson, Associate Counsel