Citation Nr: 18148014 Decision Date: 11/07/18 Archive Date: 11/06/18 DOCKET NO. 10-07 818 DATE: November 7, 2018 REMANDED Entitlement to service connection for hiatal hernia is remanded. Entitlement to service connection for diabetes mellitus is remanded. Entitlement to service connection for the left side of the body being smaller than the right side of the body is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from April 1974 to April 1978. These matters come before the Board of Veterans’ Appeals (Board) on appeal from September 2008 and June 2011 rating decisions. The Veteran testified at an August 2016 videoconference hearing before the Board; a transcript of the hearing is associated with the record. These matters were previously before the Board in January 2017 and October 2017. 1. Entitlement to service connection for hiatal hernia is remanded. The November 2017 VA examination addendum provided the same rationale for its opinion regarding hiatal hernia as it did in the March 2017 VA examination. This rationale is insufficient because the VA examination presented only facts without explaining the significance of those facts to the claimed condition. This issue must be addressed on remand. 2. Entitlement to service connection for diabetes mellitus is remanded. The November 2017 VA examination addendum found that the Veteran did not have a current diagnosis of diabetes mellitus. This is contradicted by the VA medical center (VAMC) records, however, which diagnose and address diabetes mellitus throughout the records. Thus, an additional VA medical opinion is necessary to justify the finding of no diabetes mellitus with the VAMC records that document it. In addition, the October 2017 Remand stated that the diabetes mellitus issue should be addressed by an endocrinologist. It is unclear whether the November 2017 VA examination addendum was provided by an endocrinologist. See Stegall v. West, 11 Vet. App 268, 271 (1998) (holding that the Board errs as a matter of law when it fails to ensure compliance with its remand orders). 3. Entitlement to service connection for the left side of the body being smaller than the right side of the body is remanded. The November 2017 VA examination addendum provided the same rationale for its opinion regarding the left side being smaller than the right side as it did in the March 2017 VA examination. This rationale was found insufficient because it did not address the October 2001 private examination finding that the girth of the Veteran’s right arm was ½ inch larger than the left. The November 2017 VA examination addendum also did not address the ½ inch finding; therefore, the issue must be remanded. See Stegall v. West, 11 Vet. App 268, 271 (1998). The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s hiatal hernia is at least as likely as not related to service, to include in-service surgery on a non-cancerous tumor. The examiner must also consider the Veteran’s reports of symptoms since service. 2. Obtain an addendum opinion from an endocrinologist regarding (a.) Whether the Veteran has a current diagnosis of diabetes mellitus or had such a diagnosis at any time during the pendency of the claim. (b.) Whether diabetes mellitus is at least as likely as not related to service, to include in-service surgery on a non-cancerous tumor and any low glucose readings. The clinician must specifically address a November 1977 service treatment record showing a glucose level of 69 two hours after eating and a document from the Bluefield Regional Medical Center’s Diabetes Management Program. The document notes “when your body doesn’t make enough insulin to keep the insulin/glucose balance, or when the insulin you do doesn’t work as well as it should, you have diabetes.” 3. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s left side being smaller than the right side is at least as likely as not related to service, to include in-service surgery on a non-cancerous tumor. The clinician must specifically address the October 2001   private medical finding that the Veteran’s right arm girth is ½ inch larger than the left. M. H. HAWLEY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD W. Ripplinger, Associate Counsel