Citation Nr: 18148828 Decision Date: 11/08/18 Archive Date: 11/08/18 DOCKET NO. 14-44 264 DATE: November 8, 2018 REMANDED Entitlement to service connection for diabetes mellitus, type II, is remanded. Entitlement to service connection for hypertension is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1982 to July 1982 and from January 2003 to January 2005, and he also had Reserve service. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a May 2012 rating decision. In May 2012, a VA examination found that the Veteran’s diabetes mellitus, type II, which clearly and unmistakably existed prior to his active duty service was clearly and unmistakably not aggravated beyond its natural progression by an in-service injury, event, or illness. The examiner stated that during his 2003-2005 active duty mobilization, the Veteran was able to remain complaint with diet and exercise and was able to remain on oral medication without complications, which indicated that the Veteran’s diabetes had not been aggravated beyond its normal progression during his active service. However, in June 2013, the Veteran submitted a statement and supporting service treatment records (STRs) which indicated that during the course of his 2003-2005 active service his diabetes and hypertension medications were increased. As the May 2012 VA examination did not address the Veteran’s documented medication adjustment in connection with his claims for service connection, the Board finds that the May 2012 VA examination is inadequate for adjudication purposes. Additionally, the May 2012 VA examiner stated that the Veteran’s hypertension was not worsened by the Veteran’s military service. The examiner did not undertake a hypertension examination of the Veteran or offer an opinion as to whether the Veteran’s hypertension had been aggravated beyond its normal progression by the Veteran’s active duty service. Therefore, the Board finds that in regard to the Veteran’s claim for hypertension, the May 2012 VA examination is inadequate for adjudication purposes. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). When an examination is inadequate, the Board must remand the case for further development. Bowling v. Principi, 15 Vet. App. 1 (2001), 38 C.F.R. § 4.2. Accordingly, these matters are REMANDED for the following action: 1. Schedule the Veteran for an appropriate examination, by a physician (M.D.), to determine the nature and likely etiology of his diabetes mellitus, type II, and hypertension. The claims file and all pertinent records must be made available to the examiner for review. The examiner should be notified of the Veteran’s specific periods and types of service. Based on the examination and review of the record, the examiner should address the following: a. Is there (i) clear and unmistakable (obvious, manifest, and undebatable) evidence that the Veteran’s diabetes mellitus, type II, and hypertension preexisted the Veteran’s service and (ii) if so, is there also clear and unmistakable (obvious, manifest, and undebatable) evidence that diabetes mellitus, type II, and hypertension were NOT aggravated (i.e., permanently worsened) during or by his active duty service, meaning exacerbated beyond their natural progression? A discussion of the facts and medical principles involved as well as the Veteran’s lay assertions should be addressed in giving this opinion. The examiner is specifically asked to address the Veteran’s contention that his increase in diabetes mellitus, type II, and hypertension medications during his active duty service evidence a worsening or aggravation of these disabilities. The examiner must explain the rationale for all opinions, citing to supporting clinical data and/or medical texts or treatises as deemed appropriate. If the examiner determines that a requested opinion cannot be given without resort to speculation, the examiner must explain the reason for that conclusion. LESLEY A. REIN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Parrish, Associate Counsel