Citation Nr: 18150205 Decision Date: 11/14/18 Archive Date: 11/14/18 DOCKET NO. 14-43 104 DATE: November 14, 2018 REMANDED Entitlement to service connection for diabetes mellitus, type II, as secondary to a service connected left knee disability is remanded. Entitlement to a total disability evaluation based on individual unemployability due to service-connected disabilities (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1965 to March 1968. These matters come before the Board of Veterans’ Appeals (Board) on appeal from an April 2014 rating decision. In September 2013, the Veteran sought service connection for diabetes mellitus, type II, as secondary to his service connected left knee disability. A March 2013 VA examination of the Veteran’s diabetes indicated that it was less likely as not that the Veteran’s diabetes was proximately due to or the result of his service connected left knee disability. However, the March 2013 VA examiner’s opinion did not address whether the Veteran’s diabetes was aggravated by his left knee disability. Pursuant to 38 C.F.R. § 3.310, a disability which is proximately due to or the result of a service-connected disease shall be service connected, to include based on aggravation. See also Allen v. Brown, 7 Vet. App. 439 (1995). Thus, the Board finds the March 2013 VA examination 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). Additionally, the Board finds that the Veteran’s claim for TDIU is inextricably intertwined with his claim for service connection for diabetes on appeal. The appropriate remedy where a pending claim is inextricably intertwined with a claim currently on appeal is to remand the claim on appeal pending the adjudication of the inextricably intertwined claim. Harris v. Derwinski, 1 Vet. App. 180 (1991). The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA medical examination by a physician (M.D.) to determine the nature and etiology of his diabetes mellitus, type II. The claims file, including a copy of this Remand, must be made available to the examiner and the examiner should indicate in his/her report whether such was reviewed. All necessary tests and studies should be accomplished. The examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s diabetes had onset in service or within one year following separation from service, or was causally related to service; or was caused or aggravated (worsened beyond its natural progression) by his service-connected left knee disability. The examiner must provide a complete rationale on which his/her opinion is based, and must include a discussion of the medical principles as applied to the medical evidence and facts used in establishing his or her opinion. The Veteran’s lay assertions as to onset and continuity and symptomatology should be recorded and considered. The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of a conclusion as it is to find against it. The examiner should note that the term “aggravated by” refers to a chronic or permanent worsening of the underlying condition, as contrasted to mere temporary or intermittent flare-ups of symptoms that resolve and return to the baseline level of disability. (Continued on the next page)   If the examiner finds that he/she cannot provide an opinion without resorting to speculation, he/she should explain the inability to provide an opinion. LESLEY A. REIN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Parrish, Associate Counsel