Citation Nr: 18151551 Decision Date: 11/19/18 Archive Date: 11/19/18 DOCKET NO. 15-43 943 DATE: November 19, 2018 REMANDED Service connection for diabetes mellitus type two is remanded. Service connection for complications of diabetes, including but not limited to loss of vision is remanded. Service connection for coronary artery disease, claimed as heart problem is remanded. Service connection for sleep apnea is remanded. REASONS FOR REMAND This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R § 20.900(c). Veteran served on active duty with the United States Army from October 1948 to October 1951. In determining whether the duty to assist requires that a VA medical examination be provided or medical opinion obtained with respect to a veteran's claim for benefits, there are four factors for consideration. These four factors are: (1) whether there is competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) whether there is evidence establishing that an event, injury, or disease occurred in service, or evidence establishing certain diseases manifesting during an applicable presumption period; (3) whether there is an indication that the disability or symptoms may be associated with the veteran's service or with another service-connected disability; and (4) whether there otherwise is sufficient competent medical evidence of record to make a decision on the claim. 38 U.S.C. § 5103A (d); 38 C.F.R. § 3.159 (c)(4). The threshold for determining a possibility of a nexus to service is a low one. McLendon v. Nicholson, 20 Vet. App. 79 (2006). The Veteran is service connected for posttraumatic stress disorder (PTSD), and records reflect current diagnoses of the claimed conditions. He alleges service connection as secondary to PTSD, directly or indirectly, and has submitted several articles which tend to support his allegations. Examinations are therefore required. Accordingly, the matters are REMANDED for the following action: 1. Schedule the Veteran for a VA diabetes examination; the claims folder must be reviewed in conjunction with the examination. The examiner must state whether diabetes mellitus is diagnosed, and if so, whether such is at least as likely as not related to military service, to include as secondary to service connected PTSD. In so opining, the examiner must discuss the allegation that PTSD has caused an unhealthy lifestyle leading to diabetes. The articles cited in the October 2018 appellant's brief must be discussed. 2. Schedule the Veteran for a VA eye examination; the claims folder must be reviewed in conjunction with the examination. The examiner must state whether any current eye condition is diagnosed, and if so, whether such is at least as likely as not related to military service, to include as secondary to PTSD. In so opining, the examiner must discuss the allegation that PTSD has caused an unhealthy lifestyle leading to diabetes. The articles cited in the October 2018 appellant’s brief must be discussed. 3. Schedule the Veteran for a VA heart examination; the claims folder must be reviewed in conjunction with the examination. The examiner must state whether coronary artery disease or another heart condition is diagnosed, and if so, whether such is at least as likely as not related to military service, to include as secondary to service connected PTSD. In so opining, the examiner must discuss the allegation that PTSD has caused an unhealthy lifestyle leading to diabetes. The articles cited in the October 2018 appellant’s brief must be discussed. 4. Schedule the Veteran for a VA sleep apnea examination; the claims folder must be reviewed in conjunction with the examination. The examiner must state whether sleep apnea is diagnosed, and if so, whether such is at least as likely as not related to military service, to include as secondary to service connected PTSD. In so opining, the examiner must discuss the allegation that PTSD has caused an unhealthy lifestyle leading to diabetes. The articles cited in the October 2018 appellant’s brief must be discussed. 5. A full and complete rationale for any opinion expressed is required. If the examiner feels that the requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e. no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e. additional facts are required, or the examiner does not have the needed knowledge or training). Jones v. Shinseki, 23 Vet. App. 382 (2010). 6. Upon completion of the above, and any additional development deemed appropriate, readjudicate the remanded issue. If the benefits sought remain denied, the Veteran should be provided with a supplemental statement of the case. The case should then be returned to the Board for appellate review if otherwise in order. WILLIAM H. DONNELLY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Emily A. Kotroco, Law Clerk