Citation Nr: 18151601 Decision Date: 11/19/18 Archive Date: 11/19/18 DOCKET NO. 15-06 418 DATE: November 19, 2018 REMANDED Entitlement to service connection for diabetes mellitus, type II, to include as secondary to service-connected hypertension and post-traumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a May 2018 memorandum decision of the United States Court of Appeals for Veterans Claims (hereinafter “the Court”) that vacated and remanded this matter for additional development and adjudication. The Veteran originally filed his claim for service connection for diabetes in October 2011 and it was denied in a September 2012 rating decision. The Veteran filed a Notice of Disagreement in October 2012 and, ultimately, he appealed this matter to the Board in February 2015. In May 2016, the Board remanded this matter for a VA examination to consider the etiology of the Veteran’s diabetes and its relationship to the Veteran’s service-connected PTSD and hypertension. Once the matter returned to the Board, the Board denied the Veteran’s claim in a December 2016 decision, finding that the Veteran’s diabetes is not etiologically related to service and is not secondary to a service-connected disability. The Veteran appealed this matter to the Court and, in its May 2018 memorandum decision, the Court vacated the Board’s decision and remanded it back to the Board. Although the Board sincerely regrets the additional delay, this matter must be remanded for a new VA examination. VA’s duty to assist includes obtaining a medical examination or medical opinion when it is necessary to decide a claim. See 38 U.S.C. § 5103A(d) (2012). Furthermore, when VA undertakes to provide an examination or opinion, it must ensure that it is adequate. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). A medical examination or opinion is adequate if it considers the veteran’s medical history, if it describes the disability in sufficient detail, and if it sufficiently informs the Board of a medical expert’s opinion on the medical issue in question and the rational for that opinion. See Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007); Monzingo v. Shinseki, 26 Vet. App. 97, 105 (2012). With specific regard to claims for service connection on a secondary basis, a medical opinion is not adequate if it does not discuss whether a disability was both caused by and aggravated beyond its natural progression by the service-connected disability in question. Allen v. Brown, 7 Vet. App. 439 (1995). Pursuant to the Board’s May 2016 remand, the Veteran underwent a VA examination for his diabetes. In finding that the Veteran’s diabetes is not related to service or to his service-connected disabilities, the examiner stated only that “credible medical literature do not report [hypertension or PTSD] as a causative or risk factor for the development of diabetes mellitus.” This short, conclusory opinion, without supporting analysis, is not adequate to decide the claim. In addition, the examiner did not provide an adequate opinion as to whether the Veteran’s diabetes was aggravated by his service-connected hypertension or PTSD. She discussed the Veteran’s a1c hemoglobin levels in the context of an aggravation analysis, but she did not relate her findings to the Veteran’s service-connected disabilities. Furthermore, in finding that the Veteran’s diabetes had not worsened between 2004 and 2015, she relied only on measurements from those two years, thereby ignoring several measurements taken in the interim period that were higher than the 2004 baseline. Based on the foregoing, a remand is necessary to obtain a medical opinion that addresses the aggravation component of the Veteran’s service connection claim more thoroughly and that provides supporting rationale for all opinions expressed. In addition, in light of the remand, the Veteran should be provided an opportunity to submit additional evidence. The matter is REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for any records related to his diabetes mellitus, type II, that he wishes to have associated with the claims file. Make two requests for the authorized records, unless it is clear after the first request that a second request would be futile. 2. Obtain an addendum opinion from an appropriate clinician regarding the nature and etiology of the Veteran’s diabetes mellitus, type II. The clinician is asked to do the following: (a.) Opine whether the Veteran’s diabetes mellitus, type II, is at least as likely as not related to an in-service injury, event, or disease. (b.) Opine whether the Veteran’s diabetes mellitus, type II, is at least as likely as not (1) proximately due to any of the Veteran’s service-connected disabilities (and, specifically, hypertension and PTSD) or (2) aggravated beyond its natural progression thereby. In formulating this opinion, the examiner is asked to specifically consider all of the Veteran’s a1c measurements taken over the course of his treatment for diabetes. K. PARAKKAL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Freda J. F. Carmack, Associate Counsel