Citation Nr: 18100445 Decision Date: 04/13/18 Archive Date: 04/13/18 DOCKET NO. 14-30 964 DATE: April 13, 2018 ISSUES DECIDED: 0 ISSUES REMANDED: 1 REMANDED ISSUE Entitlement to service connection for diabetes mellitus, type II is remanded for additional development. The Veteran served on active duty from November 1985 to March 2006. In April 2016, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. The Veteran contends that his current diabetes is related to the in-service elevated levels of glucose, triglycerides, and cholesterol. He stated that he had high blood sugar and was considered obese by the military, and stated that these were precursors to diabetes. An unsigned, undated statement received in 2014, indicated that it was clear, based on the 2001 National Cholesterol Education Program/ATP III Guidelines that the Veteran suffered from metabolic syndrome during his service based on hyperglycemia, hypertriglyceridemia, and a low HDL. The physician noted that the Veteran was also obese based on a body mass index (BMI) of over 30 and attended a weight loss program. An assessment of possible Tangiers disease was also made. The document noted that he also had impaired fasting glucose while in service which is a precursor for diabetes mellitus. The Veteran underwent VA examination in January 2015 and the examiner provided a negative nexus opinion. In this regard, the examiner stated that the 2014 VA medical opinion noted the Veteran had elevated fasting glucose levels in the military, but stated that there was no objective evidence that any of the cited labs were fasting. Moreover, the examiner noted that at the time the Veteran was in the military, the glucose normal range was 70-110, so only one of the labs potentially represented a minimal glucose elevation. She stated that the pre-discharge examination did not report any diagnoses of diabetes mellitus, impaired glucose testing or hyperglycemia or metabolic syndrome. Post-military, the Veteran had normal glucose values on his initial 2006 VA evaluation. He did not have elevated glucose values until August 2007, more than one year after his military separation. However, the examiner did not explain why the Veteran’s diabetes was not a maturation of the elevated glucose in service and did not address the significance of the elevated triglycerides and cholesterol. In light of the above, an addendum opinion would be helpful in adjudicating the Veteran’s claim. Updated VA treatment records should also be obtained. The matter is REMANDED for the following actions: 1. Ask the Veteran to provide the names and addresses of all medical care providers who have recently treated him for his diabetes mellitus. After securing any necessary releases, the AOJ should request any relevant records identified. In addition, obtain updated VA treatment records. If any requested records are unavailable, the Veteran and his representative should be notified of such. 2. After the above development has been completed to the extent possible, send the claims file to the January 2015 examiner, if available to obtain an addendum medical opinion. If the examiner is not available, the claims file should be sent to another appropriate examiner. If a new examination is deemed necessary to respond to the question below, one should be scheduled. Following review of the claims file, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the current diabetes mellitus is a maturation of elevated glucose readings in service. The examiner should explain why or why not, to include discussing the significance if any, of the elevated cholesterol and triglycerides, and the Veteran’s contention that these elevated levels and the fact that he was obese during service led to his diabetes. A rationale for all opinions expressed should be provided. 3. After undertaking the development above and any additional development deemed necessary, the Veteran’s claim should be readjudicated. If the benefit sought on appeal remains denied, the Veteran and his representative should be furnished a supplemental statement of the case and be given an appropriate period to respond thereto before the case is returned to the Board, if in order. K. A. BANFIELD Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Medina, Associate Counsel