Citation Nr: 19123328 Decision Date: 03/27/19 Archive Date: 03/27/19 DOCKET NO. 17-52 612 DATE: March 27, 2019 ORDER Service connection for melioidosis is granted. REMANDED Entitlement to service connection for diabetes mellitus is remanded. FINDING OF FACT The Veteran’s melioidosis is reasonably shown to be due to an event in service. CONCLUSION OF LAW Service connection for melioidosis is warranted. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The appellant is a Veteran who served on active duty from April 1967 to December 1985. These matters are before the Board of Veterans’ Appeals (Board) on appeal of a July 2016 Department of Veterans Affairs (VA) rating decision. His October 2017 substantive appeal limited the appeal to the issues of service connection for melioidosis and diabetes mellitus. Therefore, the July 2016 rating decision is final with regard to the claims of service connection for cholelithiasis, hypertension, gout, lumber spine condition, left shoulder condition, and right knee condition. Service connection for melioidosis is granted. Service connection may be granted for a disability resulting from a disease or injury incurred or aggravated by active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. To substantiate a claim of service connection, there must be evidence of: (1) a current disability (for which service connection is sought); (2) incurrence or aggravation of a disease or injury; and (3) a nexus between the disease or injury in service and the present disability. See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). The Veteran contends he contracted melioidosis during service. The Veteran’s service personnel records (SPRs) note that he was stationed at the Korat Royal Thai Air Force Base (RTAFB) from July 1975 to January 1976. In August 2015, the Veteran was hospitalized and melioidosis was diagnosed. He has not been afforded any VA examination to ascertain the etiology of melioidosis. However, the Board does not find that an examination is warranted. An August 2015 private treatment record notes the Veteran was seen by an infectious disease physician during his hospitalization for melioidosis. The physician noted that melioidosis is found in Southeast Asia, has an incubation period of many years (described as 20 or more years) and can present at any time in the future. After a careful review of the foregoing and having resolved reasonable doubt in favor of the Veteran, the Board has interpreted the Veteran’s private physician’s statement as supporting the Veteran’s claim that his service in Thailand in Southeast Asia caused his melioidosis. As there is no evidence to contradict the August 2015 opinion by the Veteran’s private physician, the Board finds a preponderance of the evidence of record weighs in favor of the Veteran’s claim. Accordingly, service connection for melioidosis is warranted. REASONS FOR REMAND Entitlement to service connection for diabetes mellitus. A review of the record found that further development is needed for VA to fulfil its duty to assist the Veteran with the development of evidence necessary to substantiate his claims. The Veteran has not been afforded any VA examination to ascertain the date of onset or etiology of his diabetes mellitus. In the October 2017 substantive appeal, the Veteran raised an alternative theory of entitlement (that the diabetes mellitus is secondary to his now service-connected melioidosis). Such theory has not been adequately addressed in a medical opinion or considered by the Agency of Original Jurisdiction (AOJ). The record does not include any medical opinions regarding the whether the Veteran’s diabetes mellitus is related to his service or is secondary to (was caused or aggravated by) his now service-connected melioidosis. An examination to secure a medical nexus opinion in the matter is necessary. The matters are REMANDED for the following: 1. Arrange for the Veteran to be an examined by an appropriate clinician to determine the nature and etiology of his diabetes mellitus. The examiner must offer opinions that respond to the following: Identify the likely etiology for the Veteran’s diabetes. Specifically, is it at least as likely as not (a 50% or better probability) that (i) it is etiologically related to his service, or (ii) was noted during service with continuity of the symptomatology since, or (iii) was caused or   aggravated by a service-connected melioidosis. [The opinion must address aggravation.] All opinions must include rationale opinion. M. H. HAWLEY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Naumovich, Associate Counsel