Citation Nr: 20009809 Decision Date: 02/05/20 Archive Date: 02/05/20 DOCKET NO. 17-38 882 DATE: February 5, 2020 REMANDED Entitlement to service connection for diabetes mellitus (claimed also as hyperlipidemia) is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from December 1986 to March 2011. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a July 2015 Department of Veterans Affairs (VA) rating decision. In November 2019, a videoconference hearing was held before the undersigned; a transcript is in the record. The Veteran requested, and was granted, a 30-day abeyance period for submission of additional evidence. 1. Entitlement to service connection for diabetes mellitus type II is remanded. The Veteran contends that he had high blood sugar in service, and that if was an early manifestation of, or resulted in, his current diabetes. The Veteran’s STRs are silent for complaints, treatment, or diagnosis of diabetes mellitus; they do show he had elevated glucose levels (by studies in August 2008, November 2008, April 2010, and September 2010. A February 2011 VA examination (while the Veteran was still in service) included testing which showed an elevated glucose level (100 mg/dL). The examiner indicated that this is “considered within normal limits, showing no significant findings”. The examiner did not comment on the significance of multiple elevated blood glucose studies during service. In April 2014 the Veteran received a diagnosis of diabetes mellitus. At the November 2019 Board hearing, he testified that he had elevated blood sugar levels in service, but did not discuss the findings in service with any postservice treatment provider. Whether the Veteran’s elevated glucose levels during his service were early manifestations of his current diabetes mellitus/developed into diabetes is a medical question. In January 2020 the Veteran submitted a Disability Benefit Questionnaire (DBQ) completed by a private physician. The provider did not offer an opinion (regarding the etiology of the Veteran’s diabetes (and the DBQ is inadequate for rating purposes). The current record does not include a medical opinion addressing whether the Veteran’s diabetes mellitus is related to his elevated blood sugar levels in service. An examination to secure an adequate medical opinion in the matter is necessary. See McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). The matter is REMANDED for the following: 1. Ask the Veteran to identify all providers of evaluations and treatment he has received for diabetes mellitus since service (records of which are outstanding), and to submit authorizations for VA to secure for the record complete clinical records of the evaluations and treatment from all private providers identified (of particular interest are the records from when his diagnosis of diabetes was first made). Secure for the record complete (all outstanding) clinical records of the evaluations and treatment from all providers identified. If private records identified are not received pursuant to VA’s request, the Veteran should be notified and advised that ultimately it is his responsibility to ensure that private medical records are received. 2. Then, arrange for the Veteran to be examined by an appropriate physician to determine the etiology of his diabetes mellitus. On review of the record and examination of the Veteran, the examiner should: (a) Identify the likely etiology for the Veteran’s diabetes mellitus. Specifically, is it at least as likely as not (a 50% or greater probability) that it is etiologically related to his service/was incurred therein, including by virtue of being manifested (by multiple elevated blood glucose studies) therein, being manifested to a compensable degree within a year following his discharge from service, or by continuity of symptoms since service? (b) If the diabetes is determined to not be related to the Veteran’s service/elevated blood glucose levels therein, identify the etiology considered to be more likely (and explain why that is so). All opinions must include rationale. The rationale must include comment on the significance of the elevated blood glucose levels in service. GEORGE R. SENYK Veterans Law Judge Board of Veterans’ Appeals Law Clerk for the Board Norman R. McNeal The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.