Citation Nr: 20037527 Decision Date: 06/02/20 Archive Date: 06/02/20 DOCKET NO. 18-22 417 DATE: June 2, 2020 REMANDED Entitlement to service connection for diabetes mellitus, type II, to include as secondary to service-connected posttraumatic stress disorder (PTSD) and major depressive disorder, is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1987 to June 1992. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2014 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In September 2019, the Veteran appeared and testified at a videoconference Board hearing before the undersigned Veterans Law Judge. A transcript of the proceeding is associated with the claims file. This case was previously before the Board in December 2019 when it was remanded for further development. 1. Entitlement to service connection for diabetes mellitus, type II, to include as secondary to service-connected PTSD and major depressive disorder The Veteran maintains that his currently diagnosed diabetes mellitus, type II, was caused by medication taken for his service-connected PTSD and major depressive disorder. Specifically, the Veteran claims that the medication taken for his psychiatric disabilities caused him to gain weight, and that this weight gain caused his diabetes. See Hearing Transcript, page 8. The Veteran was provided with a VA examination in February 2018. Therein, the VA examiner opined that it was less likely than not that the Veteran’s diabetes mellitus was proximately due to or the result of his service-connected disability. The examiner reasoned that while the Veteran’s psychiatric medication is associated with moderate weight gain, research has not shown a definitive causative relationship between the Veteran’s psychiatric medication and diabetes. In the September 2019 remand, the Board found that the matter should be remanded in order to obtain an addendum VA medical opinion that addressed whether the Veteran’s diabetes mellitus was aggravated by his service-connected PTSD with major depressive disorder. The Board also asked for the VA examiner to address the indications that the Veteran’s psychotropic medications could be contributing to his weight gain. Subsequently, a VA addendum medical opinion was obtained in January 2020. The VA examiner opined that the Veteran’s diabetes mellitus was less likely than not caused by his service-connected PTSD with major depressive disorder. The examiner noted that diabetes mellitus has numerous risk factors, one such risk factor being obesity. The examiner added that there was no evidence that the Veteran’s obesity is solely due to his service-connected mental health condition. She noted that numerous strategies can be employed to prevent obesity regardless of any mental health conditions or medication side effects. The examiner noted that PTSD and depression are common mental health conditions in the United States and are commonly treated with selective serotonin reuptake inhibitors (SSRIs). While these have a possible side effect of weight gain, not all individuals become obese. The examiner also found that there was no evidence of aggravation of the diabetes. The Board finds that the January 2020 medical opinion is not supported by an adequate rationale. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The Board finds that although the VA examiner concluded that the Veteran’s obesity was not solely due to his service-connected mental health condition, she did not rule out the possibility that the Veteran’s PTSD with major depressive disorder contributed to his diabetes mellitus. Additionally, the VA examiner noted that not all individuals who take SSRIs become obese. However, she did not explain whether the SSRIs contributed to this Veteran’s weight gain, and whether this ultimately contributed to his diabetes mellitus. As such, the Board finds that an addendum medical opinion is required prior to adjudication of this issue. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding the following: Whether it is at least as likely as not (a 50 percent probability or greater) that any currently diagnosed diabetes mellitus, type II, was caused AND/OR aggravated (increased in severity) by the Veteran’s service-connected PTSD and major depressive disorder, to include any medication the Veteran takes for these service-connected psychiatric disabilities. If aggravation is found, the examiner must attempt to establish a baseline level of severity of the diagnosed disability prior to aggravation by the service-connected disability. The VA examiner should address the indications in the Veteran’s VA treatment records that his psychotropic medications could be contributing to his weight gain. A fully articulated medical rationale for any opinion expressed must be set forth in the medical report. The examiner should discuss the particulars of this Veteran’s medical history and the relevant medical science as applicable to this case, which may reasonably explain the medical guidance in the study of this case. M. Donohue Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Morrad, Associate Counsel 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.