Citation Nr: 20042337 Decision Date: 06/22/20 Archive Date: 06/22/20 DOCKET NO. 17-59 443 DATE: June 22, 2020 REMANDED Entitlement to service connection for diabetes mellitus type II, including as secondary to service-connected chronic lumbosacral strain and service-connected major depressive disorder (MDD) is remanded. REASONS FOR REMAND The Veteran honorably served in the United States Army from September 1982 to March 1989. This matter appears before the Board of Veterans’ Appeals (Board) on appeal of a December 2016 rating decision of the Regional Office (RO). Preliminarily, the Board notes that, in a February 2020 rating decision, the Veteran’s claim of entitlement to service connection for obstructive sleep apnea (OAS) was granted with an evaluation of 50 percent effective September 23, 2016. This is a full grant of benefits. As such, the claim is no longer before the Board. Entitlement to service connection for diabetes mellitus type II, including as secondary to service-connected chronic lumbosacral strain and service-connected major depressive disorder (MDD) is remanded. This issue has been remanded by the Board in June 2018, April 2019, and November 2019. In pertinent part, the Board remanded the Veteran’s claim in April 2019 because the Veteran brought forth a new theory of entitlement in a March 2019 statement. The Board remanded the claim again in November 2019 because the addendum opinion obtained was inadequate since it did not contain a rationale for the opinions offered. Finally, the Board is remanding the claim again today because the addendum opinion rationale was inadequate. The Board does not find substantial compliance with its November 2019 remand directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). In November 2019, rhe Board remanded the Veteran’s claim for entitlement to service connection for diabetes mellitus for additional development. Specifically, the Board asked the Agency of Original Jurisdiction (AOJ) to obtain an addendum opinion addressing (a) whether the diabetes was proximately due to the service-connected low back disability; and (b) whether the diabetes was secondary to service-connected MDD, including MDD medications. The examiner concluded that the Veteran’s diabetes is less likely than not caused by the service-connected low back disability, and the rationale was that low back pain is not a known cause for diabetes. However, the examiner was also asked to address whether the Veteran’s diabetes was caused or aggravated by MDD medications. The examiner concluded that the Veteran’s diabetes was not caused nor aggravated by service-connected MDD medications. However, in the examiner’s rationale, he did not explain why the medications less likely than not aggravate the Veteran’s diabetes. Specifically, the examiner noted that the major tranquilizers the Veteran is taking are known to cause elevated blood sugars, the Veteran was diagnosed with diabetes before he began taking these medications. The examiner does not discuss whether the MDD medications aggravate the Veteran’s diabetes when they are known to elevate blood sugar levels. While the Board regrets further delay, an addendum opinion is necessary to address whether the prescribed MDD medications aggravate the Veteran’s diabetes beyond a natural progression. Accordingly, the Veteran’s claim is remanded for an addendum opinion. The matters are REMANDED for the following action: Obtain an addendum opinion addressing whether the Veteran’s diabetes mellitus type II is aggravated beyond natural progression by the prescribed medications for service-connected MDD. Specifically, the examiner should address whether the known side effect of elevated blood sugars aggravated the Veteran’s diabetes. A rationale must be provided for the opinion offered. R. FEINBERG Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. N. Fournier, 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.