Citation Nr: 20049912 Decision Date: 07/27/20 Archive Date: 07/27/20 DOCKET NO. 15-29 452 DATE: July 27, 2020 REMANDED Entitlement to service connection for diabetes mellitus is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1995 to May 2001. This matter is before the Board of Veterans’ Appeals (Board) on appeal from an April 2013 rating decision. The Veteran testified before the undersigned during a March 2017 hearing. This matter was previously before the Board in July 2018 when the claim for service connection for diabetes mellitus was remanded. VA has a duty to ensure any medical examination or opinion it provides is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (overruled on other grounds, Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013)). A medical opinion is adequate where it is based upon consideration of the full medical history and describes a disability in sufficient detail so that the Board’s evaluation will be fully informed. Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). Here, a June 2019 VA examiner opined the Veteran’s diabetes is not related to the claimed back condition and related epidural steroid injections. In support of this opinion, the examiner provided a list of the most common risk factors for diabetes, including diet, lifestyle, and genetics. The examiner further indicated that the medical research on elevated blood glucose following epidural steroid injections shows that glucose levels typically return to normal standard deviation mean glucose levels within two days. In detailing multiple disparate risk factors for diabetes, the examiner did not relate any particular risk factors to the Veteran’s medical history either during or after service. Furthermore, though the examiner cited multiple medical lab results, including some from the Veteran’s service medical records that show elevated glucose levels, the examiner did not comment on which, if any, of these tests indicate the onset of diabetes mellitus or how the risk factors listed as rationale for the opinion relate to these tests. For these reasons, the Board finds the June 2019 VA medical opinion fails to adequately address the Veteran’s medical history, to include whether his diabetes had its onset during or shortly after service based on one of the other factors cited as a potential cause of diabetes. The Board acknowledges that an earlier March 2013 VA examiner stated that the Veteran’s diabetes was at least as likely as not aggravated by cortisone shots administered during service for his back condition. However; this examiner also provided an opinion stating an April 2001 elevated blood glucose reading during service did not show the Veteran had diabetes because it was obviously a non-fasting glucose test. As the Board noted in the July 2018 remand, these findings are contradictory. The examiner’s assertion that cortisone shots aggravated the Veteran’s diabetes beyond its natural progression is necessarily predicated on the Veteran having diabetes during service when the injections were administered. As the examiner opined the Veteran did not have diabetes during service, these findings are incompatible. For these reasons, the Board finds another remand is necessary to obtain a medical opinion that fully addresses the Veteran’s medical history and provides adequate rationale for the Board to reach a fully informed decision. The matters are REMANDED for the following action: Obtain a new medical opinion regarding the nature and etiology of any diabetes mellitus. The Veteran should only be scheduled for a new examination if deemed necessary by the selected examiner. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including cortisone shots administered during service and elevated blood glucose levels shown in the Veteran’s service treatment records. In providing this opinion, the examiner should address whether the Veteran’s elevated blood glucose levels during service, to include on tests in December 2000 and April 2001, at least as likely as not indicate the onset of diabetes during or within one year after the Veteran’s separation from service in May 2001. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be specifically acknowledged and considered in formulating any opinion. If the examiner rejects the Veteran’s reports, he or she must provide a reason for doing so. The examiner’s report must include a complete rationale for the opinion. M. HYLAND Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Pitman, 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.