Citation Nr: 20051820 Decision Date: 08/05/20 Archive Date: 08/05/20 DOCKET NO. 15-08 749A DATE: August 5, 2020 REMANDED Entitlement to service connection for diabetes mellitus is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from January 1979 to January 2005. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a January 2012 rating decision. In October 2017, the Veteran testified before the undersigned Veterans Law Judge at a Travel Board hearing. The Veteran was previously represented in this appeal by Disabled American Veterans. However, in January 2020, he revoked that representation. The Veteran has not appointed a new representative and proceeds pro se. See July 2020 report of general information. The Board remanded this case in June 2018 for additional development. Unfortunately, the Board is not satisfied that there was substantial compliance with its prior remand instructions; therefore, the appeal must once again be remanded. See Stegall v. West, 11 Vet. App. 268, 271 (1998); D’Aries v. Peake, 22 Vet. App. 97, 105 (2008). Entitlement to service connection for diabetes mellitus is remanded. The Veteran seeks entitlement to service connection for diabetes mellitus, which he contends had its initial onset during service. Service treatment records show that the Veteran had elevated blood glucose levels during service. In May 2001 and August 2002, the Veteran’s fasting blood glucose was measured to be 107 mg/dL. In May 2004, the Veteran’s fasting blood glucose was measured to be 109 mg/dL. The normal ranges for all three tests were noted to be 70 to 105 mg/dL. The Veteran was diagnosed with diabetes mellitus in 2010, five years after separation. In the June 2018 remand, the Board directed the RO to schedule the Veteran for a VA examination and to obtain a medical opinion from a qualified VA examiner to assess the nature and etiology of the Veteran’s diabetes mellitus. Specifically, the Board requested that the VA examiner discuss the relevance, if any, of the Veteran’s elevated glucose levels during service and the relatively short duration of time between discharge from service and formal diagnosis of diabetes mellitus. The Veteran underwent a VA examination in March 2019. The VA examiner opined that the Veteran’s diabetes mellitus was less likely than not incurred in or caused by service. In making this finding, the examiner noted that having elevated glucose only means that a person is at an increased risk of developing diabetes and that the Veteran did not meet the diagnostic criteria for diabetes mellitus until 2010. The Board finds this opinion to be inadequate because the examiner did not fully address the Board’s remand directives to discuss whether a relationship exists between the elevated glucose levels during service and the development of diabetes mellitus only five years after separation. In light of the above, the Board finds that the record does not contain a medical opinion that is sufficient to fairly decide the Veteran’s claim. Therefore, the claim must be remanded once again because the RO did not comply with the Board’s prior remand directive to obtain an adequate medical opinion on the Veteran’s behalf.   See Stegall, 11 Vet. App. at 268.  On remand, an addendum medical opinion must be obtained that is adequate for the Board to make an informed decision on the Veteran’s claim.  See Barr v. Nicholson, 21 Vet. App. 303, 311-12 (2007); Douglas v. Shinseki, 23 Vet. App. 19, 26 (2009).  Accordingly, the matter is REMANDED for the following action: Obtain an addendum medical opinion from a VA examiner (M.D.) of appropriate expertise discussing the nature and etiology of the Veteran’s diabetes mellitus. An in-person examination should not be scheduled unless it is deemed necessary by the examiner or otherwise required by the evidence. The examiner must review the claims file in its entirety, to include a copy of this REMAND, and the review should be noted in the examination report. Thereafter, the examiner is asked to provide an opinion with respect to the following: (a) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s diabetes mellitus had its onset in service, within one year of separation, or is otherwise etiologically related to his active duty service? The requested medical opinion must include a discussion of the relevance, if any, of (i) the three glucose tests in service, in May 2001, August 2002, and May 2004, which showed the Veteran to have elevated blood glucose levels, and (ii) the short duration (five years) between discharge and diagnosis. If it is determined that there is another more likely etiology for the Veteran’s diabetes mellitus, that should be stated. The examiner is reminded that the term “at least as likely as not” does not mean “within the realm of possibility.” Rather, it means that the weight of the medical evidence both for and against the claim is so evenly divided that it is as medically sound to find in favor of the claim as it is to find against it. The examiner should set forth a complete rationale for the conclusion(s) reached. In providing the requested opinion, the examiner must adequately consider and address the relevant evidence of record, to include: the Veteran’s service treatment records, lay statements and hearing testimony, VA treatment records, the March 2019 VA examination report and medical opinion, and any other pertinent evidence of record. The examiner must provide a complete rationale for any opinion expressed, citing to the examiner’s clinical experience, medical expertise, and established medical principles, as necessary. If the examiner is unable to provide an opinion without resorting to speculation, he or she should explain why this is so and what, if any, additional evidence would be necessary before an opinion could be rendered. LESLEY A. REIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Melissa Barbee, 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.