Citation Nr: 21000896 Decision Date: 01/06/21 Archive Date: 01/06/21 DOCKET NO. 09-32 112A DATE: January 6, 2021 REMANDED Entitlement to service connection for diabetes mellitus, to include as secondary to service-connected disabilities is remanded. Entitlement to service connection for peripheral neuropathy, to include as secondary to diabetes mellitus is remanded. Entitlement to service connection for testicular hypofunction, to include as secondary to service-connected disability is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from October 1987 to October 1991, and he had additional service in the Army National Guard. 1. Entitlement to service connection for diabetes mellitus, to include as secondary to service-connected disabilities is remanded. In a September 2020 informal hearing presentation, the Veteran’s representative raised a new argument that the Veteran’s diabetes mellitus was secondary to his service-connected obstructive sleep apnea and coronary artery disease (CAD) disabilities. It was generally noted that both obstructive sleep apnea and CAD are known risk factors for development of diabetes mellitus. A remand is needed to obtain a new VA medical opinion that addresses the Veteran’s most recent contention. In addition, the Veteran has submitted VA medical handouts that discuss how stress associated with mental health disorders can impact blood sugar levels, which were provided to him by his treating VA mental health providers. He generally referenced studies that show individuals with PTSD are more likely to have diabetes mellitus. In a December 2018 VA medical opinion report, the VA examiner had stated that the medical literature did not demonstrate a causal relationship between diabetes mellitus and PTSD. Given the foregoing additional evidence submitted by the Veteran, the Board finds that an addendum VA medical opinion is needed to address whether the Veteran’s diabetes mellitus is secondary to his PTSD disability. 2. Entitlement to service connection for peripheral neuropathy, to include as secondary to diabetes mellitus is remanded. In the September 2020 informal hearing presentation, the Veteran’s representative raised a new argument that the Veteran’s peripheral neuropathy was secondary to his service-connected obstructive sleep apnea and coronary artery disease (CAD) disabilities. A remand is needed to obtain a new VA medical opinion that addresses the Veteran’s most recent contention. 3. Entitlement to service connection for testicular hypofunction, to include as secondary to service-connected disability is remanded. In the September 2020 informal hearing presentation, the Veteran’s representative raised a new argument that the Veteran’s testicular hypofunction was secondary to his service-connected obstructive sleep apnea and coronary artery disease (CAD) disabilities. A remand is needed to obtain a new VA medical opinion that addresses the Veteran’s most recent contention. The matters are REMANDED for the following action: 1. Obtain an addendum opinion regarding whether the Veteran’s diabetes mellitus is at least as likely as not related proximately due to service-connected disability or is aggravated beyond its natural progression by service-connected obstructive sleep apnea, coronary artery disease, and PTSD disabilities. In doing so, the examiner is asked to consider the Veteran’s VA medical handouts on relationship between stress associated with mental health disorders and blood sugar levels. 2. Obtain an addendum opinion regarding whether the Veteran’s peripheral neuropathy is at least as likely as not related proximately due to service-connected disability or is aggravated beyond its natural progression by service-connected obstructive sleep apnea and coronary artery disease disabilities. 3. Obtain an addendum opinion regarding whether the Veteran’s testicular hypofunction is at least as likely as not related proximately due to service-connected disability or is aggravated beyond its natural progression by service-connected obstructive sleep apnea and coronary artery disease disabilities. K. J. ALIBRANDO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Murray 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.