Citation Nr: 21001301 Decision Date: 01/07/21 Archive Date: 01/07/21 DOCKET NO. 14-36 081 DATE: January 7, 2021 REMANDED Entitlement to service connection for a back disorder is remanded. Entitlement to service connection for diabetes mellitus is remanded. Entitlement to a heart disorder, to include as secondary to diabetes mellitus, is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1981 to March 1988. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a May 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office in Seattle, Washington. This matter was previously remanded by the Board in June 2018 and since been returned for further appellate review. 1. Entitlement to service connection for a back disorder is remanded. Remand is required for compliance with the Board’s prior directives. Compliance with remand directives is not optional or discretionary, and the Board errs as a matter of law when it fails to ensure remand compliance. Stegall v. West, 11 Vet. App. 268 (1998). In a June 2018 remand, the Board requested a VA examination regarding the claim, directing the examiner to address the Veteran’s duties as an engineer equipment operator including heavy lifting. An August 2019 VA examination was conduct; the report contained a negative nexus opinion. The VA examiner noted the Veteran’s MOS but did not address the duties associated with this MOS, which includes heavy lifting. Accordingly, remand is required for an addendum opinion. 2. Entitlement to service connection for diabetes mellitus is remanded. Remand is required for an adequate opinion that addresses all relevant evidence. Where VA provides the veteran with an examination in a service connection claim, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). An August 2019 VA examination was conducted. The examiner opined that the Veteran’s diabetes was not related to his period of service, to include the rattlesnake bite and/or treatment with antivenom. The examiner noted there is no evidence found in the medical literature to support the contention of diabetes mellitus being due to snake bite or treatment with antivenom, explaining neither are a known risk factors for diabetes mellitus. The examiner, however, did not address medical articles submitted by the Veteran in 2014. Remand is required for an addendum opinion. 3. Entitlement to a heart disorder, to include as secondary to diabetes mellitus, is remanded. Remand is required for an adequate opinion that addresses all relevant evidence. Where VA provides the veteran with an examination in a service connection claim, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). An August 2019 VA examination was conducted. The examiner opined that the Veteran’s heart disorders were not related to his period of service, to include the rattlesnake bite and/or treatment with antivenom. The examiner noted there is no evidence found in the medical literature to support the contention of a heart disorder being due to snake bite or treatment with antivenom, explaining neither are a known risk factors for diabetes mellitus. The examiner, however, did not address medical articles submitted by the Veteran in 2014. Remand is required for an addendum opinion. The matters are REMANDED for the following action: 1. Obtain an addendum opinion regarding the etiology of his back disorder. The entire claims file must be made available to and be reviewed by the examiner. If an examination is deemed necessary, it shall be provided. An explanation for all opinions expressed must be provided. (a.) The examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s back disorder had onset in, or is otherwise related to, active military service. The examiner must address the following: 1) the Veteran’s assertions of an in-service 1987 motor vehicle accident; 2) his January 2018 Board hearing testimony describing his duties as an engineer equipment operator including heavy lifting; and 3) the notations of treatment for the back in February 1987 and March 1987 contained in the Veteran’s STRs. 2. Obtain an addendum opinion regarding the etiology of the Veteran’s diabetes mellitus. The entire claims file must be made available to and be reviewed by the examiner. If an examination is deemed necessary, it shall be provided. An explanation for all opinions expressed must be provided. (a.) The examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s diabetes mellitus had onset in, or is otherwise related to, active military service, to include as due to an in-service rattlesnake bite and administration of anti-venom. The examiner must address the following: 1) the medical articles submitted in 2014; 2) the August 2019 VA examination; and 3) service treatment records (STRs) documents noting a rattlesnake bite and an adverse reaction to anti-venom drug. 3. Obtain an addendum opinion regarding the etiology of the Veteran’s diabetes mellitus. The entire claims file must be made available to and be reviewed by the examiner. If an examination is deemed necessary, it shall be provided. An explanation for all opinions expressed must be provided. The examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s heart disorder had onset in, or is otherwise related to, active military service, to include as due to an in-service rattlesnake bite and administration of anti-venom. The examiner must address the following: 1) the medical articles submitted in 2014; 2) the August 2019 VA examination; and 3) service treatment records (STRs) documents noting a rattlesnake bite and an adverse reaction to anti-venom drug. The examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s heart disorder is caused or aggravated by diabetes mellitus. The examiner must address the following: 1) a 2013 private examination that showed cardiac conditions and hypertension as being conditions that are at least as likely as not due to diabetes mellitus. K. MILLIKAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Braxton, 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.