Citation Nr: 21002252 Decision Date: 01/13/21 Archive Date: 01/13/21 DOCKET NO. 13-28 471 DATE: January 13, 2021 REMANDED Entitlement to service connection for diabetes mellitus, including as secondary to exposure to asbestos, and/or chronic obstructive pulmonary disease (COPD) with sleep apnea, is remanded. Entitlement to a total disability rating based upon individual unemployability (TDIU) due to service-connected disabilities is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1965 to April 1968. These matters come before the Board of Veterans Appeals (Board) from a December 2011 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). These matters were previously before the Board in August 2017 and February 2019. 1. Entitlement to service connection for diabetes mellitus, including as secondary to exposure to asbestos, and/or COPD with sleep apnea, is remanded. Review of the record reveals that the Veteran initially sought to establish service connection for diabetes mellitus as secondary to his exposure to asbestos. See February 2011 Statement in Support of Claim. The record reflects that a September 2017 VA administrative decision found in-service exposure to asbestos. The record also reflects that, during the pendency of this claim and appeal, the Veteran has raised the theory of entitlement to service connection for diabetes mellitus as secondary to his service-connected COPD with sleep apnea. See November 2020 Appellate Brief. The RO denied the Veteran’s claim on the basis of a November 2019 VA opinion in which the examiner opined it is less likely than not that the Veteran’s diabetes mellitus is incurred in or caused by service because there was no diagnosis or treatments during active duty for diabetes or any related diabetes condition. In a separate November 2019 VA opinion, the examiner further opined that it is less likely than not that the Veteran’s current diabetes mellitus, including as secondary to exposure to asbestos is related to the Veteran’s service-connected COPD condition. The VA examiner provided a rationale in support of his opinion, which was based on the lack of evidence directly linking COPD causing or contributing to diabetes. However, the November 2019 VA examiner did not address the aggravation element of the Veteran’s secondary service connection claim, i.e., whether it is likely the Veteran’s diabetes mellitus is aggravated by his exposure to asbestos and/or his service-connected COPD with sleep apnea. See Allen v. Brown, 7 Vet. App. 439, 449 (the phrases “caused by” and “related to” do not address the aggravation aspect of secondary service connection). An addendum opinion is needed. 2. Entitlement to a TDIU due to service-connected disabilities is remanded. The Veteran contends that he has been unable to secure and follow substantially gainful employment due to his daily breathing treatments for his service-connected COPD and daily shots for diabetes. Specifically, in a January 2012 correspondence, he stated he cannot stand for long periods of time and cannot walk any distance because of the pain in his feet and legs from his diabetes and shortness of breath due to COPD. The issue of entitlement to TDIU is inextricably intertwined with the above remanded claim given, in part, that the readjudication of the Veteran’s diabetes mellitus may impact whether he meets the disability rating thresholds for consideration of TDIU on a schedular basis. See Harris v. Derwinski, 1 Vet. App. 180 (1991). Thus, a remand for further development on this basis is necessary. The matters are REMANDED for the following action: 1. Arrange for an appropriate health care provider to review the Veteran’s claims file and provide an opinion as to the nature and likely etiology of the Veteran’s diabetes mellitus. If the reviewing health care provider finds that physical examination or telehealth interview of the Veteran and/or diagnostic testing is necessary, such should be accomplished. The examiner should indicate whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s diabetes had causal origins in service or is otherwise related to the Veteran’s active duty service, to include his in-service asbestos exposure. The examiner should also indicate whether it is at least as likely as not, (50 percent probability or greater), that the Veteran’s diabetes mellitus was (A) caused or (B) aggravated beyond its normal progression by service-connected COPD with sleep apnea. Aggravation means an increase in disability – any additional impairment of earning capacity – of the nonservice-connected disability. If aggravation is found, the examiner must attempt to establish a baseline level of severity of the diagnosed disability prior to aggravation by the service-connected disability. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 2. Once the above action is complete, ask the Veteran to complete a TDIU claim form. Then, schedule the Veteran for an examination by an appropriate clinician regarding the current severity of his COPD. The examiner should elicit from the Veteran his complete educational, vocational, and employment history and should note his complaints regarding the impact of the COPD and, if service connected, the diabetes on employment. The examiner should identify all limitations or functional impairment caused by the COPD and, if service connected, the diabetes. M. Donohue Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Aston, 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.