Citation Nr: 21004171 Decision Date: 01/26/21 Archive Date: 01/26/21 DOCKET NO. 14-31 592A DATE: January 26, 2021 REMANDED Entitlement to service connection for diabetes mellitus is remanded. Entitlement to service connection for hypertension is remanded. Entitlement to service connection for a heart disorder is remanded. REASONS FOR REMAND The Veteran had active service in the Navy from February 1969 to November 1970. The appeal originates from a June 2012 decision of a Department of Veterans Affairs (VA) Regional Office. It is noted that an October 2005 Board decision previously denied these claims. As relevant military personnel records were thereafter obtained (pertaining to the question of herbicide agent exposure from the Veteran’s naval service), the claims were reviewed on a de novo basis. See October 2014 Military Personnel Record. The Veteran contends that his diagnosed diabetes mellitus, hypertension, and coronary artery disease are related to in-service herbicide agent exposure (on a presumptive or factual basis). See September 2011 Claim; April 2014 Correspondence. He also contends that diabetes mellitus had its onset in service and that hypertension and coronary artery disease are secondary to diabetes. See July 2003 Statement; July 2018 Appellate Brief. The appeal was remanded in October 2018 to obtain private treatment records from Gadsden Medical Center and updated VA treatment records. Although the VA treatment records were obtained, the Veteran was not sent notice requesting authorization for the private treatment records. VA nevertheless sent a request for records (for treatment from December 2019) to Gadsden Medical Center in January 2020 and received a response that authorization from the Veteran was required to fulfill the request. The Veteran submitted correspondence shortly thereafter indicating that he was treated at Gadsden Medical Center as recently as November 2019. As development for these private treatment records was not completed, remand is required. With respect to herbicide agent exposure, the Veteran argues that he had presumptive exposure to herbicide agents from serving aboard the USS America near Vietnam, that he was exposed to herbicide agents from personnel and other contaminated sources on the ship, and that he was once physically present in Vietnam. See November 2011 Correspondence; September 2012 Correspondence. Service treatment records and military personnel records do not appear to confirm herbicide agent exposure. VA made a formal finding of a lack of information to corroborate the Veteran’s claimed herbicide exposure. See June 2012 VA Memo. The Blue Water Navy centralized processing team at VA reviewed complete deck logs for the USS America and determined that the ship did not operate in the 12 nautical mile shoreline of Vietnam. See October 2020 SSOC. However, as noted above, the Veteran also argues that his diabetes mellitus had its initial onset during his active service. There is some probative evidence in this regard. Notably, service treatment records reflect a “borderline” blood glucose test in August 1969. A VA examination with opinion was obtained in February 2003 in which the examiner opined that the service treatment records did not show early diabetes. The opinion was partly based on a rationale that diabetes was not diagnosed until 1994. The examiner added that the Veteran would have been recognized as diabetic when he underwent coronary artery bypass grafting in 1985. In an October 2006 opinion, the Veteran’s physician challenged the findings of the February 2003 opinion. The physician explained that the diagnostic standards and criteria for pre-diabetic or diabetic status have changed since 1985 and that the medical records should be reviewed again to determine whether the Veteran had such a status at the time. A new opinion should therefore be obtained regarding the etiology of diabetes mellitus, which also bears on the hypertension and heart claims based on secondary service connection. As to other development, the record contains a December 2020 request for the Veteran’s complete service treatment records and military personnel records from the NPRC. No response has been received. VA should confirm that the complete records have been associated with the file and, if new records are obtained, reconsider whether herbicide exposure can be established. In March 2020, the Veteran submitted an authorization form to obtain private treatment records from multiple providers. One of the providers (Dr. Cooper) responded that all available records were provided, while another (DaVita) found no records for the Veteran. See March 2020 Medical Treatment Records; April 2020 Report. The other providers (UAB Medicine, Southern Cardiovascular Associates, and Doctor’s Care) responded and sent treatment records. However, it is unclear whether these records are complete as they do not date to January 2000 as specified by the Veteran as the beginning of his treatment. The providers failed to indicate whether all available records were attached. The remaining records (if any) should again be requested. The matters are REMANDED for the following action: 1. Request authorization from the Veteran to obtain private treatment records from Gadsden Medical Center and request the remainder of the Veteran’s private treatment records from UAB Medicine, Southern Cardiovascular Associates, and Doctor’s Care. 2. Confirm that complete service treatment records and military personnel records have been associated with the file per the December 2020 request to the NPRC. If additional records are associated with the file, the RO should conduct appropriate development to determine whether herbicide exposure can be established based on the new evidence. 3. Provide the Veteran’s file to an examiner with the appropriate knowledge and expertise to opine on diabetes mellitus, hypertension, and a heart disorder. The examiner is asked to address the following: a. Is it at least as likely as not that diabetes mellitus had its onset in or is otherwise etiologically related to active service? The examiner should address the in-service blood glucose testing and the October 2006 private opinion indicating a change in diagnostic standards and criteria for pre-diabetic or diabetic status. If the examiner determines that diabetes mellitus is related to service, please address the following: b. Is it at least as likely as not that hypertension was proximately caused by diabetes mellitus? c. Is it at least as likely as not that hypertension underwent any incremental increase in disability, regardless of its permanence, due to diabetes mellitus? d. Is it at least as likely as not that a heart disorder was proximately caused by diabetes mellitus? e. Is it at least as likely as not that a heart disorder underwent any incremental increase in disability, regardless of its permanence, due to diabetes mellitus? The term “incremental increase in disability” means additional impairment of earning capacity.  Objective measurement, or numerical quantification, is not required to ascertain an increase in disability.  Moreover, any “incremental increase in disability” need not be permanent.  MICHAEL A. HERMAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Alhinnawi 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.