Citation Nr: 21004751 Decision Date: 01/28/21 Archive Date: 01/28/21 DOCKET NO. 12-24 452 DATE: January 28, 2021 REMANDED Entitlement to service connection for ischemic heart disease is remanded. Entitlement to service connection for diabetes mellitus, type II, is remanded. Entitlement to service connection for peripheral neuropathy of the bilateral lower extremities is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1948 to February 1955. This matter is on appeal from a December 2011 rating decision by the regional office. In December 2012, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. This transcript has been associated with the record. This matter was previously remanded by the Board and most recently in August 2020 for additional evidentiary development. 1. Entitlement to service connection for ischemic heart disease. 2. Entitlement to service connection for diabetes mellitus, type II. 3. Entitlement to service connection for peripheral neuropathy of the bilateral lower extremities. Unfortunately, remand is necessary to ensure compliance with the Board’s August 2020 remand directives. Stegall v. West, 11 Vet. App. 268, 270-71 (1998). The Veteran contends that he suffers from ischemic heart disease, diabetes mellitus, and peripheral neuropathy of the bilateral lower extremities, as a result of his exposure to herbicides, chemicals, and/or radiation during service. The Veteran has stated that he served in Guam from 1948-1950, at the Dugway Proving Grounds (DPG) in Utah from 1950-1951, and in Korea from 1951-1953. In an August 2020 remand, the Board pointed out deficiencies of a previous April 2020 VA opinion and remanded for an addendum opinion. Specifically, the Board instructed that “[t]he examiner must specifically discuss the October 1948 service treatment record prescribing DDT powder, the favorable medical opinions received in March 2014 and April 2014, as well as any other pertinent lay and medical evidence which informs the examiner’s opinion(s).” See August 2020 Board remand at 3. In October 2020, the AOJ obtained VA contract opinions for coronary artery disease (CAD), diabetic peripheral neuropathy (DMPN), and diabetes mellitus, type II (DM II). Based on a review of records, the examiner found that a nexus was not established for each diagnosed condition of CAD, DMPN, and DM II. See VA contract opinions dated October 2020. A similar rationale was provided for all three opinions. The October 2020 examiner indicated that while the veteran had a confirmed diagnosis of the claimed condition, there was no objective evidence of AO exposure in Korean War. The examiner noted “the veteran was treated with DDT powder in 1948” but found “human health effects from DDT at low environmental doses are unknown.” The examiner added “the veteran has medically recognized risk factors for diabetes such as age, obesity and family history. PN is a medically recognized complication of diabetes. A nexus is not established to service. A nexus to service or exposure to various chemicals is not established.” Id. Unfortunately, the examiner failed to consider favorable evidence of record as requested in the August 2020 remand. In particular, the Board’s remand instructed the examiner discuss “favorable medical opinions received in March 2014 and April 2014”, which was not accomplished. For clarification, the record shows a lay statement dated April 2014 where the Veteran references a private opinion from Dr. J.G. dated December 2012. Indeed, the record shows a statement from J.L.G., M.D. dated December 2012, which should be considered. Additionally, the Board notes that in February 2020, the Veteran submitted Disability Benefits Questionnaires (DBQs) completed by a non-treating physician dated August 2019. See IHD DBQ dated August 2019, previously submitted December 2019; Diabetes Mellitus DBQ and Diabetic Sensory Motor Peripheral Neuropathy DBQ dated August 2019, received February 2020. Accordingly, remand is necessary for consideration of the favorable evidence submitted by the Veteran. By this remand, the Board makes no determination, express or implied, concerning the credibility of any lay statements on file. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate VA medical professional to determine the nature and etiology of the Veteran’s diagnosed ischemic heart disease (IHD), diabetes mellitus type II (DM), and peripheral neuropathy (PN) of the lower extremities. The Veteran’s electronic claims file must be made accessible to the examiner along with any other information the medical professional deems pertinent. After reviewing the claims file, the examiner is to provide an opinion addressing the following: a) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran’s IHD is etiologically related to his active duty service, including in-service exposure to DDT powder in October 1948? b) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran’s DM is etiologically related to his active duty service, including in-service exposure to DDT powder in October 1948? c) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran’s PN of the lower extremities etiologically related to his active duty service, including in-service exposure to DDT powder in October 1948? (Continued on the next page)   In rendering the opinions, the examiner should acknowledge review of and consider favorable medical and lay evidence of record. Specifically, private opinion from Dr. J.L.G. dated December 2012; VA opinion dated March 2014; Veteran’s lay statement dated April 2014; and IHD, DM and PN DBQs submitted by Veteran dated August 2019. A complete rationale for all findings and conclusions is requested. KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. An, 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.