Citation Nr: 21005081 Decision Date: 01/28/21 Archive Date: 01/28/21 DOCKET NO. 05-23 047 DATE: January 28, 2021 REMANDED The issue of service connection for diabetes mellitus type II, on direct and secondary bases and as aggravated by service-connected hypertension or its medications, is remanded. REASONS FOR REMAND The Veteran had active service from September 1972 to June 1980. Pursuant to a joint motion for partial remand (JMPR) filed by VA and the Veteran, in August 2020 the Court of Appeals for Veterans Claims (CAVC) vacated a portion of the Board’s July 2019 decision denying service connection for diabetes mellitus type 2 and remanded it to the Board for compliance with its instructions. Before the CAVC, the parties agreed that the Board did not obtain an adequate opinion on secondary service connection, and did not adjudicate the Veteran’s claim based on direct service connection. Pursuant to the JMPR, the matter is remanded for further development. Service connection for diabetes mellitus type II: This matter is REMANDED for the following action: 1. BACKGROUND INFORMATION FOR RO ADJUDICATOR: This is a remand under Stegall v. West, 11 Vet. App. 268, 271 (1998) and pursuant to a Court vacatur and remand. Before the Court, the parties agreed that VA did not fully develop and adjudicate the Veteran’s claim because: The Board did not adjudicate the Veteran’s claim for service connection on a DIRECT basis; A November 2018 VA medical examiner did not provide a sufficient explanation about whether the Veteran’s service-connected hypertension CAUSED OR WORSENED the Veteran’s diabetes; The November 2018 examiner limited his inquiry about whether the Veteran’s medications for service-connected hypertension caused or worsened his diabetes mellitus to those medications before 2015. THE EXAMINER MUST ALSO RESPONDE TO THE QUESTION ABOUT WHETHER MEDICATIONS TAKEN AFTER 2015 CAUSED OR WORSENED the Veteran’s diabetes mellitus type 2. These deficiencies require further medical development, as directed below. 2. DEVELOPMENT DIRECTIVES: Return the file to the physician who conducted the November 2018 VA examination. If that examiner is no longer available or if the November 2018 examiner finds it necessary, schedule the Veteran for a new examination. If necessary and appropriate, an examination or other inquiry may be conducted by telemedicine/electronic means due to COVID-19 restrictions. Ensure that the examiner reviews the electronic file. Based upon a review of the relevant evidence of record, history provided by the Veteran, and sound medical principles, the VA examiner should provide the following opinions: a) Was the Veteran’s current diabetes mellitus type 2 diagnosis incurred in service or caused by an in-service injury, event or illness? b) Is the Veteran’s current diabetes mellitus type 2 diagnosis proximately due to the Veteran’s service-connected hypertension disability, to include prescribed medications as indicated below? c) Is the Veteran’s current diabetes mellitus type 2 diagnosis aggravated (e.g. worsened, and if so, to what degree) by the Veteran’s service-connected hypertension disability?” If aggravation is found, the examiner should also state, to the extent possible, the baseline level of disability prior to aggravation. This may be ascertained by the medical evidence of record and by the Veteran’s statements as to the nature, severity, and frequency of his observable symptoms over time. The examiner must review the entire record in conjunction with rendering the requested opinions. IN ADDITION TO ANY RECORDS THAT ARE GENERATED BECAUSE OF THIS REMAND, the VA examiner’s attention is drawn to the following: * Service treatment records do not indicate any complaints, diagnoses or treatments for the onset of diabetes mellitus type 2 during service. The Veteran’s June 1972 report of medical history at enlistment indicates he denied high or low blood pressure and sugar or albumin in his urine. The Veteran’s June 1972 entrance report of medical examination indicated clinically normal vascular and endocrine systems. In May 1977 the Veteran reported he had high blood pressure. The February 1978 report of medical examination indicated clinically normal vascular and endocrine systems. In January 1980 the Veteran demonstrated high blood pressure and the examiner diagnosed him with essential hypertension. The Veteran’s May 1980 report of medical history at separation indicates the Veteran endorsed high or low blood pressure but denied sugar or albumin in his urine. The examiner noted the Veteran was taking blood pressure medication as of 3 months prior. The Veteran’s May 1980 report of medical examination at separation indicated clinically normal vascular and endocrine systems. The examiner’s notation indicated the Veteran had hypertension that was controlled on medication. See “STR – Medical,” received March 10, 2015, 121 pages. * The Veteran’s contention that he was exposed to herbicide while traveling aboard an airplane during service has not been substantiated. Military personnel records indicate the only overseas service the Veteran performed was in Germany between May 1976 and May 1978. See “Military Personnel Record,” received February 26, 2018, 50 pages. * An October 1997 nerve study indicated no evidence of peripheral neuropathy. See “Medical Treatment Record – Government Facility,” received February 9, 1998, 48 pages. * A September 1998 nerve study indicated no evidence of peripheral neuropathy. See “Medical Treatment Record – Government Facility,” received March 2, 1999, 12 pages. * VA treatment records indicate the Veteran was diagnosed with diabetes mellitus type 2 in March 2015. * A March 2015 statement in which the Veteran stated his doctor informed him one of the side effects of his blood pressure medication was diabetes mellitus type 2. See “VA 21-4138 Statement in Support of Claim,” received April 13, 2015. * June 2015 and July 2015 VA medical examination reports and opinions. * A December 2015 notice of disagreement (NOD) statement in which the Veteran’s representative indicated the Veteran’s doctor informed the Veteran that his hypertension medication can cause or aggravate diabetes mellitus type 2. See “NOD,” received December 18, 2015. * November 2018 VA medical examination report and opinion. * VA treatment records indicate the Veteran has been prescribed Adalat, amlodipine besylate, Atenolol, hctz/lisinopril, hydralazine, hydrochlorothiazide, lisinopril, metoprolol tartrate, and Verapamil for his blood pressure. A thorough explanation must be provided for the opinion rendered. If the examiner cannot provide the requested opinion without resorting to speculation, s/he should expressly indicate this and provide supporting rationale as to why the opinion cannot be made without resorting to speculation. The examiner should schedule a new examination ONLY IF NECESSARY to provide an adequate opinion. THE EXAMINER IS ADVISED THAT BY LAW, THE MERE STATEMENT THAT THE CLAIMS FOLDER WAS REVIEWED, AND/OR THE EXAMINER HAS EXPERTISE IS NOT SUFFICIENT TO FIND THE EXAMINATION/OPINION SUFFICIENT. 2. Following the review and any additional development deemed necessary, readjudicate the claim. Should the claim not be granted in its entirety, issue an appropriate supplemental statement of the case (SSOC) and forward the claim to the Board for adjudication. (Continued on the next page)   The Veteran has the right to submit additional evidence and argument on the matter the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board or by the United States Court of Appeals for Veterans Claims (Court) for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C. §§ 5109B, 7112 (West 2014). Vito A. Clementi Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Anwar, Attorney-Advisor 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.