Citation Nr: 21064625 Decision Date: 10/21/21 Archive Date: 10/21/21 DOCKET NO. 17-08 270 DATE: October 21, 2021 REMANDED Entitlement to service connection for left lower extremity neuropathy is remanded. Entitlement to service connection for right lower extremity neuropathy is remanded. Entitlement to service connection for insulin resistance/metabolic syndrome is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1967 to September 1969. These matters come before the Board of Veterans' Appeals (Board) on appeal from a December 2014 rating decision issued by Department of Veterans Affairs (VA) Regional Office (RO). In October 2019, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A copy of the hearing transcript is associated with the claims file. 1. Entitlement to service connection for insulin resistance/metabolic syndrome is remanded. In June 2020, the Board denied the claim of entitlement to service connection for insulin resistance/metabolic syndrome. Subsequently, the Veteran filed an appeal to the Court of Appeals for Veterans Claims (the Court) contesting the June 2020 Board decision. In July 2021, the Court granted a Joint Motion for Partial Remand (JMPR) vacating the portion of the June 2020 Board decision denying entitlement to service connection for insulin resistance/metabolic syndrome, and remanded the claim to the Board for further development. In the JMPR, the parties agreed that the evidence of record suggested the potential existence of outstanding private treatment records such that the Board was required to address whether VA satisfied its duty to assist regarding such records. Specifically, the outstanding records include treatment notes from the Veteran's private ophthalmologist and/or optometrist, and his endocrinologist. The Board notes that the Veteran submitted additional treatment records from 2013 from his endocrinologist in September 2021, but the treatment records from his private eye physicians remain outstanding. Remand is required to acquire these records. 2. Entitlement to service connection for left lower extremity neuropathy is remanded. 3. Entitlement to service connection for right lower extremity neuropathy is remanded. In the June 2020 decision, the Board remanded the claims of entitlement to service connection for bilateral neuropathy to obtain an addendum VA medical opinion that fully addressed the Veteran's circumstances and allegations of bilateral lower extremity peripheral neuropathy related to in-service exposure to herbicide agents. In the same decision, the Board determined that because the Veteran's claim seeking service connection for insulin resistance/metabolic syndrome was denied, there was no need to obtain additional evidentiary development regarding his claims of bilateral lower extremity peripheral neuropathy as secondary to insulin resistances/metabolic syndrome. A new medical opinion was obtained in August 2020, as directed. However, now that the insulin resistance/metabolic syndrome claim has been remanded for additional development, the decision on that claim could significantly impact a decision on the issue of bilateral lower extremity peripheral neuropathy. Therefore, the issues are inextricably intertwined, and a remand is required. The matters are REMANDED for the following action: 1. Obtain and associate with the claims file any outstanding VA medical records. 2. Ask the Veteran to provide the identifying information and releases necessary for VA to secure the Veteran's complete records of treatment from: (a.) Dr. Carl Vance (b.) The Veteran's private ophthalmologist and/or optometrist (c.) Any other relevant private treatment records identified by the Veteran. 3. Secure for the claims file the complete records from all providers/sources identified. If any records requested are unavailable, the reason must be explained in the record. If a private provider does not respond to a VA request for records, the Veteran must be so advised, and also advised that ultimately it is his responsibility to ensure that private records are received. 4. Thereafter, forward the Veteran's record to an appropriate physician for review and an addendum medical opinion. The examiner must address the following: (a.) State whether the Veteran's current insulin resistance/metabolic syndrome is, in and of itself, a disease, injury, or defect. The examiner should also indicate whether the Veteran's insulin resistance/metabolic syndrome results in a disease, injury, or defect and report the nature and severity of all such manifestations. (b.) If the current insulin resistance/metabolic syndrome is a disease, injury, or defect, or results in such, the examiner should opine as to whether it is at least as likely as not that the current metabolic syndrome/insulin resistance had its onset in service or is the result of a disease or injury in service, to include exposure to herbicides (Agent Orange) in the Republic of Vietnam. (c.) A negative opinion based on the rationale that such conditions are not a disease presumptively associated with exposure to certain herbicide agents is inadequate. The examiner must consider direct service causation. 5. Additionally, obtain an addendum opinion from an appropriate clinician regarding the Veteran's bilateral lower extremity neuropathy. The examiner must address the following: (a.) State whether it is at least as likely as not that the Veteran's bilateral lower extremity neuropathy is caused by his insulin resistance/metabolic syndrome. (b.) State whether it is at least as likely as not that the Veteran's bilateral lower extremity neuropathy is aggravated (worsened beyond normal progression) by his insulin resistance/metabolic syndrome. 6. In offering any opinion, the examiners must consider the full record, to including any newly obtained medical records, the Veteran's lay statements regarding the incurrence of his insulin resistance/metabolic syndrome and peripheral neuropathy, and the continuity of symptomatology. The rationale for any opinion offered should be provided. Cynthia M. Bruce Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N. Miller, 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.