Citation Nr: 21065564
Decision Date: 10/26/21	Archive Date: 10/26/21

DOCKET NO. 15-15 715
DATE: October 26, 2021

REMANDED

Service connection for diabetes mellitus is remanded.

REASONS FOR REMAND

The Veteran served on active duty from December 1984 to March 1985 and January 1987 to August 1991. In May 2021, the Board of Veterans' Appeals (Board) remanded his claim to the agency of original jurisdiction (AOJ) for additional development. 

The Veteran contends his diabetes mellitus is related to shots he received during service and medications prescribed for treatment of his service-connected psychiatric disorder. In other words, he contends the diabetes is secondary to the service-connected psychiatric disorder. 

The Board instructed the AOJ to obtain an addendum medical opinion on the etiology of his diabetes. In July 2021, a VA contractor reviewed the claims file and provided an opinion. The July 2021 examiner determined it is less likely than not that the Veteran's diabetes was due to inoculations in service or medications for his psychological conditions. The examiner explained there is no medical basis for the claim per established medical knowledge and practice. 

An adequate VA medical opinion on secondary service connection must address both proximate causation and aggravation. El Amin v. Shinseki, 26 Vet. App. 136, 140 (2013). Because the July 2021 examiner failed to address whether the Veteran's diabetes is aggravated beyond its natural clinical course by the service-connected psychiatric disorder, including medications used to treat that disorder, the opinion is inadequate. 

Another remand is necessary to ensure compliance with the Board's previous instructions. Stegall v. West, 11 Vet. App. 268, 271 (1998); see also Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (when VA undertakes the effort to provide a VA examination or obtain an opinion, it must ensure that the examination or opinion is adequate). 

The Board by this remand makes no determination, expressed or implied, concerning the credibility of any statements on file.

The matter is REMANDED for the following action:

1. Obtain an addendum opinion on the etiology of the Veteran's diabetes mellitus from an appropriate clinician, preferably an endocrinologist. After reviewing the claims file, the examiner must address the following:

(a.) Is it at least as likely as not (50 percent or greater probability) that the Veteran's diabetes mellitus is proximately due to his service-connected psychiatric disorder, including treatment thereof? 

(b.) Is it at least as likely as not (50 percent or greater probability) that the Veteran's diabetes mellitus is aggravated beyond its natural clinical course by his service-connected psychiatric disorder, including treatment thereof?

2. Review the medical opinion above to ensure substantial compliance with the Board's directives. Take any necessary corrective action.

3. Readjudicate the Veteran's claim. If it remains denied, issue a supplemental statement of the case and allow the Veteran and his representative the opportunity to respond. Then return to the Board for further appellate review.

 

KELLI A. KORDICH

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	D.Z. Wall, 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.