Citation Nr: 21067254 Decision Date: 11/03/21 Archive Date: 11/03/21 DOCKET NO. 15-02 918 DATE: November 3, 2021 REMANDED Entitlement to service connection for Type II diabetes mellitus is remanded. Entitlement to service connection for diabetic neuropathy of the bilateral upper and lower extremities, to include as secondary to diabetes mellitus is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1968 to August 1972. These matters come before the Board of Veterans' Appeals (Board) on appeal from a February 2014 rating decision. The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a hearing in May 2015. A transcript of that hearing is of record. These matters were previously remanded by the Board in May 2018 and June 2020. 1. Entitlement to service connection for Type II diabetes mellitus is remanded. Unfortunately, there has not been substantial compliance with the Board's previous remand directives and another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). The June 2020 remand instructed the examiner to provide an opinion discussing the Veteran's duties as a necropsy technician, mortician, and embalmer in Guam while on active duty service and whether that would have exposed him to herbicides, by inhalation or transdermally. The June 2021 examination provided an opinion essentially arguing that exposure to herbicide agents does not cause diabetes mellitus unless the Veteran was diagnosed with acute or chronic pancreatitis. The Board points out that if a veteran is found to be exposed to herbicide agents, then a nexus between that exposure and Type II diabetes mellitus is presumed. 38 C.F.R. § 3.309(e). The June 2021 examiner has not discussed the relevant question of whether duties as a necropsy technician, mortician, and embalmer would expose him to herbicide agents. Upon remand, a supplemental opinion should be obtained that complies with the June 2020 remand. Additionally, an attempt should be made to determine if any organization within VA has performed research on whether an individual would be exposed to herbicide agents by handling clothing, equipment, or bodies that had been in Vietnam. 2. Entitlement to service connection for diabetic neuropathy of the bilateral upper and lower extremities, to include as secondary to diabetes mellitus is remanded. Finally, because a decision on the remanded issue of service connection for Type II diabetes mellitus could significantly impact a decision on the issue of service connection for diabetic neuropathy of the bilateral upper and lower extremities, to include as secondary to diabetes mellitus, the issues are inextricably intertwined. A remand is thus required. The matters are REMANDED for the following action: 1. Contact an appropriate department to attempt to verify the Veteran's asserted in-service exposure to herbicide agents, to include determining whether it is possible for an individual to be exposed to herbicide agents by inhalation or transdermally by handling clothing, equipment, or bodies that had been in Vietnam, including by performing autopsies or embalming the bodies of individuals who died in Vietnam. In attempting to verify this asserted exposure, consider the fact that exposure to herbicide agents has been conceded for individuals who regularly and repeatedly operated, maintained, or served onboard C-123 aircraft known to have been used to spray an herbicide agent during the Vietnam era. 38 C.F.R. § 3.307(a)(6)(v). 2. Obtain an addendum opinion from an appropriate clinician regarding the etiology of the Veteran's Type II diabetes mellitus. The examiner must answer the question: Is it at least as likely as not (50 percent or greater probability) that the Veteran's Type II diabetes mellitus is related to service, to include embalming and performing autopsies on the bodies of servicemembers, including some who died in Vietnam? In answering this question, the examiner must consider and discuss whether the Veteran's duties as a necropsy technician, mortician, and embalmer in Guam, including removing clothing from and embalming or performing autopsies on the bodies of servicemembers who had died in Vietnam, would expose him to herbicide agents. The clinician is not asked whether exposure to herbicide agents causes type II diabetes mellitus, as the nexus between exposure to herbicide agents and type II diabetes mellitus is presumed. The opinion offered must be supported by a complete rationale. M.E. Larkin Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Budd, 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.