Citation Nr: 21068267 Decision Date: 11/09/21 Archive Date: 11/09/21 DOCKET NO. 18-34 963 DATE: November 9, 2021 REMANDED Entitlement to service connection for peripheral nerve damage, right lower extremity (to include burning sensation, tingling, and numbness of feet, ankles, and legs) claimed as due to exposure to herbicide agents and/or as secondary to diabetes, is remanded. Entitlement to service connection for peripheral nerve damage, left lower extremity (to include burning sensation, tingling, and numbness of feet, ankles, and legs) claimed as due to exposure to herbicide agents and/or as secondary to diabetes, is remanded. REASONS FOR REMAND The Veteran served honorably in the United States Army from March 1967 to March 1969. These issues come before the Board of Veterans' Appeals (Board) on appeal from a November 2016 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In November 2019, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. The transcript is of record. 1. Entitlement to service connection for peripheral nerve damage, right lower extremity (to include burning sensation, tingling, and numbness of feet, ankles, and legs) due to herbicide exposure and/or as secondary to diabetes. 2. Entitlement to service connection for peripheral nerve damage, left lower extremity (to include burning sensation, tingling, and numbness of feet, ankles, and legs) due to herbicide exposure and/or as secondary to diabetes. The Veteran contends that his bilateral lower extremity peripheral nerve damage is the result of in-service exposure to herbicide agents. In addition, he contends that his bilateral lower extremity peripheral nerve damage was caused or aggravated by his diabetes. The Board notes that this matter was remanded in March 2021 for additional development, including referral to the AOJ of the diabetes claim for development and adjudication. The Veteran underwent a VA examination in July 2021. The examiner found no evidence of a diabetes diagnosis. He noted that a review of the medical records did not reveal a diabetes diagnosis. In addition, he noted that the Veteran did not qualify for diabetes per VA regulations, as fasting glucose and A1C testing were never elevated to diabetic levels. No other opinions or rationale were provided. The VA has a duty to assist veterans in developing their claims for benefits. 38 C.F.R. § 3.159. The duty to assist including providing a medical examination when necessary to decide a claim. 38 C.F.R. § 3.159 (c)(4). When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The Board finds that the VA examination is inadequate for adjudicative purposes. The examiner failed to consider all the evidence of record when rendering his opinion. A review of the evidence demonstrates that the Veteran was diagnosed and treated for diabetes. An opinion based on an inaccurate factual background is not entitled to any probative value. As such, the Board remands these matters for the issuance of an addendum VA medical opinion that addresses all the evidence of record. The matters are REMANDED for the following action: 1. Obtain updated VA and/or private treatment records to the extent possible. If such records are unavailable, the Veteran's claims file must be clearly documented to that effect and the Veteran notified in accordance with 38 C.F.R. § 3.159 (e). 2. In remanding this case, the Board makes no credibility determination, expressed or implied, at this juncture. 3. Obtain a VA medical opinion regarding the Veteran's diabetes from a medical professional with appropriate expertise. The examiner should review the Veteran's claims file. If the examiner determines that an opinion cannot be provided without an examination, the Veteran should be scheduled for one. Based on a review of the record, and a new examination if necessary, the reviewer must address the following: (a.) Does the Veteran have a diagnosis of diabetes at any point during the appeal period (2016 to the present)? The examiner is to address the pertinent medical evidence, which notes a diagnosis and treatment for diabetes. (b.) If the answer to (a.) is positive, it is at least as likely as not (a balance of positive and negative evidence) that the Veteran's bilateral lower extremity nerve damage was caused or aggravated by the Veteran's diabetes? The term "at least as likely as not" does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a certain conclusion is so evenly divided that it is as medically sound to find in favor of such a conclusion as it is to find against it. "Aggravation" means any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease, and not due to the natural progress of the nonservice-connected disease. If aggravation is found, the examiner should attempt to quantify the extent of additional disability resulting from the aggravation. (Continued on the next page) The examiner is advised that the Veteran is competent to report his medical history including symptoms and treatment, and that his reports must be taken into account, along with the other evidence of record in formulating the requested opinions. A complete rationale must be provided for all opinions presented. If the medical professional cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation for why an opinion cannot be rendered. In so doing, the medical professional shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). G. A. WASIK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J.T. Massey, 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.