Citation Nr: 21069514 Decision Date: 11/18/21 Archive Date: 11/18/21 DOCKET NO. 19-38 188 DATE: November 18, 2021 REMANDED Service connection for diabetes is remanded. Service connection for heart condition is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1961 to June 1963. These issues are before the Board of Veterans' Appeals (Board) on appeal from a December 2018 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at an April 2021 videoconference hearing before the undersigned Veterans Law Judge. A copy of the transcript is of record. These issues were previously before the Board in May 2021 when remanded for further development. The Board finds that the RO substantially complied with its remand order. Stegall v. West, 11 Vet. App. 268 (1998). 1. Service connection for diabetes is remanded. The Board cannot make a fully informed decision on the issue of service connection for diabetes because no VA examiner has opined whether the Veteran has a current diabetes disability that is related to active service. The Veterans Claims Assistance Act (VCAA), as part of the duty to assist, requires VA to obtain an exam or opinion in certain circumstances. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). A VA examination or opinion must be obtained in conjunction with a claim if there is: competent evidence of a current disability; evidence of an in-service event, injury, or disease; an indication that the current disability may be associated with the veteran's service or another service-connected disability; and there is otherwise insufficient competent medical evidence to decide on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006). Recently obtained medical records confirm a January 1996 diagnosis of type I diabetes. Service treatment records show a July 1961 diagnosis of albuminuria. The Board cannot, in making its decisions, assert its own medical opinion on the relevance of this in-service finding to the Veteran's current diabetes. Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991). A VA examination of the Veteran's diabetes and a nexus opinion is warranted. 2. Service connection for heart condition is remanded. The Board cannot make a fully informed decision on the issue of service connection for heart condition because no VA examiner has opined whether the Veteran's active service may have aggravated a preexisting heart condition. The Veterans Claims Assistance Act (VCAA), as part of the duty to assist, requires VA to obtain an exam or opinion in certain circumstances. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). A VA examination or opinion must be obtained in conjunction with a claim if there is: competent evidence of a current disability; evidence of an in-service event, injury, or disease; an indication that the current disability may be associated with the veteran's service or another service-connected disability; and there is otherwise insufficient competent medical evidence to decide on the claim. McLendon, 20 Vet. App. at 79. Recently obtained medical records confirm a February 1996 diagnosis of congenital heart disease "probably" atrial septal defect, right bundle branch block, and a small area of ischemic myocardium. March 1961 service treatment records show that prior to enlistment the Veteran underwent a physician's repair of pinhead size interventricular septal defect in September 1959 and was hospitalized for two and a half weeks following the repair. The Board cannot, in making its decisions, assert its own medical opinion on the relevance of this in-service report to the Veteran's current heart condition. Colvin, 1 Vet. App. at 175. A VA examination of the Veteran's heart condition and a nexus opinion is warranted. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination for diabetes. The examiner must review the claims file, including the July 1961 service treatment record noting a diagnosis of albuminuria, the April 2021 Board hearing transcript, and a copy of this remand order. The examiner is asked to provide a response to the following: (a.) Is the Veteran's current diabetes at least as likely as not related to service, including July 1961 diagnosis of albuminuria? Provide a rationale to support the opinion. If the examiner cannot provide an opinion without resorting to mere speculation, then the examiner should explain whether more information is needed or whether the limits of current medical knowledge have been exhausted. In providing the requested opinion, consider the Veteran's description of post-service symptoms. Do the Veteran's reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? In remanding these matters, the Board makes no finding, implicit or otherwise, as to the credibility of the Veteran's assertions. Neither the Veteran's credibility nor any lack thereof should be presumed in this remand order. 2. Schedule the Veteran for a VA examination for heart conditions. The examiner must review the claims file, including the March 1961 service treatment record noting a September 1959 interventricular septal repair, the April 2021 Board hearing transcript, and a copy of this remand order. The examiner is asked to provide a response to the following: (a.) Did a heart condition clearly and unmistakably (undebatable) preexist the Veteran's service? (b.) If the examiner finds that the heart condition did clearly and unmistakably preexist service, was it clearly and unmistakably not aggravated by service? (c.) Did the Veteran's heart condition, if it existed prior to service, at least as likely as not increase in severity during service? (d.) If so, was the increase in severity clearly and unmistakably (undebatable) due to the natural progress of the disease? (e.) If the examiner finds that the heart condition either did not clearly and unmistakably preexist service or was not clearly and unmistakably not aggravated by service, then the examiner must opine whether it is at least as likely as not related to service. Provide a rationale to support the opinions. If the examiner cannot provide an opinion without resorting to mere speculation, then the examiner should explain whether more information is needed or whether the limits of current medical knowledge have been exhausted. In providing the requested opinion, consider the Veteran's description of post-service symptoms. Do the Veteran's reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? (Continued on the next page) In remanding these matters, the Board makes no finding, implicit or otherwise, as to the credibility of the Veteran's assertions. Neither the Veteran's credibility nor any lack thereof should be presumed in this remand order. 3. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal. If the benefit sought is not granted to the Veteran's satisfaction, send the Veteran and representative a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. G. A. WASIK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board James Hekel 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.