Citation Nr: 21070075 Decision Date: 11/22/21 Archive Date: 11/22/21 DOCKET NO. 10-17 456 DATE: November 22, 2021 REMANDED Entitlement to service connection for diabetes mellitus, type II, as secondary to service-connected musculoskeletal disabilities is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1968 to April 1979. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in September 2008 by a Department of Veterans Affairs (VA) Regional Office (RO). In March 2013, the Veteran testified at a Board hearing before a Veterans Law Judge. A transcript of the hearing is associated with the record. As such Veterans Law Judge has since retired, he was provided with an opportunity to testify at another Board hearing before a different Veterans Law Judge in June 2021; however, as he did not respond to such letter within 30 days, the Board assumed he did not desire another hearing. In November 2013, June 2016, and October 2018, the Board remanded the case for additional development and, in April 2020, denied service connection for diabetes mellitus, type II. Thereafter, the Veteran appealed such decision to the United States Court of Appeals for Veterans Claims (Court), and in January 2021, the Court granted the Secretary of VA's and the Veteran's (the parties') Joint Motion for Partial Remand (JMPR), which vacated the portion of the Board's April 2020 decision that denied entitlement to service connection for diabetes mellitus, type II, as secondary to service-connected musculoskeletal disabilities. In July 2021, the Board remanded such issue for additional development and the case now returns for further appellate review. Entitlement to service connection for diabetes mellitus, type II, as secondary to service-connected musculoskeletal disabilities. The Veteran contends that his diabetes mellitus, type II, is caused or aggravated by his service-connected musculoskeletal disabilities with obesity as an intermediary step. As noted in the July 2021 remand, the JMPR found that a July 2019 VA examiner's opinion was inadequate insofar as it did not address whether the Veteran's service-connected musculoskeletal disabilities aggravated his obesity, whether the aggravation of obesity as a result of such service-connected disability was a substantial factor in causing diabetes mellitus, type II, and whether the Veteran's diabetes mellitus, type II would have occurred but for obesity aggravated by such service-connected disabilities. Thus, the Board remanded the case in order to obtain an opinion addressing such matters. In September 2021, a VA examiner reviewed the record, interviewed the Veteran, and conducted a physical examination, and opined that his diabetes mellitus, type II, was less likely than not proximately due to, the result of, or aggravated by his service-connected musculoskeletal disabilities as there was nothing in the medical literature to support a finding that any service-connected disability resulted in a diagnosis of diabetes mellitus, type II. Rather, she observed that the Veteran had diabetic risk factors that included being overweight, hypertension, and dyslipidemia. The examiner further opined that it was less likely than not that the Veteran's service-connected musculoskeletal disabilities caused or aggravated his obesity, and his diabetes mellitus, type II, would not have occurred but for obesity caused or aggravated by the service-connected disabilities as the medical literature does not support a finding that such disabilities cause inactivity or obesity. In this regard, she indicated that the Veteran's diabetes mellitus, type II, can be controlled by oral intake and medication, and is not affected by his inactivity. The examiner also noted that, while sedentary lifestyle and obesity are recognized risk factors for diabetes mellitus, they alone are not causative factors, and the Veteran's age (around 51 or 52 at the time of diagnosis), his hypertension, and his dyslipidemia (with onset prior to diabetes mellitus, type II) are also recognized risk factors for such disease. However, as the September 2021 VA examiner provided the same rationale as the July 2019 VA examiner, which the JMPR found to be inadequate, and only addressed causation in her rationale, her opinion is inadequate to decide the instant claim. Consequently, a remand is necessary in order to obtain an addendum opinion that adequately addresses the Board's inquiries. The matters are REMANDED for the following action: Forward the record, to include a copy of this remand, to an appropriate VA clinician other than the September 2021 examiner for an addendum opinion addressing the etiology of the Veteran's diabetes mellitus, type II. Following a review of the record, the examiner should offer an opinion as to the following inquiries: Is it at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran's service-connected musculoskeletal disabilities aggravated his obesity? If so, was the aggravation of obesity as a result of the Veteran's service-connected musculoskeletal disabilities a substantial factor in causing his diabetes mellitus type II? Would the Veteran's diabetes mellitus, type II, not have occurred but for the obesity aggravated by his service-connected disabilities? A rationale for any opinion offered should be provided. In this regard, the examiner is advised that the prior opinions relying on a finding that the medical literature does not support a finding that the Veteran's musculoskeletal disabilities cause inactivity or obesity have been found to be inadequate as such do not address aggravation. A. JAEGER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Breckenridge 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.