Citation Nr: 21074893 Decision Date: 12/16/21 Archive Date: 12/16/21 DOCKET NO. 20-11 523 DATE: December 16, 2021 REMANDED Entitlement to service connection for diabetes mellitus type II is remanded. Entitlement to service connection for peripheral neuropathy is remanded. Entitlement to service connection for high blood pressure is remanded. Entitlement to service connection for arthritis condition is remanded. Entitlement to service connection for kidney and bladder stones are remanded. Entitlement to service connection for erectile dysfunction is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1964 to August 1967. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2018 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). This matter was last before the Board in June 2021, when it was remanded to the agency of original jurisdiction (AOJ) for further development. After taking further action, the AOJ confirmed and continued the prior denial and returned the case to the Board. 1. Entitlement to service connection for diabetes mellitus type II is remanded. 2. Entitlement to service connection for peripheral neuropathy is remanded. 3. Entitlement to service connection for high blood pressure is remanded. 4. Entitlement to service connection for arthritis condition is remanded. 5. Entitlement to service connection for kidney and bladder stones are remanded. Although the Board regrets the additional delay, further development is necessary to ensure substantial compliance with the prior remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The Veteran contends that his current diabetes mellitus, peripheral neuropathy, high blood pressure, kidney and bladder stones and arthritis disabilities were incurred during service as he had in-service herbicide exposure due to his service in Korea where he was exposed to Agent Orange. The Veteran also contends that these disabilities resulted from his exposure to radiation as he served in the Radar Operation Room both at Hunter Air Force Base and on his Air Force base in Korea. These claims were remanded for an examiner to address the Veteran's alleged exposure to water contamination at the American Lake Gardens/McChord Air Force Base (AFB) and herbicide agents during service in South Korea. In September 2021, a VA examiner opined that it was less likely than not that any current diabetes mellitus II, peripheral neuropathy, high blood pressure, arthritis and kidney/bladder stones were related to exposure to herbicide agents and contaminated water at McChord AFB, due to lack of diagnosis in service and the lapse of time between exposure and the Veteran's onset of symptoms. Here, the examiner relied largely on the lack of documented complaints, diagnosis, and treatment in service without specifically addressing the Veteran's assertions and claims of exposure to water contamination and herbicide agents, and provided an otherwise conclusory rationale. See Dalton v. Nicholson, 21 Vet. App. 23, 39-40 (2007) (examination inadequate where the examiner relied on the lack of evidence in service treatment records to provide negative opinion). In addition, merely the lack of contemporaneous medical evidence after service for such condition is not a bar for warranting service connection on this basis. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). Given the foregoing, a remand is warranted for adequate rationale. Stegall v. West, 11 Vet. App. 268, 271 (1998). 6. Entitlement to service connection for erectile dysfunction is remanded. The Veteran contends that his erectile dysfunction disability is a result of medication taken for his claimed diabetes mellitus, peripheral neuropathy, high blood pressure, kidney and bladder stones and arthritis disabilities. The Board finds this claim is inextricably intertwined with the entitlement to service connection for his claimed diabetes mellitus, peripheral neuropathy, high blood pressure, arthritis, kidney and bladder stones disabilities. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician(s) regarding the etiology of the Veteran's diabetes, peripheral neuropathy, high blood pressure, arthritis, and kidney/bladder stone. The electronic claims file must be made available to the examiner(s) for review. After reviewing the record, the examiner(s) should offer an opinion as to whether it is at least as likely as not (i.e., whether it is 50 percent or more probable) that diabetes, peripheral neuropathy, high blood pressure, arthritis, and kidney/bladder stone had its onset in, or is otherwise attributable to, his period of active service, to include purported exposure to herbicide agents during service in South Korea and/or purported exposure to contaminated water at McChord AFB. In formulating this opinion, the examiner must address each disability separately. Additionally, the examiner is advised that the Veteran is competent to report injuries and symptoms and that his reports must be considered in formulating the requested opinions. If lay assertions in any regard are discounted, the physician should clearly so state, and explain why. (Continued on the next page) A complete rationale for all opinions expressed should be provided and must not be based on the lack of an in-service record of the claimed disability. The need for another examination and/or telephonic or video interview of the Veteran is left to the discretion of the examiner selected to offer the requested opinion. 2. After completing the above, and any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraphs, the issues on appeal should be readjudicated based on the entirety of the evidence. If any benefit sought remains denied, the Veteran and his representative should be issued a supplemental statement of the case. An appropriate period of time should be allowed for response. Richard Kettler Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Asare, 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.