Citation Nr: 21075343 Decision Date: 12/20/21 Archive Date: 12/20/21 DOCKET NO. 14-38 806A DATE: December 20, 2021 REMANDED Entitlement to service connection for diabetes mellitus, type II (DMII) is remanded. Entitlement to service connection for peripheral neuropathy bilateral upper extremities is remanded. Entitlement to service connection for peripheral neuropathy bilateral lower extremities is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1971 to March 1975. In August 2021, the Board most recently remanded the current claims for additional development. 1. Entitlement to service connection for DMII is remanded. As discussed in the previous Board remand, the Veteran contends he has DMII that is related to service, to include as due to herbicide agents exposure during his service in Guam. The Veteran's service personnel records reflect that he was stationed at Andersen Air Force Base (AFB), Guam from May 1972 to August 1973. The previous Board remand directed the Agency of Original Jurisdiction (AOJ) to make appropriate requests to verify whether the Veteran was exposed to herbicide agents during his service in Guam. The Board finds that such development has been completed. Although there was no evidence to show herbicide agent exposure in Guam, such development suggested that the Veteran may have been exposed to various other hazardous substances, to include bacterial contamination, commercial herbicides, and trichloroethane (TCE) that were present in the groundwater. See August 2021 VA Memo. The Veteran also provided an article from May 2020 that suggests there was improper hazardous waste disposal and various hazardous pollutants. The article cites to Environmental Protection Agency (EPA) soil test results from Anderson AFB that show concentrations of tetrachlorodibenzo dioxin (TCDD). There is no medical opinion of record that addresses whether the Veteran's DMII is otherwise related to exposure to the chemical and environmental hazards during his service at Andersen AFB. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). Accordingly, the Board finds that remand is warranted for a VA examination and medical opinion consistent with the directives herein. 2. Entitlement to service connection for bilateral upper and lower extremity peripheral neuropathy is remanded. The record suggests that the Veteran has peripheral neuropathy associated with his DMII. See September 2003 VA Treatment records. To date, no VA examinations have been obtained to assess the etiology of the Veteran's neuropathy. Accordingly, the Board finds that such evidence is sufficient to trigger VA's duty to obtain a VA examination and medical opinion to determine the nature and etiology of these disorders. The matters are REMANDED for the following actions: 1. Obtain a VA examination and opinion from an appropriate examiner to determine the nature and etiology of the Veteran's DMII. The claims folder (including a copy of this remand) must be provided to and reviewed by the examiner as part of the examination. All indicated tests should be accomplished and all clinical findings reported in detail. The examiner must render an opinion as to whether it is at least as likely as not (i.e., a 50 percent probability or greater) that the Veteran's DMII is related to his active duty service, to include the reports of exposure to chemical and environmental hazards during his service at Andersen AFB. In rendering the above opinion, the examiner must consider and discuss the August 2021 VA Memo and May 2020 article that suggests there was improper hazardous waste disposal and various other hazardous pollutants. It is advised that the Veteran is competent to report his symptoms/history and that such reports must be acknowledged and considered in formulating any opinion. If his reports are discounted, a reason should be provided for doing so. A rationale for all requested opinions shall be provided. The rationale must include a discussion of the underlying medical principles specific to the facts of this case and not simply reference generic medical literature. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner 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. 2. Obtain a VA examination and opinion from an appropriate examiner to determine the nature and etiology of the Veteran's bilateral upper and lower extremity peripheral neuropathy. The claims folder (including a copy of this remand) must be provided to and reviewed by the examiner as part of the examination. All indicated tests should be accomplished and all clinical findings reported in detail. a) Provide a diagnosis for any current peripheral nerve condition present during the course of the appeal. b) If, and only if, the Veteran's DMII is found to be etiologically related to service, the examiner must opine as to whether it is at least as likely as not (i.e., 50 percent probability or greater) that any diagnosed peripheral neuropathy was caused, or aggravated, by the Veteran's DMII. For the purposes of secondary service connection, the examiner is advised that aggravation is defined as "any increase in disability." c) The examiner must render an opinion as to whether it is at least as likely as not (i.e., a 50 percent probability or greater) that any diagnosed peripheral nerve disorder is related to the Veteran's active duty service, to include the reports of exposure to chemical and environmental hazards during his service at Andersen AFB. In rendering the above opinion, the examiner must consider and discuss the August 2021 VA Memo and May 2020 article that suggests there was improper hazardous waste disposal and various other hazardous pollutants. It is advised that the Veteran is competent to report his symptoms/history and that such reports must be acknowledged and considered in formulating any opinion. If his reports are discounted, a reason should be provided for doing so. A rationale for all requested opinions shall be provided. The rationale must include a discussion of the underlying medical principles specific to the facts of this case and not simply reference generic medical literature. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner 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. A. ISHIZAWAR Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Metzner, Paul 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.