Citation Nr: 21075522 Decision Date: 12/20/21 Archive Date: 12/20/21 DOCKET NO. 15-35 541 DATE: December 20, 2021 REMANDED Entitlement to service connection for diabetes mellitus type II is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1973 to January 1987. This matter is on appeal from a February 2015 decision of a Department of Veterans Affairs (VA) Regional Office (RO). In December 2018, a hearing was held before the undersigned. A transcript of the hearing is in the record. The case was previously before the Board in July 2019 when it was remanded for further development. Entitlement to service connection for diabetes mellitus type II is remanded. The Veteran contends that he is entitled to service connection for diabetes mellitus type II. Upon review of the record, the Board finds that further development is necessary to determine whether the Veteran was exposed to herbicide agents and obtain an opinion which adequately addresses the etiology of the Veteran's condition. First, the Board notes that pursuant to the Board's July 2019 remand, personnel records have been associated with the claims file which identify Marine Corps Base Camp Butler, Marine Corps Air Station Iwakuni, and Marine Corps Air Station Futenma as locations where the Veteran served. The record does not reflect that development has been completed to determine whether herbicide agents were used at these locations. Thus, this matter must be returned to the RO to complete this development. Second, in this case, the Veteran was provided with a VA examination in February 2020 in which the examiner opined that it is less likely than not that the Veteran's diabetes mellitus type II was incurred in or related to service. A February 2015 email from VA's Agent Orange mailbox indicates that although tactical herbicide agents were not used, tested, or stored in Okinawa, commercial herbicides were used in Okinawa. The February 2020 opinion does not specifically address whether the Veteran's condition is at least as likely as not related to exposure to commercial herbicides. Further, the Board notes that the July 2019 remand directives requested an opinion as to the likelihood that the Veteran's condition is due to any chemical exposures other than herbicide agents. However, the examiner stated that relative proximity to storage of these chemicals or toxins does not automatically confer exposure, which the Board interprets as finding that the Veteran was not in fact exposed to such chemicals. To ensure substantial compliance with the prior remand directive, the examiner is asked to presume for the sake of providing an opinion that the Veteran was in fact exposed to other such chemicals in service. Thus, if the development discussed above does not substantiate the claim of exposure to herbicide agents, then an addendum opinion must be obtained to address these alternative theories of entitlement. The record also reflects the Veteran receives VA treatment; thus, updated VA treatment records should be associated with the claims file. The matters are REMANDED for the following action: 1. Obtain the Veteran's VA treatment records for the period from July 2020 to the present. 2. Complete all development deemed necessary to determine whether the Veteran was exposed to herbicide agents during his service in Okinawa, to include at Marine Corps Base Camp Butler, Marine Corps Air Station Iwakuni, and Marine Corps Air Station Futenma. The Veteran should be contacted if any further information is required regarding the circumstances of the alleged exposure. If exposure to herbicide agents is established upon completion of this development, no further development is necessary. 3. After completing the development requested in items 1 and 2 and if it is determined that the Veteran did not have exposure to tactical herbicide agents, return the claims file to the February 2020 VA examiner, or another appropriate clinician if that examiner is not available, for review and an addendum medical opinion. The reviewing clinician should be requested to provide opinions (based on a review of the record) to answer the following: (a.) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran's diabetes mellitus type II is related to exposure to commercial herbicides in service? (b.) If not, is it at least as likely as not (a 50 percent or greater probability) that the Veteran's diabetes mellitus type II is related to other chemical exposures? In providing an opinion, the examiner is asked to presume that the Veteran was exposed to the toxic materials discussed in the February 2013 Memorandum from the Department of the Air Force indicating the storage of drums containing various chemicals found near Kadena Air Force Base. A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. M. SORISIO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. H. White, 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.