Citation Nr: 21076356 Decision Date: 12/23/21 Archive Date: 12/23/21 DOCKET NO. 10-49 333 DATE: December 23, 2021 REMANDED Entitlement to service connection for diabetes mellitus, to include as due to in-service high cholesterol is remanded. Entitlement to service connection for a heart disability, to include as due to in-service high cholesterol is remanded. REASONS FOR REMAND The Veteran had active service from November 1979 to August 1992. He had additional service in the United States Army Reserves. He passed away in July 2016. The Appellant is the Veteran's surviving spouse. In July 2019, the Appellant testified at a videoconference hearing, a transcript of which is of record. The matter was then remanded by the Board in December 2019. Regrettably, remand is again necessary. In this regard, while some of the development requested by the Board was completed, some was not. Recognizing that the Agency of Original Jurisdiction (AOJ) had previously determined that the Veteran's active-duty personnel and treatment records were unavailable, the Board requested that the AOJ attempt to obtain the Veteran's service travel records through the Defense Travel Management Office (DTMO) or acquire the Veteran's reserve medical and personnel records. If unavailable, the AOJ was to issue a formal finding of their unavailability. The record shows that the AOJ sent a letter to the Appellant in December 2019 requesting that she provide the Veteran's Reserve unit information so that the AOJ could request the Veteran's complete military personnel records, including his travel records. The record then shows that the AOJ requested the Veteran's complete medical and personnel file through the National Personnel Records Center (NPRC); the NPRC responded in December 2020 and said that it was unable to locate the records identified in the request, such that the records either did not exist or were not located at NPRC. The AOJ then sent a letter in January 2021 to the Department of the Army requesting all treatment records, hospital summaries, findings and/or diagnoses during his active and Reserve service. In April 2021, the AOJ received notification that a thorough review of all known systems, as appropriate, had been accomplished, and that it was concluded that no further records existed for the Veteran. In June 2021, the AOJ received a letter from the Army Service Center/Department of the Army advising that there were no additional documents available at that Command aside from those already available. While it appears that the AOJ made sufficient attempts to request and obtain the Veteran's Reserve records, it does not appear that the AOJ contacted the Defense Travel Management Office (DTMO) to secure the Veteran's travel records. This should be accomplished on Remand. Also, the AOJ was requested to conduct any additional development to determine the Veteran's exposure to herbicide agents, chemical toxins, and ionizing radiation, based on the Veteran's assertion during his lifetime that he was exposed to herbicide agents, chemical toxins, and ionizing radiation while serving in Southwest Asia during the Persian Gulf War. He specifically identified the decontaminating agent DS2 as well as medication issued to soldiers to protect against nerve agents. See VA 21-526, October 2006. It does not appear that attempts were made to verify any exposure. Lastly, a medical opinion was obtained, as requested. The September 2021 VA opinion provider offered an opinion that the Veteran's diabetes and/or heart conditions were not related to the Veteran's service; the rationale was that review of the Veteran's service records showed no evidence of a diagnosis of, treatment for, or symptoms suggestive of diabetes. Rather, the examiner stated that the Veteran was diagnosed with diabetes in 2001 which worsened due to non-compliance with medication. The examiner added that there was no evidence of any toxic exposure or any evidence of significant coronary disease. However, the opinion provider did not address specific pieces of evidence including a November 1991 laboratory finding of a cholesterol level of 219; the report of a September 1997 Army physical examination showing elevated blood sugar, cholesterol, and triglycerides; or a notation on the Veteran's June 2005 Reserves examination that he had diabetes for four years, as had been requested by the Board. Without addressing those pieces of evidence, the examiner did not adequately answer the question of whether either of the Veteran's conditions were related to in-service high cholesterol. Therefore, another opinion is necessary. The matters are REMANDED for the following action: 1. Contact the Defense Travel Management Office (DTMO) to request the Veteran's military personnel records, including any travel periods during his period of active military service. 2. Conduct development to determine the Veteran's exposure to herbicide agents, chemical toxins, and ionizing radiation by contacting any appropriate entities or records repositories. Based on the results of such development, make the appropriate findings as to exposures during the Veteran's active-duty service. 3. Then, return the claims file to an examiner other than the one who provided the September 2021 opinion. The selected clinician must review the entire claims file, and then respond to the following: Is it at least as likely as not (approximately 50 percent probability) that the Veteran's diagnosed diabetes and/or any heart condition had onset in, or was otherwise related to an in-service injury, event, or disease, to include in-service high cholesterol and elevated blood sugars; or, to any exposure to herbicide agents, chemical toxins, or ionizing radiation? The examiner is asked to specifically consider the following evidence: (i) a November 1991 laboratory finding of a cholesterol level of 219;(ii) the report of a September 1997 Army physical examination showing elevated blood sugar, cholesterol, and triglycerides; (iii) the notation on a Veteran's June 2005 Reserves examination that he had diabetes for four years; (iv) the Veteran's lay statements during his lifetime and the Appellant's statements at her July 2019 hearing regarding the onset of the Veteran's conditions. If the examiner concludes that there is no evidence that the Veteran suffered from any heart conditions during his lifetime, as the September 2021 VA examiner concluded, a medical rationale for that opinion must be provided. 4. Then, readjudicate the issues on appeal. If the benefits sought remain denied, provide a Supplemental Statement of the Case (SSOC) to the Appellant and her representative. V. Chiappetta Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Polly Johnson, 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.