Citation Nr: 21077396 Decision Date: 12/29/21 Archive Date: 12/29/21 DOCKET NO. 15-15 534 DATE: December 29, 2021 REMANDED Service connection for diabetes mellitus type I ("diabetes") is remanded. REASONS FOR REMAND The Veteran served on active duty from February 2002 to February 2006. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 2012 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a December 2016 Board hearing before the undersigned Veterans Law Judge. A copy of the hearing transcript is associated with the claims file. This matter has been remanded on three occasions, most recently in July 2021. The July 2021 remand directed the RO to obtain an addendum medical opinion expressly considering the Veteran's lay statements and several notations potentially relevant to diabetes in the Veteran's service treatment records. The RO obtained an addendum medical opinion in October 2021; however, the examiner addressed almost none of the statements or notations as requested in the remand. As such, the Board finds that the RO did not substantially comply with the remand directives and further remand is necessary. See Stegall v. West, 11 Vet. App. 268, 271 (1998). In addition to the above Stegall violation, the October 2021 also mischaracterized the Veteran's service treatment records (STRs) and concluded that service-connection was not warranted due to the lack of an in-service diagnosis. Specifically, the examiner began his opinion by indicating that "STR from 12/27/2001, 12/20/2001 did not state any record of diabetes incurred during service or exposure to any etiologically related factors that could cause diabetes." The Board notes that the Veteran did not begin active service until February 2002; therefore, the records referenced above (which document the Veteran's enlistment examination) provide no insight as to whether his diabetes was incurred during service. Additionally, the examiner cited several post-service glucose and A1C levels, but no in-service glucose and A1C levels, and reasoned that service connection was not warranted because his A1C levels shortly prior to separation from service were normal and he was not diagnosed with diabetes until over five years later. The Board notes that it is insufficient for an examiner to determine a disease is not related to service merely because the Veteran's condition was normal at separation. As such, the Board finds that the examiner's failure to comply with the Board's prior remand directives, mischaracterization of and improper reliance on the Veteran's enlistment examination, and conclusory rationale relying on the Veteran's condition being normal at separation renders the opinion inadequate. On remand, the examiner must review the complete claims file, including this remand, and must specifically discuss the Veteran's lay statements and the several notations in the service treatment records suggesting possible in-service symptoms of diabetes. Any opinion that fails to discuss these statements and notations will be deemed inadequate. While the Board sincerely regrets the additional delay, another remand is necessary to afford the Veteran due process of law. Accordingly, the matter is again remanded to obtain an adequate opinion and to ensure compliance with the Board's previous remand directives. Stegall, 11 Vet. App. at 271. The matters are REMANDED for the following action: Request an addendum medical opinion from an examiner other than the examiner who provided the March 2021 and October 2021 opinions. The examiner must review the entire claims file, including this remand, and must specifically discuss the following service treatment records and lay statements, prior to rendering an opinion: (a.) August 2002, his blood test results indicated his glucose level was at 98 and he was put in the weight loss program; (b.) September 2003, he had a diabetes check and was placed on a lower calorie and high fiber diet; (c.) August 2004, his active medical conditions included obesity and dietary surveillance and counseling; (d.) November 2004, he reported his mother had a history of diabetes; (e.) February 2005, his triglyceride levels were 66, and his HGB A1C level was 5.7 with the listed interpretation as "diabetic patients in good control may have Hgb A1C values in the normal range. When using HbA1C to monitor the diabetic patient, results must be interpreted on an individual basis." (f.) September 2005, he gained 16 pounds in one week; (g.) January 2006, his endocrine system was within normal limits; (h.) His diagnosis of uncontrolled diabetes in 2010, as testified to and noted in his VA treatment records; (i.) The April 2015 statement by the Veteran that during his ongoing weight loss program in the military, he was eventually "asked to obtain these over the counter weight loss aids (with ephedra ingredients) and continue to perform physical fitness routines several times a day" and that following service, he "began to gain weight at a significant rate causing health complications." (j.) The December 2016 sworn testimony where the Veteran stated he had weight problems during service and that he took ephedra and Hydroxycut to help lose the weight. He testified having jitters and rapid heart rate and sweating after taking these pills. He stated he requested the blood work to be tested as his mother had gestational diabetes and other people with a similar weight issue in service had tested positive for diabetes after leaving service. He stated he had had symptoms such as thirst, fluctuations in weight, and frequent urination for years prior to the 2010 diagnosis. (k.) The December 2016 sworn testimony where the Veteran stated that he has been told by dieticians and endocrinologists have told him that the extreme nature of his routine during service could have caused metabolic issues that resulted in diabetes, and that he gained about 100 pounds within the first year post-service. After specifically discussing the above-mentioned service treatment records and lay statements, the examiner must opine: (l.) Is it at least as likely as not that the Veteran's diabetes mellitus type I had its initial onset in service or is otherwise etiologically related to the Veteran's active service? The examiner is advised that simply stating that the Veteran's condition was normal at separation is not an adequate rationale, as service connection can be granted for a condition diagnosed after service so long as it is related to an in-service injury or disease. The opinion must be accompanied by a rationale reflecting full consideration of the evidence of record. Discussion and analysis of the pertinent evidence, relevant medical treatises, and generally accepted medical principles is required. MICHELLE L. KANE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Tierno 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.