Citation Nr: 21005985 Decision Date: 02/03/21 Archive Date: 02/03/21 DOCKET NO. 15-18 670A DATE: February 3, 2021 REMANDED Entitlement to service connection for diabetes mellitus type II, to include as secondary to hypertension, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from February 1980 to February 1983. This matter comes before the Board of Veterans’ Appeals (Board) on appeal of a decision issued by the Department of Veterans Affairs (VA). This matter was previously before the Board in September 2018 and July 2020. In September 2018, the Board remanded this matter to obtain a VA examination and medical opinion addressing the nature and etiology of the Veteran’s diabetes mellitus, to include as secondary to her service-connected hypertension. In July 2020, the Board remanded to procure an addendum opinion regarding the question of whether diabetes mellitus was aggravated by hypertension. See 38 C.F.R. § 3.310(b). Regrettably, the Board finds that further remand is necessary. In June 2015, the Veteran submitted lay statements with her VA Form 9. She asserted that she takes medications for hypertension, including Lisinopril and Nifedipine, and that one of Nifedipine’s side effects is weight gain. She contended that she gained weight after taking Nifedipine, and that this weight gain caused or predisposed her to develop diabetes mellitus. However, the VA examiners did not address this theory of causation. As VA is obligated to consider all theories of entitlement reasonably raised by the Veteran and the evidence of record, an addendum medical opinion must be obtained before the Board issues a decision. See 38 U.S.C. § 5103A(d); Robinson v. Peake, 21 Vet. App. 545, 552 (2008) (holding that the Board is required to consider all issues either raised by the claimant or the evidence of record); Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (holding that when VA provides a medical opinion, it must be adequate). The Board sincerely regrets the delay occasioned by multiple remands and appreciates the Veteran’s patience as VA works to fulfill its statutory obligation to assist her in obtaining information necessary to substantiate her claim for benefits. The matter is REMANDED for the following actions: 1. Please secure for the record copies of complete updated clinical records of all VA and non-VA treatment the Veteran has received for the disorders on appeal. 2. Obtain an addendum medical opinion regarding the nature and etiology of the Veteran’s diabetes mellitus type II. ONLY IF the clinician believes that a VA examination is necessary to answer the questions below should one be scheduled. The clinician is asked to review the claims file and to opine on the following: (a) Is it at least as likely as not that the Veteran’s diabetes mellitus is proximately due to or a result of service-connected hypertension, to include weight gain caused by the hypertension medications Lisinopril and Nifedipine? (b) Is it at least as likely as not that the Veteran’s diabetes mellitus is aggravated by service-connected hypertension, to include weight gain caused by the hypertension medications Lisinopril and Nifedipine? A complete rationale should be provided for all opinions. The clinician is asked to consider and discuss relevant lay and medical records, to specifically include: • The Veteran’s lay statements submitted with a VA Form 9 in June 2015, including contentions that medications taken for her hypertension (to include Lisinopril and Nifedipine) caused her to gain weight, which in turn caused or predisposed her to develop diabetes mellitus type II • The VA examination report and medical opinion in September 2019 and the addendum opinion in August 2020 The clinician is reminded that the term “at least as likely as not,” does not mean “within the realm of medical possibility,” but rather that the evidence of record is so evenly divided that it is as medically sound to find in favor of the proposition as it is to find against. ANTHONY C. SCIRÉ, JR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Reed, 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.