Citation Nr: 21007510 Decision Date: 02/09/21 Archive Date: 02/09/21 DOCKET NO. 14-09 319 DATE: February 9, 2021 REMANDED Entitlement to service connection for a low back disorder is remanded. Entitlement to service connection for diabetes mellitus, type II, to include as secondary to a service-connected disability is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Navy from November 1976 to July 1979. In a December 2017 decision, the Board denied service connection for alcoholism, service connection for diabetes mellitus, type II, and service connection for major depressive disorder. The Board also remanded the Veteran’s claim for service connection for a low back disorder. The Veteran appealed the Board’s decision to the U.S. Court of Appeals for Veterans Claims (Court). In an April 2019 Memorandum Decision, the Court vacated the Board’s December 2017 decision and remanded the matters to the Board for compliance with the decision. In June 2020, the Board remanded the claims for entitlement to service connection for major depressive disorder, service connection for diabetes mellitus, type II, service connection for alcoholism, and service connection for a low back disorder for additional development. After conducting the requested development, the Agency of Original Jurisdiction (AOJ) issued a rating decision in September 2020 which granted service connection for an acquired psychiatric disorder (claimed as depression with a history of alcoholism). As this constitutes a full grant of the benefit sought on appeal with regard to the claims for service connection for major depressive disorder and alcoholism, those claims are no longer before the Board. 1. Entitlement to service connection for a low back disorder is remanded. The Board regrets the delay of an additional remand, but finds that it is necessary to ensure a complete record upon which to base its decision. The Veteran has undergone VA examinations in January 2018 and September 2020 to ascertain the etiology of his current low back disorder. Both VA examiners based their negative opinions, in part, upon the results of a 1991 X-ray of the spine, which has not been associated with the claims file. As the results of the 1991 X-ray form the basis for each of the VA opinions of record, remand is warranted to obtain a copy of the 1991 X-ray of the lumbar spine. 2. Entitlement to service connection for diabetes mellitus, type II, to include as secondary to a service-connected disability is remanded. The Veteran contends that his diabetes mellitus, type II, was caused or aggravated by alcoholism. During his January 2017 hearing before the Board, the Veteran testified that he thought that his diabetes may have been caused or aggravated by his alcoholism and the way that his alcoholism impacted his eating habits. As noted above, in a September 2020 rating decision, the AOJ granted service connection for an acquired psychiatric disorder (claimed as depression with a history of alcoholism). As the Veteran has not yet undergone a VA examination to determine the etiology of his diabetes mellitus, type II, a VA examination should be obtained to determine whether his diabetes was caused or aggravated by his service-connected psychiatric disorder with alcoholism. The matters are REMANDED for the following action: 1. Obtain and associate with the claims file a copy of the 1991 lumbar spine X-ray referenced by both the January 2018 and September 2020 VA examiners. If, and only if, the 1991 X-ray of the lumbar spine cannot be located and associated with the claims file, provide the Veteran with a new VA examination to assess the etiology of his low back disorder which considers only the evidence of record. Based upon a complete review of the evidence of record, the VA examiner must state whether it is at least as likely as not (i.e., a 50 percent probability or more) that any back disorder currently diagnosed or diagnosed during the pendency of the Veteran’s claim was caused or incurred as a result of the Veteran’s active duty service. A complete rationale for all opinions must be provided. The examiner must consider and discuss all pertinent evidence in the claims file, to include the Veteran’s lay statements regarding in-service and post-service symptomatology. Also, the examiner is advised that the Veteran is competent to report observable symptomatology. 2. Provide the Veteran with a VA examination to determine the etiology of his diabetes mellitus, type II. The Veteran’s claims file, all electronic records, and a copy of this remand must be reviewed by the examiner, and the examiner must state that this evidence was reviewed in the examination report. All pertinent symptomatology and findings must be reported in detail. All indicated tests and studies must be accomplished. Based upon a complete review of the evidence of record, to include the Veteran’s lay statements, the VA examiner must provide the following opinions: (a.) Is it at least as likely as not that the Veteran’s diabetes mellitus, type II, was caused or incurred as a result of his active duty service? (b.) Is it at least as likely as not that the Veteran’s diabetes mellitus, type II, was caused or aggravated beyond its normal progression by the Veteran’s service-connected acquired psychiatric disorder with alcoholism? A complete rationale for all opinions must be provided. The examiner is advised that a finding that the Veteran’s claimed disability was aggravated beyond the normal progression due to a service-connected disability does not require evidence of permanent worsening and may encompass any additional impairment in earning capacity resulting from an already service-connected condition. The examiner is advised that the Veteran is competent to report observable symptomatology. ANTHONY C. SCIRÉ, JR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Katz, 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.