Citation Nr: 21007850 Decision Date: 02/10/21 Archive Date: 02/10/21 DOCKET NO. 17-21 382 DATE: February 10, 2021 REMANDED Entitlement to service connection for diabetes mellitus type II is remanded. Entitlement to service connection for migraine headaches is remanded. Entitlement to service connection for twitching fingers left upper extremity claimed as twitching fingers is remanded. Entitlement to service connection for twitching fingers right upper extremity claimed as twitching fingers is remanded. REASONS FOR REMAND The Veteran had active service from January 2, 1985 to May 31, 1985 and from December 6, 1990 to July 4, 1991 with additional periods of active duty for training and inactive duty for training with the National Guard or Army Reserve. Service connection may be established for disability resulting from personal injury suffered or disease contracted in the line of duty in the active military, naval, or air service. 38 U.S.C. § 1110, 1131. To establish a right to compensation, a Veteran must show: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. 38 C.F.R. § 3.303(a); see also Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). “Active military, naval, and air service” includes (as relevant here) any period of ACDUTRA (Active duty for training) during which the individual concerned was disabled from a disease or injury incurred in or aggravated in line of duty, or any period of INACDUTRA (inactive duty for training) during which the individual concerned was disabled from injury (and not disease) incurred in or aggravated in line of duty. See 38 C.F.R. § 3.6. 1. Entitlement to service connection for diabetes mellitus type II (DM) is remanded. The Veteran contends that he developed DM as a result of active service. The Veteran’s records support an ongoing diagnosis of diabetes mellitus type II. In various submissions, the Veteran contends that either he developed DM because of an Anthrax vaccine or because he was exposed to burn pits in Saudi Arabia during active service. The Veteran submitted medical research regarding the potential relationship between Anthrax vaccinations and the development of diabetes. The Board notes that the Veteran’s file contains evidence of Anthrax vaccination dated 2009. The Veteran was afforded a VA examination for DM in February 2020. The associated medical opinion references a diagnosis of DM in 2009 as being both during service to support service connection as well as being the initial diagnosis of DM. However, the evidence of record shows that the Veteran first visited with a VA medical provider for an initial diabetes assessment in 2006 and was subsequently diagnosed and treated for DM prior to 2009. The VA opinion medical provider also referred to 2009 as a time of military service during which diabetes developed. However, according to the Veteran’s service records, the Veteran’s active duty periods were in 1985 and 1990 to 1991. The evidence shows that the Veteran was called under Title 10 orders from his National Guard unit in 2009, however at an October 22, 2009 appointment for medical clearance for deployment, the Veteran left the appointment prior to completing the process. Subsequently, the Veteran was not deployed under Title 10 orders and there is not a DD-214 record supporting active duty service in that time frame. Because the VA medical provider in her opinion did not include a discussion on the other contentions of Anthrax vaccine or burn pit exposure, in addition to using inactive service periods as justification for service connection entitlement, the Board must remand this claim for entitlement to service connection for diabetes mellitus Type II to obtain a new medical opinion. The Board cannot determine the medical etiologies of disease. See Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991) (VA may only consider independent medical evidence to support its findings and is not permitted to base decisions on its own unsubstantiated medical conclusions). The RO should request an addendum opinion that discusses these issues. 2. Entitlement to service connection for migraine headaches is remanded. The Veteran contends that a possible etiology of his diagnosed migraine headaches is that while deployed to Saudi Arabia, he had headaches that have been ongoing yet were diagnosed as sinus-related but were in fact misdiagnosed migraines. The Veteran also mentioned exposure to regular “SCUD missile attacks.” In the February 2020 VA medical opinion associated with the headache examination, the medial provider opined on service connection for migraine headaches based on reported headaches in medical records dated 1987. The Veteran was not in active service at that time. In the September 2018 VA Form 9, the Veteran contended that he was exposed to nerve gas in Saudi Arabia. As above, because the medical provider relied on information from a non-service period and did not include a discussion on other possible etiologies, the Board must remand this claim for entitlement to service connection for migraines. 3. Entitlement to service connection for twitching fingers left upper extremity claimed as twitching fingers is remanded. 4. Entitlement to service connection for twitching fingers right upper extremity claimed as twitching fingers is remanded. The Veteran contends that he was exposed to nerve gas while deployed to Saudi Arabia in 1990 to 1991. Additionally, the Veteran’s records show he was diagnosed with right carpal tunnel syndrome and has a record of abnormal EMG. The February 2020 VA examination and related opinion show a diagnosis of bilateral upper extremity diabetic peripheral neuropathy. The related February 2020 medical opinion denied a relationship for service connection for the left upper extremity neuropathy/twitching fingers and supported a positive association for service connection for right upper extremity neuropathy/twitching fingers. However, the medical provider referenced right arm conditions diagnosed or treated in 2001 and 2006, which were not active duty time periods. Additionally, the medical provider did not discuss a possible association with any potential nerve gas exposure or other contentions like a relationship to diabetes. Additionally, because the Veteran has been diagnosed with diabetic peripheral neuropathy in the bilateral upper extremities, and the claim for service connection for diabetes is being remanded, the possibility remains that bilateral upper extremity neuropathy could be claimed as secondary to diabetes. Therefore, these issues are also intertwined and must be remanded. The matters are REMANDED for the following action: 1. Obtain a new medical opinion from an appropriate clinician regarding the Veteran’s diabetes mellitus type II. The examiner is asked to provide a response to the following based on a thorough review of the Veteran’s electronic claims file: a. Is diabetes mellitus type II at least as likely as not related to service? In responding to this inquiry, the provider is requested to reference the following: i. The Veteran’s active duty time is from January 1985 to May 1985 and from December 1990 to July 1991. ii. The Veteran stated that he was exposed to nerve gas in Saudi Arabia. iii. The Veteran stated that he had an Anthrax vaccine. iv. The Veteran has submitted medical research regarding a relationship between diabetes and Anthrax vaccines. v. The Veteran stated that he was exposed to burn pits on deployment, such as burning of feces. b. Is it at least as likely as not that diabetes mellitus (1) began during active service, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service? The examiner should provide a rationale to support any opinion(s) rendered. 2. Obtain a new medical opinion from an appropriate clinician regarding the Veteran’s migraine headaches. The examiner is asked to provide a response based on a thorough review of the Veteran’s electronic claims file, referencing the following: Does the veteran have a confirmed diagnosis of chronic migraine headache condition? And, are migraine headaches at least as likely as not related to service? In responding to these inquiries, the provider is requested to reference the following: i. The Veteran’s active duty time is from January 1985 to May 1985 and from December 1990 to July 1991. ii. The Veteran stated that he was exposed to nerve gas in Saudi Arabia. iii. The Veteran stated that he was exposed to regular SCUD missile attacks in Saudi Arabia. iv. The Veteran stated that he had an Anthrax vaccine. v. The Veteran stated that he was exposed to burn pits on deployment, such as burning of feces. 3. Obtain a new medical opinion from an appropriate clinician regarding the Veteran’s bilateral upper extremity condition, claimed as “twitching fingers” on each hand. The examiner is asked to provide a response based on a thorough review of the Veteran’s electronic claims file, referencing the following: Does the Veteran have any diagnosed condition(s) in one or both upper extremities? And, is a bilateral upper extremity condition described as “twitching fingers” on both hands, at least as likely as not related to service? In responding to these inquiries, the provider is requested to reference the following: i. The Veteran’s active duty time is from January 1985 to May 1985 and from December 1990 to July 1991. ii. The Veteran stated that he was exposed to nerve gas in Saudi Arabia. iii. The Veteran stated that he had an Anthrax vaccine. iv. The Veteran stated that he was exposed to burn pits on deployment, such as burning of feces. DAVID L. WIGHT Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Miller 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.