Citation Nr: 21009669 Decision Date: 02/23/21 Archive Date: 02/23/21 DOCKET NO. 11-19 582 DATE: February 23, 2021 REMANDED Entitlement to service connection for diabetes mellitus, Type II (DM) is remanded. REASONS FOR REMAND The Veteran, who is the appellant, had active service from November 1984 to November 1987 and from October 1996 to January 2001 The Veteran testified before the undersigned Veterans Law Judge at a videoconference hearing in October 2014. A transcript of the hearing is of record. This matter was previously before the Board in February 2015 and November 2017, at which time it was remanded for further development. The matter was again remanded for further development in March 2020. As will be discussed in detail below, the matter must once again be remanded for clarification purposes. In connection with the March 2020 Board remand, several opinions were obtained. In an opinion dated November 18, 2020, the examiner indicated that the claimed condition was less likely than not (less than 50 percent probability) proximately due to or the result of Veteran’s service-connected condition. She stated that the conditions of Diabetes Mellitus Type 2 and leg, knee, limitation of flexion with retropatellar pain syndrome, were not medically related. She reported that Diabetes Mellitus Type 2 was a separate entity entirely from the leg, knee, limitation of flexion with retropatellar pain syndrome and unrelated to it. She noted that a thorough review of medical literature failed to demonstrate a causal relationship. A nexus had not been established. As to the aggravation question, the examiner indicated that she could not determine a baseline level of severity of (claimed condition/diagnosis) based upon medical evidence available prior to aggravation or the earliest medical evidence following aggravation by (service-connected condition). The examiner then checked the “yes” box when asked if regardless of an established baseline, was the Veteran’s (claimed condition/diagnosis) at least as likely as not aggravated beyond its natural progression by service-connected condition. As rationale she listed Pts HbgA1C in 01/03 was 10.4 and 02/04 was 6.1. In a medical opinion dated November 19, 2020, the same medical examiner indicated that the claimed condition was less likely than not (less than 50 percent probability) proximately due to or the result of Veteran’s service-connected condition. She stated that the conditions of Diabetes Mellitus Type 2 and hypertension and/or left knee disorder, to include inactivity resulting from the left knee disorder, were not medically related. She reported that the Diabetes Mellitus Type 2 was a separate entity entirely from the hypertension and/or left knee disorder, to include inactivity resulting from the left knee disorder, and unrelated to it. She also noted that a thorough review of medical literature failed to demonstrate a causal relationship. A nexus had not been established. The examiner further indicated that she could determine a baseline level of severity of (claimed condition/diagnosis) based upon medical evidence available prior to aggravation or the earliest medical evidence following aggravation by (service-connected condition). She reported that the baseline level of severity of (claimed condition/diagnosis) based upon medical evidence available prior to aggravation or the earliest medical evidence following aggravation by (service-connected condition) was that the Veteran’s HgbA1c on 01/03 was 10.4 and 6.1 on 2/04. She stated the current severity was not greater than the baseline. Based upon the above, the examiner has provided conflicting opinions as to whether the Veteran’s service-connected hypertension and/or left knee disorders aggravate his DM. Where the Board makes a decision based on an examination report that does not contain sufficient detail, remand is required "for compliance with the duty to assist by conducting a thorough and contemporaneous medical examination." Goss v. Brown, 9 Vet. App. 109, 114 (1996); Stanton v. Brown, 5 Vet. App. 563, 569 (1993). It also appears that the appropriate boxes may not have been checked, which is one of the bases for the prior remand. The matter is REMANDED for the following action: If available, please return the claims folder to the examiner who provided the November 2020 medical opinions. Following a review of the folder, the examiner is requested to render the following opinion: Is it at least as likely as not (50 percent probability or greater) that any current DM is aggravated by the service-connected hypertension and/or left knee disorder, to include inactivity resulting from the left knee disorder? If aggravation is found, to the extent that is possible, the examiner is requested to provide an opinion as to approximate baseline level of severity of the nonservice-connected disorder before the onset of aggravation. (Continued on the next page)   The examiner is requested to specifically address the discrepancies in the November 18 and November 19, 2020 opinions when rendering the above opinions and to specifically indicate whether it is at least as likely as not (50 percent probability or greater) that any current DM is aggravated by the service-connected hypertension and/or left knee disorder, to include inactivity resulting from the left knee disorder, with detailed rationale being provided. When providing the opinions, please ensure the appropriate boxes are addressed and that rationale is provided in the appropriate place. K. Parakkal Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. S. Kelly, 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.