Citation Nr: 21011723 Decision Date: 03/02/21 Archive Date: 03/02/21 DOCKET NO. 15-25 266 DATE: March 2, 2021 REMANDED Entitlement to service connection for diabetes mellitus, as secondary to service-connected posttraumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND The Veteran had active service in the United States Navy from July 1988 to July 1992 and in the United States Army from September 2003 to November 2003 and from July 2006 to October 2007. This matter is before the Board of Veterans’ Appeals (Board) on appeal from an October 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). Entitlement to service connection for diabetes mellitus, as secondary to service-connected posttraumatic stress disorder (PTSD), is remanded. The Veteran asserts service connection for diabetes mellitus. Specifically, the Veteran asserts that his diabetes mellitus is a result of his service-connected PTSD. See August 2012 statement in support of the claim. The Veteran has a diagnosis of diabetes, to include as noted in his VA treatment records. As such, the first element of service connection is met. See 9/15/2017, CAPRI, at 37. In October 2020, the VA obtained an opinion in which the examiner opined that it was less likely than not that the Veteran’s diabetes mellitus was caused by the Veteran’s service-connected PTSD. Specifically, the examiner reasoned that diabetes develops when the body becomes resistant to insulin or when the pancreas is unable to produce enough insulin and that genetics and environmental factors, such as being overweight and inactive, seem to be contributing factors. The examiner then concluded that PTSD is not associated with aggravating diabetes. The Board notes that the VA examiner failed to provide a sufficiently detailed rationale for the conclusion that the Veteran’s diabetes mellitus is unrelated to his service-connected PTSD. Although the examiner used the term aggravation in his opinion, the Board notes that the examiner discussed causation instead and only used the term aggravation instead of causation. A finding of aggravation by a service-connected disability is one of two ways in which a disability may be granted service connection on a secondary basis. An adequate medical opinion regarding secondary service connection must address causation and aggravation separately. See El Amin v. Shinseki, 26 Vet. App. 136, 140 (2013) (indicating that findings of “not due to,” “not caused by,” and “not related to” a service-connected disability are insufficient to address the question of aggravation under 38 C.F.R. § 3.310(b)). Further, the Board finds the October 2020 opinion is completely devoid of any specific and relevant facts associated with the Veteran’s claim. The opinion is conclusory in nature by stating that contributing factors to diabetes are genetics and environmental factors, such as being overweight and inactive. However, the examiner did not discuss whether the Veteran’s PTSD symptoms led to the environmental factors that could have aggravated the Veteran’s diabetes mellitus. For the foregoing reasons, the Board finds the October 2020 opinion is inadequate for determining medical nexus. As such, remand is required to afford the Veteran an adequate VA examination. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The matter is REMANDED for the following action: Schedule the Veteran for a VA examination with a physician who has not previously rendered an opinion in this matter and possessing suitable expertise to fully assess and provide an opinion (in the appropriate DBQ form) regarding the nature, severity, and etiology of the Veteran’s diabetes mellitus for the entire appeal period. All pertinent evidence of record must first be made available to and reviewed by the examiner. Any indicated studies should be performed. If the examiner is unable to conduct the required testing, or concludes any such testing is not necessary, he or she must explain why that is so. The examiner must obtain a full history from the Veteran. It should be noted the Veteran is competent to attest to factual matters of which he has first-hand knowledge, such as observable symptomology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner must provide a fully-reasoned explanation. All pertinent symptomology and findings must be reported in detail. Based upon a review of all pertinent documents in the Veteran’s claims file, including medical records, lay statements, and the examination results, the examiner must provide an opinion as to whether it is at least as likely as not (i.e., 50 percent probability or greater) that the Veteran’s diabetes mellitus is proximately due to, related to, or aggravated by service-connected PTSD. If it is not possible to provide the above-requested opinion without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (i.e., no one could respond given medical science and the known facts), a deficiency in the record (i.e., additional facts are required), or the examiner (i.e., does not have the knowledge or training). L. M. BARNARD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Hammad Rasul, 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.