Citation Nr: 21011727 Decision Date: 03/02/21 Archive Date: 03/02/21 DOCKET NO. 19-37 733 DATE: March 2, 2021 REMANDED Entitlement to a rating in excess of 20 percent for diabetes mellitus type II is remanded. Entitlement to service connection for hypertension, to include as secondary to service-connected diabetes mellitus type II, is remanded. Entitlement to a total disability rating for individual unemployability due to service-connected disabilities (TDIU) for the period prior to May 13, 2019 is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1965 to March 1967. These matters are before the Board of Veterans’ Appeals (Board) on appeal from an April 2017 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). A Board hearing was held before the undersigned in December 2020. A transcript of the hearing is of record.   Regarding the issue of entitlement to a TDIU, the Board notes that the assignment of a total schedular rating does not categorically render a TDIU claim moot. See Bradley v. Peake, 22 Vet. App. 280 (2008) (finding that VA must consider a TDIU claim despite the existence of a schedular total rating and award special monthly compensation (SMC) under 38 U.S.C. § 1114(s) if VA finds a separate disability supports a TDIU independent of the disability with a 100 percent rating). A March 2020 rating decision granted a 100 percent evaluation for service-connected squamous cell carcinoma of the larynx, effective May 13, 2019. The Veteran was also granted SMC in the March 2020 rating decision from May 13, 2019 based on his 100 percent schedular rating and additional disabilities that are independently rated at 60 percent or more. Therefore, the decision in Bradley does not apply and the claim for a TDIU from May 13, 2019 onward is moot. However, the period prior to May 13, 2019 remains on appeal and the matter has been characterized accordingly. 1. Entitlement to a rating in excess of 20 percent for diabetes mellitus type II is remanded. The Board finds further development is required before a decision can be made regarding the Veteran’s claim. In February 2016, the Veteran underwent a VA examination in which the examiner indicated that medical management of the Veteran’s diabetes did not require regulation of activities. In January 2017, the Veteran submitted a Disability Benefits Questionnaire (DBQ) completed by Dr. S.C., his VA doctor. Dr. S.C. noted that the Veteran’s diabetes required regulation of activities but did not provide any examples or explanation about how the Veteran must regulate his activities. In March 2017, the Veteran underwent another VA examination and the examiner noted that regulation of activities was not required for management of the Veteran’s diabetes. Additionally, October 2017 and January 2018 VA treatment records indicate the Veteran was encouraged to engage in physical activity. Lastly, during the December 2020 Board hearing, the Veteran’s attorney reported that the Veteran “has to keep from moving around very much.” Additionally, the Veteran testified that his activities have to be in moderation due to his diabetes. As there is conflicting evidence on the issue of whether regulation of activities is required for medical management of the Veteran’s diabetes, the Board finds remand for a medical opinion necessary. The Board also finds there is conflicting information regarding whether the Veteran has additional diabetes complications that could be separately compensable. 38 C.F.R. § 4.119, Diagnostic Code 7913, Note (1). In this regard, the January 2017 DBQ submitted by Dr. S.C. noted complications including, cardiac condition(s), hypertension, and chronic renal disease. However, a VA examination completed a few months later, in March 2017, revealed no diabetes complications. Consequently, the Board finds it is unclear whether the Veteran has additional diabetes complications and remand for an additional VA examination is necessary. 2. Entitlement to service connection for hypertension, to include as secondary to service-connected diabetes mellitus type II, is remanded. The Veteran contends his hypertension is secondary to his service-connected diabetes. A review of the record reflects that the Veteran has a current diagnosis of hypertension and that he is service-connected for diabetes mellitus type II. However, the Board finds the medical opinions of record inadequate for determining whether the Veteran’s hypertension is secondary to his service-connected diabetes. Barr v. Nicholson, 21 Vet. App. 303 (2007). In January 2017, Dr. S.C. indicated that the Veteran’s hypertension was at least as likely as not due to and permanently aggravated by his service-connected diabetes. However, Dr. S.C. did not provide any rationale to support his opinions. Thus, the Board finds the opinions inadequate. In March 2017, the Veteran underwent a VA examination in which a VA examiner opined that the Veteran’s hypertension was less likely than not caused by his service-connected diabetes because, at the time the Veteran was diagnosed with hypertension, his renal function was normal. However, the examiner did not provide an opinion as to whether the Veteran’s hypertension was aggravated by his service-connected diabetes. As secondary service connection may be granted for a disability that is proximately caused by or proximately aggravated by a service-connected disability, and the examiner failed to address aggravation, the Board finds the opinion incomplete. See 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439, 448 (1995). Consequently, the Board finds remand for a new VA medical opinion is necessary to determine whether the Veteran's hypertension is secondary to his service-connected diabetes. 3. Entitlement to TDIU for the period prior to May 13, 2019 is remanded. The Veteran contends he is unable to work due to his service-connected diabetes mellitus type II, as noted on his January 2017 VA Form 21-8940, Application for Compensation Based on Unemployability. Consequently, the issue of entitlement to a TDIU is inextricably intertwined with the claim of entitlement to an increased rating for diabetes mellitus type II being remanded to the Agency of Original Jurisdiction. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). Therefore, the issue of entitlement to TDIU must also be remanded. The matters are REMANDED for the following action: 1. Obtain and associate with the claims file updated VA treatment records from August 2020 to the present. 2. Schedule the Veteran for a VA examination with an appropriate clinician to determine the current severity of his service-connected diabetes mellitus type II. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. The examiner should provide an opinion as to whether medical management of the Veteran’s diabetes requires regulation of activities. In providing the opinion, the examiner should consider and address the January 2017 Disability Benefits Questionnaire (DBQ) completed by Dr. S.C. that indicates the Veteran requires regulation of his activities as part of the medical management of his diabetes. The examiner should also identify any complications of the Veteran’s diabetes mellitus type II and complete an appropriate DBQ for each identified complication. For any identified complication, the examiner should also provide an opinion on the following: (a) Whether it is at least as likely as not (a 50 percent or greater probability) the identified complication was caused by or proximately due to the Veteran’s service-connected diabetes mellitus type II. (b) Whether it is at least as likely as not (a 50 percent or greater probability) the identified complication was aggravated (i.e., worsened beyond natural progression) by the Veteran’s service-connected diabetes mellitus type II. A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner.   3. Obtain an addendum opinion from an appropriate clinician to determine the nature and etiology of the Veteran’s hypertension. The electronic claims file, including this remand, must be made available to the examiner for review. An examination should only be scheduled if the examiner deems one is necessary for providing the requested opinions. Following a review of the Veteran’s claims file, the examiner is asked to provide an opinion addressing the following: (a) Whether it is at least as likely as not (a 50 percent or greater probability) the Veteran’s hypertension was caused by his service-connected diabetes mellitus type II. (b) Whether it is at least as likely as not (a 50 percent or greater probability) the Veteran’s hypertension was aggravated (i.e., any worsening beyond its natural progression) by his service-connected diabetes mellitus type II. A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not be   rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. M. SORISIO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Jiggetts 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.