Citation Nr: 21011763 Decision Date: 03/02/21 Archive Date: 03/02/21 DOCKET NO. 14-31 505A DATE: March 2, 2021 REMANDED Entitlement to service connection for diabetes mellitus, type II (DMII) to include as secondary to service-connected Parkinson’s Disease, is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1966 to August 1968, from February 1991 to March 1991, and from August 1992 to September 2003. This matter comes to the Board of Veterans’ Appeals (Board) from a September 2013 rating decision. In June 2018, the Veteran and his spouse testified before the undersigned Veterans Law Judge (VLJ) at a Travel Board hearing. A copy of the transcript is of record. In January 2019, the Board remanded the matter for further development, to include obtaining a VA medical opinion. Subsequent to the February 2020 supplemental statement of the case (SSOC), and prior to recertification of the appeal to the Board, the Veteran submitted additional evidence pertinent to the issue on appeal. When additional evidence pertinent to the issue on appeal is submitted prior to certification to the Board, the Agency of Original Jurisdiction (AOJ) must furnish a SSOC. 38 C.F.R. § 19.31. Thus, the Veteran’s claim of entitlement to service connection for DMII must be remanded for AOJ consideration of the evidence and issuance of a supplement statement of the case (SSOC). Although the claim is being remanded so that the AOJ will have an opportunity to review all the newly received evidence, no prejudice results to the Veteran in the Board considering such evidence for the limited purpose of issuing a comprehensive and thorough remand. Entitlement to service connection for diabetes mellitus, type II (DMII) to include as secondary to service-connected Parkinson’s Disease, is remanded. The Board cannot make a fully-informed decision on the issue of entitlement to service connection for DMII at this time. The Veteran contends that his DMII is secondary to his Parkinson’s disease. Specifically, that inactivity due to his Parkinson’s disease or medications used to treat his Parkinson’s disease have caused or aggravated his DMII. In January 2019, the Board remanded the matter for an addendum VA opinion, finding that a July 2013 VA examination report and medical opinion did not consider the Veteran’s contentions or evidence submitted in support of his claim, including that his Parkinson’s limits his ability to be active and a July 2013 VA treatment record noting that the Veteran struggled to lose weight related to his limited physical activity, nor did the examiner provide an opinion as to aggravation. In a March 2019 VA medical opinion, the examiner explained that DMII is a metabolic disorder characterized by increased sugar, insulin resistance, and lack of insulin. The examiner listed several drugs that could increase blood glucose, but that carbidopa and levodopa, the Veteran’s Parkinson’s medications, were not on that list. Thus, the examiner opined that it was less likely than not that the Veteran’s DMII was proximately due to his Parkinson’s disease. The examiner further opined that it was less likely than not that the Veteran’s Parkinson’s was aggravated by his DMII. The Board finds the March 2019 VA opinion unpersuasive, as it failed to provide an adequate rationale or basis for the opinion. Specifically, while the examiner indicated that the Veteran’s Parkinson’s medications were not listed as increasing blood glucose, there is no indication that the list on Up-to-Date was exhaustive and the examiner did not discuss what effects, if any, the Veteran’s medication have on blood glucose, to include medical literature cited by the Veteran. Additionally, the examiner’s opinion that the Veteran’s Parkinson’s disease was not aggravated by his DMII is not responsive to the question of whether the Veteran’s DMII is aggravated by his Parkinson’s disease. In a May 2019 VA medical opinion, the examiner opined that the Veteran’s DMII was less likely than not caused by his Parkinson’s disease, to include weight gain due to limited activity, because while there was a possibility that DMII can cause Parkinson’s disease, it was not probable as there was no association with DMII and Parkinson’s disease, and DMII medications tend to cause weight loss. The May 2019 VA examiner also opined that it was less likely as not that the Veteran’s DMII was aggravated or permanently worsened by his Parkinson’s disease, to include consideration of a July 2013 VA treatment record which notes that the Veteran struggled to lose weight related to his limited physical ability. The examiner noted the Veteran was diagnosed with Parkinson’s disease while in service in 1999 and with DMII by VA criteria in 2012 and that his Parkinson’s medications did not have side effects of weight gain or hypoglycemia. Furthermore, his weight from 2009 to 2019 had not been steady, varying from 205 to 215 pounds, and that Parkinson’s patients can lose weight from loss of sense of smell and taste, but that weight can normalize once treatment is started. While dopamine agonist medications for Parkinson’s have been linked to compulsive behavior such as binge-eating, there was not a direct effect on weight gain, and that difficulty swallowing and tremors often cause weight loss. The Board also finds the May 2019 VA medical opinion inadequate. Again, the opinion appears to focus on whether DMII causes Parkinson’s disease, not whether the Veteran’s Parkinson’s disease has caused or aggravated his DMII. Additionally, while the May 2019 examiner considered the Veteran’s weight around the time of his DMII diagnosis to present, or from 2009 to 2019, the examiner did not consider the Veteran’s weight at the time of his Parkinson’s diagnosis in 1999 to the date he was diagnosed with DMII, which is the time period relevant to the Veteran’s contention that lack of activity due to Parkinson’s disease caused his weight gain. Furthermore, the examiner’s discussion of medication and weight loss in Parkinson’s patients appears to be generalized and not specific to this Veteran, whose Parkinson’s disease is treated with levodopa and who contends that he has gained weight due to inactivity secondary to his Parkinson’s and. Therefore, the Board finds that a remand is warranted so that a new VA medical opinion can be obtained. The matter is REMANDED for the following actions: 1. Obtain the Veteran’s VA treatment records for the period from February 2020 to present. 2. Obtain an addendum opinion from an appropriate clinician to determine the nature and etiology of the Veteran’s diabetes mellitus, type II. The examiner must review the claims file. The examiner is asked to provide a response to the following: Is the Veteran’s diabetes mellitus, type II, at least as likely as not proximately due to service-connected Parkinson’s disease, to include weight gain from inactivity or medications to treat Parkinson’s disease? Although a complete review of the claims file is required, the examiner is asked to discuss the Veteran’s weight from the time of his Parkinson’s disease diagnosis until his diabetes mellitus, type II, diagnosis, as well as his contentions that Parkinson’s patients have abnormal glucose tolerance which may be further exacerbated by levodopa therapy. If the Veteran’s diabetes mellitus, type II, is not at least as likely as not proximately due to Parkinson’s disease, is the Veteran’s diabetes mellitus, type II, at least as likely as not aggravated, i.e., worsened beyond its natural progression, by service-connected Parkinson’s, to include weight gain from inactivity or medications to treat Parkinson’s disease? (Continued on the next page)   Provide a rationale to support the opinion(s). 3. After completing the above, and any other development as may be indicated, the Veteran’s claim should be readjudicated based on the entirety of the evidence. If the claim remains denied, the Veteran and his representative should be issued a supplemental statement of the case (SSOC). An appropriate period of time should be allowed for response. Thereafter, the case should be returned to the Board for further appellate consideration, if otherwise in order. K. Parakkal Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Owen, 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.