Citation Nr: 21013771 Decision Date: 03/10/21 Archive Date: 03/10/21 DOCKET NO. 12-13 214 DATE: March 10, 2021 REMANDED Entitlement to service connection for degenerative disc disease of the lumbar spine (claimed as lower back condition), to include as secondary to service-connected diabetes mellitus type II. REASONS FOR REMAND The Veteran had active duty service from September 1968 to August 1972. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a December 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In June 2018, the Board issued a decision denying the lumbar spine claim which was appealed to the Court of Appeals for Veterans Claims(Court). In November 2018, the Court issued an Order granting a Joint Motion for Partial Remand (JMR). This matter was last before the Board in May 2019 where it was remanded in accordance with the concerns noted by the JMR, to include that neither the October 2017 VA opinion nor any other medical opinion associated with the claims file addressed whether any aspect of the Veteran’s service-connected diabetes may have aggravated the Veteran’s lumbar spine disability. The Board finds that because the opinions that have since been obtained appear to contain inconsistencies, or lack reasoned explanations for the conclusions expressed, it will be necessary to obtain another opinion. In this regard, an opinion obtained in November 2019, appeared to conclude that diabetes did not cause the Veteran’s lumbar spine disability because they are medically distinct. It is not clear why she concluded diabetes did not aggravate the Veteran’s lumbar spine disability. She also addressed lower extremity radiculopathy, (which was caused by the Veteran’s lumbar spine disability), and concluded the radiculopathy was aggravated by the Veteran’s diabetes; i.e.; his diabetic neuropathy was worsening his lumbar radiculopathy. On the other hand, opinions obtained in October 2020 were to the effect the Veteran does not have diabetic neuropathy, but only radiculopathy effecting his lower extremities. If that were the case, there could be no aggravation of radiculopathy by diabetic neuropathy. In addition, this examiner listed diabetes as one of the risk factors for osteoarthritis, which apparently afflicts the Veteran’s lumbar spine, and although this examiner explained it was unlikely a cause for the Veteran’s condition, that it is a risk factor seems incompatible with the 2019 examiner’s reason for concluding diabetes had not caused the Veteran’s lumbar spine disorder. Further clarification should be sought as set out below. Accordingly, this matter is remanded for the following: 1. The claims file should be referred to a person with appropriate expertise to address whether the Veteran’s service connected diabetes mellitus has caused or aggravated his lumbar spine disability. Whether to examine the Veteran in order to provide the opinion is left to the discretion of the opinion provider. The reviewer should accomplish the following: i. Identify the Veteran’s lumbar spine disabilities. (The record appears to show these includes degenerative disc disease, spinal stenosis, and spondylolisthesis.) ii. For each individual diagnosis, the reviewer should express an opinion as to whether it was caused by the Veteran’s diabetes mellitus. iii. For each individual diagnosis, the reviewer should express an opinion as to whether it was aggravated by the Veteran’s diabetes mellitus. The reasons for the opinions expressed should be clearly set out, with appropriate reference to medical literature, and the Veteran’s particular history. 2. The reviewer should indicate with any lumbar spine disability has resulted in nerve impairment in the Veteran’s lower extremities. If so, the reviewer should express an opinion as to whether the Veteran’s diabetes or diabetic neuropathy, has aggravated the nerve impairment that was due to a lumbar spine disability. The reasons for these conclusions should be clearly explained. 3. Re- adjudicate the claim. MICHAEL KILCOYNE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Marcus J. Colicelli 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.