Citation Nr: 21014097 Decision Date: 03/11/21 Archive Date: 03/11/21 DOCKET NO. 16-11 142A DATE: March 11, 2021 REMANDED Service connection for diabetes mellitus (DM). Service connection for right upper extremity (RUE) diabetic peripheral neuropathy. Service connection for left upper extremity (LUE) diabetic peripheral neuropathy. REASONS FOR REMAND The Board denied the appeals in March 2019. The Veteran appealed to the Veterans Claims Court. In September 2020, the Court Clerk granted a Joint Motion for Partial Remand (JMPR), which vacated the March 2019 decision and remanded the claims back to the Board for action in compliance with the JMPR. The JMPR instructed that an addendum medical opinion regarding whether it is at least as likely as not that DM was aggravated by the Veteran’s service-connected sleep apnea must be obtained. As such, a remand is required to obtain such opinion. The JMPR also instructed that a medical opinion regarding whether DM was caused or aggravated by his service-connected back disability and/or his service-connected knee disability on the basis that he is less active and mobile due to his back and knee and as such, he is obese, which resulted in DM. Obesity may act as an “intermediate step” between a service-connected disability and a current disability that may be service-connected on a secondary basis under 38 C.F.R. § 3.310(a). VAOPGCPREC 1-2017. Therefore, on remand an opinion should be obtained regarding whether the Veteran’s service-connected disabilities led to his obesity, which, in turn, caused or aggravated DM. As the claims for service connection for diabetic peripheral neuropathy of the upper extremities are inextricably intertwined with the issue of entitlement to service connection for DM, they must also be remanded. The matters are REMANDED for the following actions: Direct the claims file to a clinician for review and to address the following: • Is it at least as likely as not (50 percent or greater probability) that the Veteran’s DM was aggravated by his service-connected sleep apnea. • Is it at least as likely as not (50 percent or greater probability) that the Veteran’s obesity was either caused or aggravated by his service connected left knee disability and/or lumbar spine disability, and thus, in turn caused or aggravated DM? In answering the above, the examiner/clinician should address the January 2015 VA examination report which noted that the Veteran’s back and knee symptoms caused mobility problems, the April 2002 VA treatment record which noted that exercise resulted in recurrent left knee pain with swelling and sometimes caused the knee to lock up or give way, the August 2013 VA treatment record notation indicating that the Veteran had gained weight due to lack of exercise, and the September 2013 VA examination report which indicated that the Veteran was obese and that obesity was a major cause of DM. A complete rationale must be provided for all stated opinions. L. HOWELL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Redman, 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.