Citation Nr: 21014723 Decision Date: 03/15/21 Archive Date: 03/15/21 DOCKET NO. 16-10 521 DATE: March 15, 2021 REMANDED Entitlement to service connection for a respiratory disorder is remanded. Entitlement to service connection for sleep apnea is remanded. Entitlement to service connection for diabetes is remanded. Entitlement to service connection for hypertension is remanded. REASONS FOR REMAND The Veteran had active military service from June 10, 1980 to October 3, 1980, and from September 27, 1990 to November 9, 1990. He also had additional service in the Alabama National Guard. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2014 rating decision of a Regional Office (RO) of the Department of Veterans Affairs (VA). In October 2018 the Board remanded the claims for further development. Specifically, the Board directed the RO to obtain VA examinations to determine whether the Veteran’s claimed conditions were due to exposure to petroleum as a result of his service. Further, the Board directed the examiner to explain what role, if any, the Veteran’s obesity has in his claimed disabilities. Unfortunately, there has not been substantial compliance with the Board’s previous remand directives. Another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). 1. Entitlement to service connection for a respiratory disorder is remanded. 2. Entitlement to service connection for sleep apnea is remanded. 3. Entitlement to service connection for diabetes is remanded. The Veteran was afforded VA examinations for all conditions on appeal in July 2019, and addendum opinions were provided in September 2020. The examiners opined that onset of the diagnosed respiratory disorders, sleep apnea, and diabetes was during service, as documented in the STRs, and there is evidence of current, chronic and continuous treatment and care for all conditions. However, these opinions are inadequate as none of the conditions were diagnosed in service. Specifically, regarding respiratory disorders, the examiner diagnosed COPD and pneumonia. COPD was not diagnosed until the July 2019 VA examination. Additionally, sleep apnea was not diagnosed until 2007. See July 2007 VA treatment records. Further, diabetes was not diagnosed until 2004, years after separation from service, and the September 2020 addendum opinion indicated that STRs do not document diabetes. See also January 2004 VA treatment records. The July 2019 respiratory disorders VA opinion is also internally inconsistent as the examiner opined that Veteran’s lung disease is related to petroleum exposure and that it would be mere speculation that it is related to petroleum exposure. The examiner did not provide a rationale for this opinion. The Board notes that opinions indicating that it would be mere speculation to opine that a condition is related to service are inadequate unless the examiner explains why the opinion cannot be provided. Jones v. Shinseki, 23 Vet. App. 382, 390–91 (2010). Additionally, while the September 2020 respiratory disorders addendum examiner opined against relation to service generally, he did not provide an opinion regarding relation to petroleum exposure. As the July 2019 VA opinions were based, at least in part, on an inaccurate factual premise which was not cured by the September 2020 addendum opinions, they are inadequate. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993). Accordingly, there has not been substantial compliance with the Board’s previous remand directives and another remand is required. Stegall, 11 Vet. App. at 271. 4. Entitlement to service connection for hypertension is remanded. Though the Veteran did not explicitly raise the issue of whether his hypertension is secondary to his currently nonservice-connected diabetes, the Board finds the issue is raised by the evidence and therefore must be addressed. The July 2019 VA examiner opined that the Veteran’s hypertension is less likely than not related to exposure to petroleum but is most likely related to his nonservice-connected diabetes. However, the July 2019 examiner did not provide a rationale for her opinion. Because a decision on the issue of entitlement to service connection for diabetes could significantly impact a decision on the issue of entitlement to service connection for hypertension, the issues are inextricably intertwined. Further, the July 2019 opinion lacked an adequate rationale. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000); Nieves-Rodriguez, 22 Vet. App. 295 (2008). Accordingly, a remand is required. The matters are REMANDED for the following action: 1. Obtain updated VA treatment records. 2. Thereafter, obtain addendum opinions from an appropriate clinician to determine the nature and etiology of a) any respiratory disorder; b) sleep apnea; c) diabetes mellitus, type II; and d) hypertension. The examiner is asked to answer the following questions: (a.) Is any diagnosed respiratory disorder, to include COPD and pneumonia, at least as likely as not (50 percent or greater probability) related to the Veteran’s in-service petroleum exposure, as described in the May 2018 Appellant’s Brief? (b.) Is sleep apnea at least as likely as not (50 percent or greater probability) related to the Veteran’s in-service petroleum exposure, as described in the May 2018 Appellant’s Brief? (c.) Is diabetes mellitus, type II, at least as likely as not (50 percent or greater probability) related to the Veteran’s in-service petroleum exposure, as described in the May 2018 Appellant’s Brief? (d.) Is hypertension at least as likely as not (50 percent or greater probability) related to the Veteran’s in-service petroleum exposure, as described in the May 2018 Appellant’s Brief? (e.) Is hypertension at least as likely as not (50 percent or greater probability) proximately due to diabetes mellitus, type II? (f.) Is hypertension at least as likely as not (50 percent or greater probability) aggravated, i.e., worsened beyond its natural progression, by diabetes mellitus, type II? The examiner must provide a complete explanation for all opinions. If the examiner is unable to render the requested opinions without resorting to speculation, the examiner must state whether there is inadequate factual information, whether the question falls beyond the knowledge of the examiner, whether the question falls beyond the scope of the medical community, or another reason. The need for additional physical examination of the Veteran is left to the discretion of the examiner. 3. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal, including the inextricably intertwined issues of service connection for hypertension as secondary to diabetes mellitus, type II. Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K.L. Blevins, 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.