Citation Nr: 21015797 Decision Date: 03/18/21 Archive Date: 03/18/21 DOCKET NO. 15-18 534A DATE: March 18, 2021 REMANDED Entitlement to service connection for diabetes mellitus, type II, is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1985 to August 1987, January 1996 to February 1996, July 2002 to March 2003, and April 2005 to July 2006. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2013rating decision of the Department of Veteran Affairs (VA) Regional Office (RO) in Philadelphia, Pennsylvania. In May 2019, the Veteran presented testimony at a video hearing before the undersigned Veterans Law Judge. Service Connection Remand is required to comply with the November 2019 Board decision. The Board is obligated by law to ensure that the RO complies with its directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). RO compliance with remand directives is not optional or discretionary and the Board errs as a matter of law when it fails to ensure remand compliance. Stegall, 11 Vet. App. at 271. The issue was remanded in November 2019 for a VA examination and opinion. The Veteran received a January 2020 VA examination. The examiner diagnosed diabetes mellitus type II. The examiner opined the Veteran’s diabetes was less likely than not related to service. The examiner stated the Veteran was diagnosed with diabetes in 2009 more than one-year post service. The examiner stated the Veteran’s service treatment records (STRs) contain no diagnosis or treatment for diabetes while on active duty. The examiner explained the Veteran’s mildly elevated glucose readings were reviewed, however, they were unable to determine if the readings occurred in a non-fasting state versus fasting state, therefore, they would be resorting to speculation to comment on the mildly elevated glucose findings as evidence the Veteran had diabetes while in the military. The examiner stated the STRs lacked preponderance of the evidence that diabetes had an onset in-service. The examiner concluded that in 2007 glucose was noted to be 111 with normal parameters noted to be 74-118, with 2007 A1c at 6.2 and indicated this was within normal limits for 2007. First, the examiner did not address high glucose readings during the presumptive period as required by the November 2019 remand directives. The examiner noted 74-118 was normal, however a February 2007 VA treatment record showed a 127 glucose. Second, the examiner indicated “normal limits” for 2007. However, the opinion should be based on the current medical standard, and it isn’t clear that this was done – versus 2007 medical standards. The May 2007 VA treatment record was particularly important because it was during the presumptive period and the Veteran was counseled on diet. Lastly, the examiner stated the STRs did not indicate whether the readings were fasting or non-fasting, and therefore they could not opine. Notably, however, an April 2005 STR showed a 105 fasting glucose and indicated that it was high. In a July 2014 statement, the Veteran noted the April 2005 STR and stated he should have been given an A1c test. Accordingly, remand is required for an addendum opinion. The matters are REMANDED for the following action: Obtain an addendum opinion regarding the etiology of the diabetes mellitus from a VA examiner. The entire claims file must be made available to and be reviewed by the examiner. If an examination is deemed necessary, it shall be provided. An explanation for all opinions expressed must be provided. First, the examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the diabetes mellitus had onset in, or is otherwise related to, active service. Second, examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the diabetes mellitus manifested to a compensable degree within one year of separation from service. The examiner must address the following: 1) the Veteran’s assertions of an in-service high glucose readings, high glucose readings shortly after deployment that led to his diabetes diagnosis, and that diabetes mellitus began in-service but was not formally diagnosed until later; 2) all glucose and A1c readings contained in the Veteran’s STRs; 3) all glucose and A1c readings within one year of separation from service; and 3) a May 2007 VA treatment record that counseled Veteran on diet and noted glucose level and A1c. K. MILLIKAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Bruton, 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.