Citation Nr: 21016082 Decision Date: 03/19/21 Archive Date: 03/19/21 DOCKET NO. 16-17 364 DATE: March 19, 2021 REMANDED Entitlement to service connection for type II diabetes mellitus, to include as secondary to service-connected hypertension, is remanded. REASONS FOR REMAND The Veteran had multiple periods of active duty service in the United States Army to include from August 1986 to September 1990, August 1992 to March 1994, January 2003 to September 2003, and January 2004 to September 2006, with additional service in the United States Army Reserve. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a June 2014 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). This matter involves an extensive procedural history that need not be detailed here. However, pertinent to this instant action, this matter was previously before the Board in September 2018 and May 2019. Most recently, in May 2019, the Board remanded the issue of entitlement to service connection for type II diabetes mellitus to obtain a medical opinion. Although further delay is regrettable, the Board finds there was not substantial compliance with the May 2019 remand directives. Stegall v. West, 11 Vet. App. 268 (1998). Therefore, to ensure due process is followed and there is a complete record upon which to decide the Veteran’s claim, remand is necessary to obtain a well-reasoned medical opinion. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. Entitlement to service connection for type II diabetes mellitus, to include as secondary to service-connected hypertension, is remanded. The Board notes, in order to prevail on the issue of secondary service connection, the record must show: (1) the evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical nexus evidence establishing a connection between the service-connected disability and the current disability. Wallin v. West, 11 Vet. App. 509, 512 (1998). In the context of a secondary theory of entitlement, Wallin makes clear the crux of the issue is not when the Veteran sustained the current disability, but rather, why and how it is caused or aggravated by the service-connected disability. Further, the Court, in Ward v. Wilkie, 31 Vet. App. 223 (2019), held that aggravation under 38 C.F.R. § 3.310(b) does not require there be “permanent worsening” of the service-connected disability. Instead, secondary service connection is warranted for any “incremental increase in disability, and additional impairment of earning capacity in nonservice-connected disabilities resulting from service-connected conditions, above the degree of disability existing before the increase, regardless of its permanence. See Id. In its May 2019 remand, the Board directed the Agency of Original Jurisdiction (AOJ) to obtain an etiological medical opinion for the Veteran’s diabetes mellitus. A December 2019 VA examination and medical opinion, and December 2019 Veterans Evaluation Services (VES) examination and medical opinion have been added to the claims file. As discussed below, the VES medical opinion is not responsive to the Board’s May 2019 remand directives. The December 2019 VES examiner provided a negative nexus opinion stating the Veteran’s diabetes mellitus type II was less likely than not caused by or aggravated by his service-connected hypertension. As rationale, the examiner stated there is no history of diabetes prior to service, and during service there was no apparent evaluation of abnormal glucose or diabetic conditions. The examiner noted the first indications of diabetes do not appear in the records consistently until 2012, which was approximately six (6) years after active duty. The examiner concluded, there is no demonstrable aggravation, adding, diabetes is not medically known to be a result of hypertension. The Board finds the examiner’s opinion inadequate, as it is not supported by any meaningful rationale. Barr v. Nicholson, 21 Vet. App. 303 (2007). The examiner only generally states there is no demonstrable aggravation without providing a medical explanation specific to the Veteran’s condition. Accordingly, to ensure substantial compliance with the directives of the May 2019 remand, and as the other examination of record does not correct the inadequacies of the December 2019 VES examination, the issue of entitlement to service connection for diabetes mellitus type II, to include as secondary to service-connected hypertension, must be remanded for an additional opinion with adequate supporting rationale. Stegall, 11 Vet. App. 268. The matters are REMANDED for the following action: 1. The AOJ should obtain an addendum opinion to determine the nature and etiology of the Veteran’s diabetes mellitus. The Veteran’s claims file and a copy of this Remand should be provided to the examiner and the examination report should reflect that these items were reviewed. The examiner is asked to provide an opinion as to the following: (a.) Whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s type II diabetes mellitus is: • Proximately due to the Veteran’s service-connected hypertension, including medications prescribed to treat his hypertension, or • Aggravated beyond its natural progression by the Veteran’s service-connected hypertension, including medications prescribed to treat his hypertension. In providing the requested opinion, it is noted that “permanent worsening” or increase in severity is not required to demonstrate aggravation. If such aggravation is found to exist, the examiner should provide an assessment, if possible, of the baseline level of impairment of the type II diabetes mellitus prior to aggravation. The clinician should then provide a quantification, if possible, of the level of additional impairment above and beyond its baseline level imposed by the service-connected hypertension. A complete rationale must be provided. If the examiner cannot provide an opinion without resorting to speculation, the examiner should provide an explanation as to why this is so and note what, if any additional evidence would permit such an opinion to be made. (Continued on the next page) 2. The AOJ must review the medical opinion addendum to ensure compliance with the Remand directives. If the addendum report is deficient in any manner, take corrective action prior to returning the case to the Board. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Grace Johnk, 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.