Citation Nr: 21021040 Decision Date: 04/09/21 Archive Date: 04/09/21 DOCKET NO. 17-09 794 DATE: April 9, 2021 REMANDED Entitlement to service connection for diabetes mellitus is remanded. Entitlement to service connection for kidney failure is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1969 to February 1970. This matter comes before the Board of Veterans’ Appeals (“Board”) on appeal from an August 2013 rating decision of the Department of Veterans Affairs (“VA”) Regional Office (“RO”). Previously the issues were characterized as “entitlement to service connection for diabetes mellitus, claimed as due to exposure to toxic chemicals and/or as a result of experimental immunization received during service” and “entitlement to service connection for kidney failure, to include as secondary to diabetes mellitus.” Since the Veteran raised multiple theories of entitlement, the Board is recharacterizing the issues as seen above, to allow for the most favorable review of the evidence and the claim. See Brokowski v. Shinseki, 23 Vet. App. 79 (2009); Clemons v. Shinseki, 23 Vet. App. 1 (2009). The Board remanded this matter in November 2018 and directed the RO to afford the Veteran a VA medical examination and opinion to ascertain the nature and etiology of his diabetes mellitus and kidney failure. The RO afforded the Veteran with examination and two medical opinions were obtained in August 2019 and April 2020. However, the Board finds that the opinions are inadequate for deciding the issues on appeal. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate). Regrettably, the Board finds that further remand is necessary in this matter. 1. Entitlement to service connection for diabetes mellitus is remanded. The Veteran raised multiple theories of entitlement. Initially, he stated that despite not being treated for diabetes mellitus in-service, he fell from a ladder after passing out from the fumes of an unknown chemical spill, leading to hospitalization and treatment with high dosages of prednisone, which he believed caused his diabetes mellitus. He later stated that the dizziness leading to him passing out was due to fumes and due to a diagnosis of fluids in his lungs, which was treated with large doses of prednisone. Thereafter, he indicated that he received a “viral shot” that caused him to pass out, and he later found this was part of experimental drug, which caused him to have flu like symptoms since service and was the beginning of his diabetes mellitus. Lastly, the Veteran and his attorney also raised the possibility that he was exposed to toxic chemicals during service, which caused diabetes mellitus and kidney disease. In November 2018 decision/remand, the Board noted that the Veteran’s service treatment records indicate that he participated in Medical Research Project Number MF 022.03.07-4018, Antiviral Drugs in the Prevention of Respiratory Disease in Naval Recruits. Consequently, the Board remanded the matter for the prupose of associating any outstanding personnel and service treatment records; and affording the Veteran an examination and medical opinion regarding nature and etiology of diabetes mellitus and kidney failure, to include as secondary to diabetes mellitus. The RO obtained personnel records, afforded the Veteran an examination, and also obtained two medical opinions in August 2019 and April 2020. In August 2019 opinion, the examiner noted the Veteran’s contentions regarding overdose of prednisone and stated that the record does not show diabetes mellitus is related to the overuse of prednisone. The examiner also noted the Veteran’s contentions regarding amantadine study and opined that there is no nexus between amantadine and diabetes mellitus. In April 2020 addendum opinion, the examiner stated that the review of the medical record shows no evidence of the diagnosis, treatment, or symptoms suggestive of diabetes mellitus or renal failure, while on active duty or within one year of separation. The veteran was diagnosed with diabetes mellitus more than 16 years after separation in 1985. While the Veteran could have been prescribed prednisone while on active duty (no record of prednisone prescription), prednisone does not cause diabetes mellitus II. Prednisone can cause corticosteroid induced hyperglycemia, (elevated blood glucose), however, it is a temporary condition that is resolved when the steroid is discontinued. The examiner also opined that there is no evidence of any chemical causing diabetes mellitus II other than the presumptive exposure to herbicides. The Board finds the April 2020 opinion adequate, regarding causal relationship between prednisone and diabetes mellitus. However, the opinion is inadequate regarding causal relationship between chemical exposure and diabetes mellitus because the statement “there is no evidence of any chemical causing diabetes mellitus other than the presumptive exposure to herbicides” is a conclusory statement without a clear explanation. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (a medical opinion “must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions”). The Board also finds that the examiner did not address the medical literature provided by the Veteran, which was pointed out in the November 2018 Board’s remand. The Board notes that the Veteran has filed an affidavit in October 2020, asserting that his duties on the Navy ship, USS Independence (CVA 62), included painting and repainting the ship’s hull, decks, and interior space. Also, his duties reportedly included offloading various containers of chemicals. The Board also notes that the Veteran has provided two private medical opinions, one in March 2020, and the other in November 2020, linking the Veteran’s diagnosed diabetes mellitus with the claimed chemical exposure, including diesel fumes, lead, and benzene, while working on the Navy ship. The private examiner also asserted that publicly available deck logs showed that the Navy ship, USS Independence (CVA 62), was in Vietnamese waters at least on September 3 and 9, 1965. Consequently, a remand is warranted to obtain a supplemental medical opinion on the nature and etiology of diabetes mellitus, and information whether the Navy ship, USS Independence (CVA 62), entered in Vietnamese waters or within 12-nautical miles territorial sea of Vietnam during the Veteran’s duty on the ship from August 13, 1969 to February 9, 1970. 2. Entitlement to service connection for kidney failure is remanded. Regarding his claim for kidney failure, the Veteran claims the same theories of entitlement as for diabetes, including as secondary to diabetes mellitus. In the June 2019 and October 2020 private opinions, which were provided by the Veteran in March 2020 and November 2020 respectively, the examiner linked the Veteran’s kidney failure with chemical exposure, including diesel fumes, lead, and benzene, while working on the Navy ship. The examiner also opined that the diabetes mellitus can cause kidney disease leading to renal failure. The Board notes that in the April 2020 opinion, the VA examiner noted that the Veteran was diagnosed with renal failure secondary to diabetes mellitus II in 2001 and ultimately required a renal transplant. However, the examiner did not opine whether the claimed chemical exposure can cause kidney disease. The Board also notes that the RO obtained service personnel records, which indicate that the Veteran was deployed on the Navy ship, USS Independence (CVA 62), from August 13, 1969 to February 9, 1970. However, the record is silent regarding the Veteran’s duties on the ship and whether there were any chemicals stored on the ship. Hence, a remand is warranted to obtain available information regarding any storage or transport of chemicals in the above described Navy ship, and supplemental medical opinion on etiology and nature of kidney disease including as secondary to diabetes mellitus. The matters are REMANDED for the following action: 1. Obtain any available information regarding the following: (a) Documentation to determine whether the Navy ship, USS Independence (CVA 62), entered in Vietnamese waters or within 12 nautical miles territorial sea of Vietnam during the Veteran’s duty on the ship from August 13, 1969 to February 9, 1970. (b) Documentation regarding storage or transport of the claimed chemicals on the Navy ship, USS Independence (CVA 62), during the time of the Veteran’s service aboard that ship. (c) Records related to the Veteran’s participation in Medical Research Project Number MF 022.03.07-4018, Antiviral Drugs in the Prevention of Respiratory Disease in Naval Recruits. If the RO cannot locate any of the above records, it must specifically document the attempts that were made to locate them and explain why further attempts to locate or obtain any government records would be futile. See 38 C.F.R. § 3.159(c)(2). 2. After completing the above development, forward the claims file and a copy of this remand to the examiner who rendered the April 2020 opinion, or to an appropriate clinician if the April 2020 examiner is unavailable, to obtain a supplemental opinion on the nature and etiology of the diabetes mellitus and kidney failure. 3. The examiner should indicate in the opinion that the claims file was reviewed. The examiner should address the following: (a) Provide an opinion as to whether it is at least as likely as not that the Veteran’s diabetes mellitus and kidney failure had its onset during his period of active service, or caused by his active service including the claimed exposure to chemicals, while working on the Navy ship, and amantadine, the experimental drug the Veteran received during Medical Research Project Number MF 022.03.07-4018, Antiviral Drugs in the Prevention of Respiratory Disease in Naval Recruits. (b) If it is determined that the Veteran’s diabetes mellitus is related to his active service, provide an opinion as to whether the Veteran’s kidney failure is at least as likely as not (i) proximately due to or (ii) aggravated beyond its natural progression by diabetes mellitus. In providing the above opinions, the examiner is advised to address private medical opinions, medical literature and affidavit provided by the Veteran, with entries dated: (i) 02/17/2017, titled “Correspondence,” discussing numerous medical conditions related to certain chemicals during the Vietnam War; (ii) 09/05/2019, titled “Medical Treatment Record – Government Facility” which includes information regarding field studies with amantadine, provided by the Veteran’s attorney; (iii) 03/11/2020, titled “Medical Treatment Record – Non-Government Facility,” which include medical literature and a private nexus opinion linking diabetes mellitus and kidney failure to chemical exposure including PCBs, mercury, diesel fumes, lead and benzene; (iv) 11/18/2020, titled “Medical Treatment Record – Non-Government Facility,” which include another private opinion along with medical literature and affidavit of the Veteran regarding chemical exposure, while working on the Navy ship. A complete rationale for the opinions rendered must be provided. If the examiner is unable to provide an opinion without resorting to mere speculation, then the examiner must state this and provide any information needed to make an opinion, if possible. 4. Thereafter, readjudicate the claim on appeal. If the benefit sought remains denied, issue the Veteran and his representative a supplemental statement of the case and provide a reasonable opportunity to respond before returning the matter to the Board for further appellate review. MICHAEL MARTIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Tariq, Nadeem, Associate Attorney 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.