Citation Nr: 21023049 Decision Date: 04/20/21 Archive Date: 04/20/21 DOCKET NO. 13-30 816 DATE: April 20, 2021 REMANDED Entitlement to service connection for kidney disorder as secondary to service-connected diabetes mellitus, type II, is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1969 to September 1971. On appeal is an October 2012 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO) that granted service connection for diabetes mellitus, type II, but denied service connection for a kidney disorder. When this matter was initially before the Board of Veterans Appeals (Board) in January 2018, the Board remanded for additional development to include obtaining a VA examination that addressed whether the Veteran’s kidney disorder was caused or aggravated by his service-connected diabetes mellitus, type II. When this matter returned to the Board in October 2019, the Board again remanded for additional development, noting that while the March 2019 VA examiner concluded that the Veteran’s kidney disorder was less likely than not incurred or caused by service, or caused by his service-connected diabetes mellitus, type II, the examiner did not opine whether the Veteran’s kidney disorder was aggravated by his diabetes. Another medical opinion was obtained in August 2020 and the matter has now been returned to the Board for appellate review. 1. Entitlement to service connection for a kidney disorder secondary to service-connected diabetes mellitus, type II is remanded. The Board regrets any further delay in the matter, but finds additional development is needed before the Board can render a decision in this matter. A previous remand confers on the claimant, as a matter of law, the right to compliance with the remand orders. Stegall v. West, 11 Vet. App. 268, 271 (1998). As noted above, another medical opinion was requested to address whether the Veteran’s kidney disorder was aggravated by his diabetes. Unfortunately, the August 2020 VA examination did not address aggravation, and the opinion itself was internally inconsistent. In the written report, the August 2020 examiner concluded that “a nexus has not been established” between the Veteran’s diabetes mellitus and his kidney disorder. However, in so finding, he noted that the Veteran has multiple risk factors that “could be the cause of his” kidney disease in addition to his diabetes. The examiner also stated that diabetes mellitus “does affect” the kidney disease, but also concluded that the Veteran’s non-service-connected hypertension “is the most likely initial cause.” The examiner did not render a clear opinion as to whether the Veteran’s kidney disorder has been aggravated by his service-connected diabetes mellitus. As such, the Board finds the August 2020 medical opinion to be both internally inconsistent and unclear about whether the Veteran’s kidney disorder was aggravated by his diabetes. The Court has held that once VA undertakes the effort to provide an examination when developing a claim for service connection, even if not statutorily obligated to do so, it must provide an adequate one. See Woehlaert v. Nicholson, 21 Vet. App. 456, 464 (2007), citing Barr v. Nicholson, 21 Vet. App. 303, 311 (2007); see also Bowling v. Principi, 15 Vet. App. 1, 12 (2001) (emphasizing the Board’s duty to return an inadequate examination report “if further evidence or clarification of the evidence... is essential for a proper appellate decision”). Based on the above, the Board finds that another remand is necessary for a new VA examination and etiological opinion supported by an adequate rationale for the Veteran’s kidney disorder. See Barr, 21 Vet. App at 311. The matter is REMANDED for the following action: Refer the Veteran’s claims file to an appropriate clinician to determine the nature and etiology of the Veteran’s kidney disorder. The examiner must provide a thorough, well-reasoned response to each of the following: (a) Is it at least as likely as not that any diagnosed kidney condition was caused by the Veteran’s service-connected diabetes mellitus, type II? (b) Is it at least as likely as not that any diagnosed kidney condition was aggravated beyond its normal progression by the Veteran’s service-connected diabetes mellitus, type II? All opinions offered must be accompanied by a clear rationale consistent with the evidence of record. If the examiner finds it impossible to provide any part of the requested opinions without resort to pure speculation, he or she should so indicate and provide a rationale as to why such a finding is made. Caroline B. Fleming Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Jiggetts 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.