Citation Nr: 21023677 Decision Date: 04/21/21 Archive Date: 04/21/21 DOCKET NO. 17-09 037 DATE: April 21, 2021 REMANDED Entitlement to a disability rating higher than 20 percent for diabetes mellitus type I is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Coast Guard from March 1982 until his honorable discharge in March 1985. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2013 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In February 2021, the Veteran presented sworn testimony during a video-conference hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the claims file. Entitlement to a disability rating higher than 20 percent for diabetes mellitus type I. The Veteran was last afforded a VA examination addressing the severity of his diabetes mellitus type I in January 2017. At that time, the Veteran’s diabetes mellitus was managed by restricted diet, prescribed oral hypoglycemic agent, and insulin (delivered by pump). There was no regulation of activities, no episodes of ketoacidosis or hypoglycemia, and the Veteran did not have any recognized diabetic complications. The Veteran argues that the 20 percent evaluation does not adequately reflect the severity of his diabetes mellitus type I. This is reflected in the Veteran’s June 2014 Notice of Disagreement, where he disagreed with the evaluation of his disability, as well as his testimony during the February 2021 hearing where he reported worsening of his diabetes mellitus. The Veteran testified that his diabetes mellitus type I requires regulation of physical activity; he reported experiencing episodes of ketoacidosis requiring hospitalization and episodes of hypoglycemia; and he reported complications of diabetes mellitus including cataracts, retinopathy, and neuropathy in his feet. See February 2021 Hearing Transcript. The Board observes the Veteran was last afforded a VA examination for his service-connected diabetes mellitus disability in January 2017. Because the evidence suggests a material worsening of the Veteran’s condition since his last VA examination, reexamination is necessary. See 38 C.F.R. §§ 3.326, 3.327; Snuffer v. Gober, 10, Vet. App. 400, 403 (1997). Additionally, evidence indicates there may be outstanding relevant treatment records. The claims file includes VA treatment records dated through January 2017. Furthermore, the Veteran, during his February 2021 hearing, confirmed ongoing treatment with a private physician for his diabetes mellitus. VA has a duty to obtain the outstanding relevant VA treatment records and a duty to assist the Veteran in obtaining the relevant private treatment records. See 38 C.F.R. § 3.159. Therefore, on remand, the Agency of Original Jurisdiction (AOJ) should afford the Veteran a new examination to determine the current level of severity of his service-connected diabetes mellitus type I and obtain the outstanding treatment records noted above. The matters are REMANDED for the following action: 1. The AOJ should afford the Veteran an opportunity to submit or identify any outstanding pertinent evidence not already associated with the claims file. The AOJ should then attempt to obtain those records if the appropriate authorization is provided. 2. The AOJ should ensure all outstanding VA treatment records are associated with the claims file, to include updated VA treatment records since January 2017. 3. After completion of the above, schedule the Veteran for an examination with an appropriate clinician to determine the current severity of his service-connected diabetes mellitus type I. The claims folder must be made available to the examiner for review in connection with the examination. The examination report must reflect that such a review was conducted. All indicated tests and studies should be conducted. (a) The examiner should describe in detail all symptomatology associated with the Veteran’s diabetes mellitus type I. The Veteran is competent to attest to observable symptoms. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. (Continued on the next page) (b) The examiner should state whether the Veteran has any recognized complications of diabetes mellitus type I. The examiner should evaluate and discuss the severity of any recognized complications. If the examiner determines separate examinations are warranted to evaluate any recognized complications, such examinations should be conducted. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Grace A. 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.