Citation Nr: 21024221 Decision Date: 04/22/21 Archive Date: 04/22/21 DOCKET NO. 13-21 546 DATE: April 22, 2021 REMANDED Entitlement to service connection for diabetes mellitus type II is remanded. Entitlement to service connection for bilateral upper extremity peripheral neuropathy is remanded. Entitlement to service connection for bilateral lower extremity peripheral neuropathy is remanded. REASONS FOR REMAND The Veteran had active duty service from November 1967 to June 1969. He died in February 2016. The Appellant is the Veteran’s next of kin. In November 2019, the Appellant was notified that he met the eligibility criteria for substitution as the claimant in the Veteran’s appeal. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2012 rating decision. In January 2020, the Board remanded this matter for further development. Unfortunately, another remand is warranted to obtain additional development. 1. Entitlement to service connection for diabetes mellitus type II is remanded. 2. Entitlement to service connection for bilateral upper extremity peripheral neuropathy is remanded. 3. Entitlement to service connection for bilateral lower extremity peripheral neuropathy is remanded. The Veteran asserted service connection for diabetes and upper and lower extremity conditions based on reported exposure to herbicide agents during service in Korea. In January 2020, the Board remanded this matter for further development regarding the claimed in-service herbicide exposure. Such development has been completed by the Regional Office. However, in addition to presumptive service connection based on herbicide agent exposure, a veteran may be able to establish service connection on a direct basis. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). Here, as to the claim for service connection for diabetes, the Veteran’s service treatment records indicate that he was evaluated for diabetes during service. An August 1968 service treatment record diagnosed the Veteran with mild prostatitis and noted that diabetes mellitus needed to be ruled out. Subsequent service treatment records show that 9 days of testing showed spillage of sugar on only one occasion, that being trace, but the service treatment record also notes that the Veteran’s fasting blood sugar and 2-hour postprandial glucose gave impossible results and that there was a problem with the labs in Korea. The service treatment record regarding glucose readings notes a recommendation for occasional urine checks. No VA examiner has opined as to whether the Veteran’s diabetes had an onset in service, manifested to a compensable degree within a year of separation from service, or is otherwise related to service in light of this in-service treatment. Accordingly, remand is warranted to obtain VA medical opinion. See 38 C.F.R. § 3.159(c)(4); see also McLendon v. Nicholson, 20 Vet. App. 79, 85-86 (2006). As to the claims for service connection for upper and lower extremity conditions, the claims are inextricably intertwined with the diabetes service connection claim being remanded and must be remanded as well. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (two issues are “inextricably intertwined” when they are so closely tied together that a final Board decision cannot be rendered unless both are adjudicated). If a positive opinion is obtained for the diabetes claim, VA medical opinion should be obtained regarding whether the Veteran’s upper and lower extremity conditions are secondary to the diabetes. The matters are REMANDED for the following action: 1. Ask the appropriate examiner to review the Veteran’s file. The examiner should opine regarding whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s diabetes mellitus: (a) had an onset in service; (b) manifested to a compensable degree within a year of separation from service (June 1970); or (c) is otherwise related to service. If the examiner opines that the Veteran’s diabetes had an onset in service, manifested within a year of separation from service, or is otherwise related to service, the examiner should also identify any upper and lower extremity disabilities the Veteran experienced during the claims period, even if resolved before his death. For each disability, the examiner should opine regarding whether it is at least as likely as not (a 50 percent or greater probability) that the disability is caused by or aggravated by his diabetes. Note that aggravation means any incremental increase in disability in non-service-connected disabilities (i.e., any additional impairment of earning capacity) resulting from service-connected condition. The examiner should consider all medical and lay evidence of record. The examiner should specifically address the Veteran’s August 1968 service treatment records considering a diabetes diagnosis. The examiner is asked to explain the reasons behind any opinions expressed. The examiner is reminded that the term “as likely as not” does not mean “within the realm of medical possibility,” but rather that the evidence of record is so evenly divided that, in the examiner’s expert opinion, it is as medically sound to find in favor of the proposition as it is to find against it. 2. After the above development, and any additionally indicated development, has been completed, readjudicate the issue on appeal. Shereen M. Marcus Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Purcell 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.