Citation Nr: 21026025 Decision Date: 04/29/21 Archive Date: 04/29/21 DOCKET NO. 14-42 638 DATE: April 29, 2021 REMANDED Entitlement to service connection for diabetes mellitus type II, to include as secondary to medication for service-connected schizoaffective disorder, is remanded. REASONS FOR REMAND The Veteran had active service from July 1972 to April 1973. The Veteran testified before the undersigned at a January 2019 videoconference hearing and a transcript of the hearing has been associated with the claims file. This matter was previously denied by the Board in April 2019. Thereafter, in December 2020, the Veteran and the Secretary of VA (parties) agreed to a Joint Motion for Partial Remand (JMPR), which was subsequently ordered by the U.S. Court of Appeals for Veterans Claims (Court). As discussed below, the Board finds that additional development is warranted pursuant to the JMPR, and the matter is remanded.   Entitlement to service connection for diabetes mellitus type II, to include as secondary to medication for service-connected schizoaffective disorder, is remanded. In the December 2020 JMPR, the parties agreed that the Board erred by failing to ensure that the Veteran was provided an adequate medical examination. Specifically, the parties agreed that the Board erred in relying on the August 2013 VA medical examination because the examiner failed to address all relevant medical questions and did not provide adequate rationale to support her conclusions. Notably, in her report, the August 2013 examiner noted that medical literature indicates that weight gain may be associated with quetiapine, a schizoaffective medication that the Veteran has been taking since 1999, and that diabetes has been reported in patients taking this medication. The Veteran’s body mass index (BMI) in 1999 was 23 and, by 2000, his BMI exceeded 30. She added that the Veteran went on a “rigorous diet” in January 2013 resulting in weight loss. She then concluded that his diabetes was less likely due to his use of quetiapine because “recent weight loss argues against the case of quetiapine causing his diabetes, and that it’s more likely that [the Veteran’s] weight gain due to his diet caused his diabetes.” Moreover, the examiner explained that “[p]eople with schizophrenia (whether they are taking quetiapine or not) may be at a higher risk of developing diabetes.” As noted in the December 2020 JMPR, the examiner’s opinion does not address whether the Veteran’s service-connected schizoaffective disorder or the medication he takes for his service-connected schizoaffective disorder caused or aggravated his diabetes. Additionally, the examiner’s conclusion is not supported by an adequate rationale. Specifically, in concluding that the Veteran’s weight gain is caused by his diet, she failed to address the medical literature relating quetiapine use to weight gain as well as directly or indirectly to diabetes. Thus, in light of the December 2020 JMPR, the Board finds that a remand is required to obtain an adequate addendum opinion that addresses whether the Veteran’s diabetes is caused or aggravated by his service-connected schizoaffective disorder or the medication, quetiapine, which he takes for his service-connected schizoaffective disorder. The matter is REMANDED for the following action: Provide the claims file to a qualified VA examiner for an addendum opinion concerning the etiology of the Veteran’s diabetes mellitus type II is caused or aggravated by his service-connected schizoaffective disorder or the medication, quetiapine, which he takes for his service-connected schizoaffective disorder. The examiner should be provided a copy of the below facts. If the examiner believes that an in-person examination is needed to provide an informed opinion, then an examination should be scheduled. To assist in a review of the claims file, the examiner is informed of the following facts with citations in the record, where applicable: • The Veteran had active service from July 1972 to April 1973. • The Veteran is service connected for schizoaffective disorder and takes quetiapine, which he has been taking since approximately 1999. • The Veteran claims that his type II diabetes mellitus is either caused or aggravated by his service-connected schizoaffective disorder or the medication, quetiapine, that he takes for the service-connected schizoaffective disorder. • The VA treatment records show that the Veteran had an elevated glucose reading in May 2010. See VBMS entry with document type, “Medical Treatment Record – Government Facility,” receipt date 01/27/2012, pp. 10-11. • The Veteran’s VA problem list shows he was diagnosed with being overweight in September 2009 and diagnosed with type II diabetes in August 2011. See VBMS entry with document type, “Medical Treatment Record – Government Facility,” receipt date 01/20/2012, p. 2. • At the January 2019 videoconference hearing, the Veteran testified that his doctor informed him that Seroquel (quetiapine) causes diabetes. See VBMS entry with document type, “Hearing Transcript,” receipt date 01/10/2019. • An August 2013 VA examiner noted that medical literature indicates that weight gain may be associated with quetiapine, a schizoaffective medication that the Veteran has been taking since 1999, and that diabetes has been reported in patients taking this medication. The examiner wrote that the Veteran’s body mass index (BMI) in 1999 was 23 and by 2000, his BMI exceeded 30. She added that the Veteran went on a “rigorous diet” in January 2013 resulting in weight loss of 22 pounds. She then concluded that his diabetes was less likely due to his use of quetiapine because “recent weight loss argues against the case of quetiapine causing his diabetes, and that it’s more likely that [the Veteran’s] weight gain due to his diet caused his diabetes.” Moreover, the examiner explained that “[p]eople with schizophrenia (whether they are taking quetiapine or not) may be at a higher risk of developing diabetes.” See VBMS entry with document type, “VA Examination,” receipt date 08/14/2013, p. 9-10. • It has been determined that the August 2013 VA examiner’s opinion did not properly address whether the Veteran’s service-connected schizoaffective disorder or the medication he takes for his service-connected schizoaffective disorder caused or aggravated his diabetes or provide an adequate explanation. For example, in concluding that the Veteran’s weight gain is caused by his diet, the examiner failed to address the medical literature relating quetiapine use to weight gain as well as directly or indirectly to diabetes. See VBMS entry with document type, “CAVC Decision,” receipt date 12/07/2020. • The examiner’s review of the record is NOT restricted to the evidence listed above. This list is provided in an effort to assist the examiner in locating potentially relevant evidence. The VA examiner is requested to opine as to the following: (1) Is it at least as likely as not (a 50 percent probability or greater) that type II diabetes mellitus was caused by the Veteran’s service-connected schizoaffective disorder or the medication, quetiapine, taken for the service-connected disability? Please state upon what facts, medical principles, and/or medical literature you base the opinion(s). (2) If the answer to (1) is negative, is it at least as likely as not (a 50 percent probability or greater) that type II diabetes mellitus was aggravated by the Veteran’s service-connected schizoaffective disorder or the medication, quetiapine, taken for the service-connected disability? Aggravation is different from causation in that it did not cause the disability but that it aggravated the disability. Please state upon what facts, medical principles, and/or medical literature you base the opinion(s). (3) If the examiner finds that the service-connected schizoaffective disorder or the medication the Veteran takes for such disorder aggravates the type II diabetes mellitus, the examiner is asked to state whether there is medical evidence created prior to the aggravation or at any time between the time of aggravation and the current level of disability that shows a baseline for the type II diabetes mellitus prior to aggravation. If the examiner is unable to establish a baseline for the type II diabetes mellitus prior to the aggravation, he or she should state such and explain why a baseline cannot be determined. A full rationale, including reference to supporting clinical data and/or medical literature relating quetiapine use to weight gain as well as directly or indirectly to diabetes, must be provided for all medical opinions given. A. P. SIMPSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Chad Johnson, 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.