Citation Nr: 21031687 Decision Date: 05/24/21 Archive Date: 05/24/21 DOCKET NO. 08-03 184 DATE: May 24, 2021 REMANDED Entitlement to a disability rating in excess of 20 percent for diabetes mellitus, type II, is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities before August 31, 2016 is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1967 to May 1969. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a January 2006 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In January 2012, the Veteran testified at a hearing before the Board. A transcript of the hearing is in the Veteran's claims file. In January 2017, the RO awarded the Veteran a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities, effective August 31, 2016. Because the RO's decision only served as a partial grant of the Veteran's TDIU claim, the appeal period before August 31, 2016 remains on appeal. See Harper v. Wilkie, 30 Vet. App. 356, 360-61 (2018). During the appeal period, the Veterans Law Judge (VLJ) who conducted the hearing retired. In May 2017, VA sent the Veteran a letter asking whether he wanted a new hearing in conjunction with this appeal. That same month, the Veteran declined the option for another hearing and asked the Board to consider his case on the evidence of record. The Board has remanded the Veteran's claim for additional development three times, most recently in January 2019. The case is once again before the Board. This appeal has been advanced on the Board's docket pursuant to 38 U.S.C. § 7107(b) and 38 C.F.R. § 20.902(c). 1. Entitlement to a disability rating in excess of 20 percent for diabetes mellitus, type II, is remanded. 2. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities before August 31, 2016 is remanded. The Veteran's service-connected diabetes is currently rated under Diagnostic Code (DC) 7913, which instructs VA adjudicators to "[e]valuate compensable complications of diabetes separately unless they are part of the criteria used to support a 100-percent evaluation." 38 C.F.R. § 4.119, DC 7913, Note 1 (2020). In the Veteran's case, the Board has spent the better part of a decade trying to ensure compliance with this regulation. Although the Board regrets the additional delay, another remand is necessary to ensure that the Veteran is afforded full compliance with VA's statutory duty to assist. In the last remand, the Board asked the examiner whether the Veteran's peripheral vascular disease (PVD), peripheral neuropathy (PN), and erectile dysfunction (ED) are related to his diabetes. The examiner initially decided that all except for the Veteran's PVD of the right lower extremity were complications of his diabetes. VA then asked for an addendum medical opinion that provided a comprehensive review of the medical evidence and considered the Veteran's complex medical history. This time, the examiner reached the opposite conclusion. His entire opinion essentially reads, "I concur with [the advisory opinion from] Dr. Li that the [Veteran's] peripheral vascular disease and neuropathy is more likely due to [a]lcoholism or B12 deficiency" because "tight control of the diabetes is contraindicated." He does not reference what medical evidence from Dr. Li's opinion he found persuasive or offer his own in support of his conclusion. Overall, the opinion is too terse to allow the Board's evaluation of the claimed disability to be a fully informed one. See Stefl v. Nicholson, 21 Vet. App. 120, 125 (2007) ("[A] mere conclusion by a medical doctor is insufficient to allow the Board to make an informed decision."). As such, remand is necessary for yet another addendum medical opinion. Because a decision on the Veteran's PVD and PN could significantly impact his TDIU claim, the issues are inextricably intertwined and a remand of both is required. Harris v. Derwinski, 1 Vet. App. 180, 181 (1991). Finally, as the case is being remanded for additional development, any outstanding VA treatment records should be associated with the claims file. See Bell v. Derwinski, 2 Vet. App. 611, 613 (1992) (per curiam). The matter is REMANDED for the following action: 1. Obtain all outstanding VA treatment records and associate them with the claims file. 2. Then, arrange for an appropriate healthcare provider to review the Veteran's claims file and provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that his peripheral vascular disorder and neuropathy are a complication of his service-connected diabetes mellitus, type II. If the reviewing health care provider finds that physical examination or telehealth interview of the Veteran and/or diagnostic testing is necessary, such should be accomplished. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 3. After undertaking any additional development deemed appropriate and giving the Veteran full opportunity to supplement the record, adjudicate the Veteran's pending claim in light of any additional evidence added to the record. If any benefit sought on appeal remains denied, the Veteran and his representative should be furnished with a Supplemental Statement of the Case and be afforded the applicable opportunity to respond before the record is returned to the Board for further review. B. G. LeMoine Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Canedy, 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.