Citation Nr: 21031767 Decision Date: 05/24/21 Archive Date: 05/24/21 DOCKET NO. 15-44 809 DATE: May 24, 2021 REMANDED Entitlement to service connection for diabetes mellitus, type 2, to include as due to exposure to herbicides, is remanded. Entitlement to service connection for a kidney disability, to include as due to exposure to herbicides and/or as secondary to diabetes mellitus, type 2, is remanded. REASONS FOR REMAND The Veteran had active service from May 1966 to April 1968. This matter comes before the Board of Veterans' Appeals (BVA or Board) from a June 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran requested a hearing before the Board. The requested hearing was conducted in October 2019 by the undersigned Veterans Law Judge. A transcript is associated with the claims file. In January 2020, the Board remanded the issues of entitlement to service connection for a heart disability, diabetes mellitus, type 2, and a kidney disability for additional development. In a July 2020 rating decision, the RO granted entitlement to service connection for a heart disability; as such, this issue is no longer on appeal. The Veteran served in Vietnam from April 1967 to April 1968; exposure to herbicides has been conceded. 1. Entitlement to service connection for diabetes mellitus, type 2, to include as due to exposure to herbicides. The Veteran seeks entitlement to service connection for diabetes mellitus, type 2. This claim was remanded in January 2020 to obtain a medical opinion in order to clarify whether the Veteran has a diagnosis of diabetes mellitus, type 2. The Veteran was afforded a VA examination in March 2020. It was noted that the Veteran has a diagnosis of impaired glucose intolerance. The Veteran's most recent hemoglobin A1C (HgbA1c) result was 6.3. The examiner stated that the Veteran currently does not have a diagnosis of diabetes mellitus, type 2, noting that his elevated HgbA1C results have been 6.3 or less without any medication being prescribed; there has never been a random blood glucose of 200mg or higher dating back to 1994; and although there have been sporadic elevations of blood glucose into the 140s and 150s, there are no fasting blood glucoses on file. The examiner explained that the only means whereby a diagnosis can be made at this juncture is via a glucose intolerance test, however, the Veteran has adamantly refused to have this test performed and stated that he has no intention of ever having it done. As such, based on the evidence of record, the Veteran does not currently have a diagnosis of diabetes mellitus, type 2. In an April 2021 statement, the Veteran's representative requested that this case be remanded again to afford the Veteran the opportunity to have a glucose intolerance test conducted and to impress upon the Veteran the importance of a complete physical examination in order to grant benefits. As noted, the Veteran's exposure to herbicides during service is conceded. Diabetes mellitus, type 2, is a presumptive disease associated with exposure to herbicides; therefore, the Veteran need only provide evidence that he has a diagnosis of diabetes mellitus, type 2, in order for his claim to be granted. The current evidence indicates that he has pre-diabetes, not diabetes mellitus, type 2, and the March 2020 VA examiner indicated that the only method to determine if the Veteran has a diagnosis of diabetes, type 2, currently, is to have a glucose intolerance test conducted. The Board is therefore remanding this case to afford the Veteran an opportunity to take a glucose intolerance test pursuant to his representative's request. The Board also reminds the Veteran that the "duty to assist is not always a one-way street," and that he has an obligation to actively participate, to include attending scheduled VA examinations. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). The Veteran is additionally notified that he is free to obtain and submit private medical evidence that demonstrates he has a current diagnosis of diabetes mellitus, type 2. 2. Entitlement to service connection for a kidney disability, to include as due to exposure to herbicides and/or as secondary to diabetes mellitus, type 2. The Veteran seeks entitlement to service connection for a kidney disability. This issue was remanded in January 2020 to afford the Veteran a VA examination and to obtain a medical opinion. The Board noted in the January 2020 remand that the prior VA opinion in January 2013 was inadequate in that it reported the Veteran's kidney cysts were congenital and provided no further rationale. The Veteran was afforded a VA examination in March 2020. He was diagnosed with nephrolithiasis and cystic kidney disease. The examiner stated that the Veteran's cysts were a developmental defect and are asymptomatic. The examiner failed to specifically answer whether the Veteran's cysts were subject to a superimposed disease or injury during active service and also failed to offer any opinion regarding the Veteran's diagnosed nephrolithiasis. On remand, an addendum opinion should be obtained. The matters are REMANDED for the following action: 1. Obtain and associate with the claims file all updated treatment records. 2. Inform the Veteran that he may submit any additional medical evidence, to include private medical records and/or a private medical opinion, that supports he has a current diagnosis of diabetes mellitus, type 2. 3. Afford the Veteran a VA examination for his diabetes mellitus, type 2, that specifically includes a glucose intolerance test. *The Veteran is reminded that he has an obligation to actively participate in the development of his claim, to include attending the scheduled VA examination and any associated testing. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). He is expected to cooperate in the efforts to adjudicate the claim, and his failure to do so could result in denial of his claim. 4. Obtain an addendum opinion for the Veteran's claimed kidney disability. No additional examination is necessary unless the examiner determines otherwise. The entire claims file, including a copy of this remand, must be reviewed by the examiner. The VA examiner should provide the following opinions: a) Were the Veteran's kidney cysts, which have been determined to be a developmental defect, subject to a superimposed disease or injury during service (i.e. aggravated), to include as due to exposure to herbicides? If so, describe the resultant disability. b) Is the Veteran's nephrolithiasis at least as likely as not causally or etiologically due to service, to include exposure to herbicides? c) If the Veteran has a current diagnosis of diabetes, is the Veteran's nephrolithiasis at least as likely as not proximately due to or aggravated (beyond a natural progression) by his diabetes mellitus, type 2? *The examiner is asked to specifically consider and discuss the Veteran's contentions that his kidney disorders are due to exposure to herbicides and/or secondary to diabetes mellitus, type 2. *The examiner is advised that the Board is cognizant there is no VA presumption of service connection for kidney cysts and nephrolithiasis as due to herbicide exposure. The question here is what is the likelihood that this Veteran's kidney disorder is related to his herbicide exposure given his medical history, family history, other risk factors, etc. All opinions should be supported by a clear rationale, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. TANYA SMITH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Andersen, 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.