Citation Nr: 21040723 Decision Date: 07/06/21 Archive Date: 07/06/21 DOCKET NO. 19-01 171 DATE: July 6, 2021 REMANDED Service connection for diabetes mellitus type II is remanded. Service connection for left upper extremity peripheral neuropathy is remanded. Service connection for right upper extremity peripheral neuropathy is remanded. Service connection for right lower extremity peripheral neuropathy is remanded. Service connection for left lower extremity peripheral neuropathy is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from January 1961 to October 1963. This matter comes before the Board of Veterans' Appeals (Board) from a November 2017 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.800 (c). The Board previously remanded this matter for further development in April 2019. The Board finds there was not substantial compliance with its April 2019 remand orders and another remand of these issues is necessary. See Stegall v. West, 11 Vet. App. 268 (1998) 1. Service connection for diabetes mellitus type II is remanded. Service personnel records establish the Veteran's assignment at Camp Lejeune, and his exposure to contaminants in the water supply has been conceded. 38 C.F.R. § 3.307. The Veteran seeks service connection for diabetes mellitus type II. The Veteran contends his diabetes mellitus type II is related to his military service, to include as due to exposure to contaminated water at Camp Lejeune. While diabetes mellitus type II is not included among those diseases listed in 38 C.F.R. § 3.309(f) for which service connection can be presumed due to exposure to contaminated water, the Veteran may nevertheless establish a nexus based on the evidence of record. See Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). The Veteran's representative submitted an informal hearing presentation in February 2019. He asserted that the examiner did not sufficiently consider the question of exposure to environmental chemicals and type 2 diabetes and exposure to chemicals by aircraft maintenance workers. Specifically, he provided links to websites from the National Institutes of Health, U.S. National Library of Medicine; "Environmental Chemicals and Type 2 Diabetes: An Updated Systematic Review of the Epidemiologic Evidence" and "Mortality of Aircraft Maintenance Workers Exposed to Trichloroethylene and other Hydrocarbons and Chemicals: extended follow up." In compliance with the Board's April 2019 Board decision, VA examinations were obtained in January 2020 and February 2021. However, the opinions provided did not address the Veteran's contention that his diabetes mellitus is due to his in-service exposure to contaminated water at Camp Lejeune, nor did it contemplate the medical articles submitted by the Veteran's representative. On remand, an addendum opinion must be provided as to the etiology of the Veteran's currently diagnosed diabetes mellitus type II, which considers the evidence and contentions raised by the representative and complies to comply with the Board's prior remand instructions. Stegall v. West, 11 Vet. App. 268, 271 (1998). 2. Service connection for bilateral upper and lower extremity peripheral neuropathy is remanded. The Veteran's claims for service connection for bilateral upper and lower extremity peripheral neuropathy is intertwined with the claim for service connection for diabetes mellitus type II which is being remanded for additional development. Harris v. Derwinski, 1 Vet. App. 180,183 (1991) (issues are "inextricably intertwined" when a decision on one issue would have a "significant impact" on a veteran's claim for the second issue). Therefore, the claims for service conneciton for bilateral upper and lower extremity peripheral neuropathy is remanded. The matters are REMANDED for the following action: 1. Return the file to the VA contract examiner who provided the February 2021 VA contract diabetes mellitus examination, or if not available, another equally qualified clinician. The claims file must be reviewed by the clinician. If the reviewer determines another VA examination is necessary, one should be scheduled. The reviewer must opine as to whether is it at least as likely as not (50 percent or greater probability) that the Veteran's diabetes mellitus type II is related to service, to include as due to exposure to contaminated water at Camp Lejeune. The opinion must address the medical articles submitted by the Veteran's representative in February 2019 located at the following links: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4327889/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2763375/ A full and complete rationale for all opinions expressed is required. 2. Then, readjudicate the remanded issues. If the benefits sought remain denied, issue a supplemental statement of the case. The case should then be returned to the Board for appellate review if otherwise in order. MARGARET M. LUNGER Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M.Aoughsten, 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.