Citation Nr: 22012168 Decision Date: 03/02/22 Archive Date: 03/02/22 DOCKET NO. 15-35 207A DATE: March 2, 2022 REMANDED Entitlement to service connection for peripheral neuropathy of the right upper extremity is remanded. Entitlement to service connection for peripheral neuropathy of the left upper extremity is remanded. Entitlement to a rating in excess of 40 percent for diabetes mellitus is remanded. Entitlement to service connection for an acquired psychiatric disorder, to include as secondary to service-connected diabetes mellitus, is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran had active duty service from August 1969 to April 1976. The Veteran testified before a now-retired Veterans Law Judge (VLJ) in February 2019. A hearing transcript is included in the file. When that VLJ retired from employment with the Board, a December 2021 letter was sent requesting clarification whether the Veteran wanted a new hearing. The letter informed the Veteran that he was entitled to another hearing with a different VLJ or if he did not respond within thirty (30) days, the Board will assume that he does not want another hearing and proceed accordingly. The Veteran did not respond to the letter and the Board has proceeded with this appeal. This matter was previously remanded by the Board for further development in August 2020. The requested development has been completed and these matters have returned to the Board for further consideration. The issues of entitlement to service connection for anemia, to include as secondary to service-connected diabetes mellitus; service connection for middle finger left hand vascular calcification, to include as secondary to service-connected diabetes mellitus; service connection for peripheral neuropathy of the right lower extremity, to include as secondary to service-connected diabetes mellitus; and service connection for peripheral neuropathy of the left lower extremity, to include as secondary to service-connected diabetes mellitus were also remanded by the Board in August 2020. Following development instructed by the Board remand, in a December 2019 rating decision, the Regional Office granted service connection for peripheral neuropathy of the right lower extremity; service connection for peripheral neuropathy of the left lower extremity; service connection for gastroparesis with anemia; service connection for diabetic retinopathy; and service connection for bilateral upper extremities peripheral vascular disease, to include the middle finger, left and vascular calcification. Since these grants constituted a full grant of the benefits sought on appeal, these claims are no longer in appellate status. See Grantham v. Brown, 114 F. 3d 1156, 1158 (Fed. Cir. 1997)., 11 Vet. App. 268 (1998). The Board finds that a remand is required for all claims for the reasons outlined below. First, and with respect to all claims, VA treatment records must be updated. The most recent VA treatment records are dated through August 2021. The Veteran has indicated that he was hospitalized within the last year for his diabetes mellitus. In addition, the Veteran's representative stated in the November 2021 Post-Remand Brief that Social Security Administration (SSA) records were also absent from the record. As the outstanding VA and SSA records might contain potentially relevant findings as to the etiology and current severity of the claimed disabilities on appeal, an attempt to secure these records and associate them with the claims file should be made. Second, and with respect to rating in excess of 40 percent for diabetes mellitus, the Veteran was afforded a VA examination to determine the current severity of his service-connected diabetes mellitus in February 2021. However, upon close review of the evidence of record, the Board finds additional development is warranted. According to the November 2021 Post-Remand Brief, the Veteran's representative stated that a higher disability rating was warranted as the Veteran was hospitalized for his condition within the last year and continued to increase in insulin. Additionally, the Veteran "[did not] go to the doctor every time he ha[d] a hypoglycemic reaction." Therefore, as there appears to be an increase in severity of his service-connected diabetes mellitus, a new VA examination is warranted. Third, and concerning the claim for service connection for an acquired psychiatric disorder, to include as secondary to service-connected diabetes mellitus, the Veteran contends that his acquired psychiatric disorder is secondary to his service-connected diabetes mellitus. He testified at the February 2019 Board hearing that his diabetes put a strain on his mental health as it made him anxious, depressed, and interfered with his relationships. He also stated that his mental health problems had started since he had separated from service. VA examined the Veteran in February 2021. The VA examiner only provided a rationale for secondary service connection relating to causation, and did not provide a rationale for aggravation. A medical opinion assessing secondary service connection must address both causation and aggravation. El-Amin v. Shinseki, 26 Vet. App. 136, 140 (2013). The VA opinion is therefore considered inadequate, and a remand is warranted for another opinion that addresses both prongs of the secondary service connection theory of the claim, as well as the direct theory of entitlement. Finally, as a decision on the other remanded issues could significantly impact a decision on the issue of entitlement to TDIU, the issues are inextricably intertwined. A remand of the claim for TDIU is required. The Board also finds that a medical opinion regarding employability is needed. These matters are REMANDED for the following action: 1. Obtain the Veteran's updated treatment records, to include VA treatment records dated since August 2021. If the Agency of Original Jurisdiction (AOJ) cannot locate or obtain such records, it must specifically document the attempts that were made to locate or obtain them and explain in writing why further attempts to locate or obtain any government records would be futile. The AOJ must then: (a) notify the claimant of the specific records that it is unable to obtain; (b) explain the efforts VA has made to obtain that evidence; and (c) describe any further action it will take with respect to the claim. All attempts to obtain records should be documented in the Veteran's electronic claims file. 2. Obtain Social Security Administration records. 3. Once all outstanding records, if any, have been associated with the claims file, schedule the Veteran for a VA examination to ascertain the current severity and manifestations of his service-connected diabetes mellitus. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file. The examiner is asked to consider and address the Veteran's lay statements regarding his symptomatology to include that he was hospitalized, continued to increase his insulin, and did not seek medical attention "every time he had a hypoglycemic reaction." 4. Once all outstanding records, if any, have been associated with the claims file, obtain an addendum opinion to address the etiology of the Veteran's acquired psychiatric disorder, specifically addressing the question of whether a service-connected disability (diabetes mellitus) aggravated his acquired psychiatric disorder. If a physical examination is found to be necessary to address the Board's questions, one should be scheduled. The examiner should answer the following questions: a. Is it at least as likely as not (50 percent or greater) that the Veteran's acquired psychiatric disorder either began during or was otherwise caused by his military service, or was manifested within a year of service discharge? Why or why not? In providing the requested opinion, the examiner should address the Veteran's February 2019 testimony that his mental health problems started since his separation from service. b) Is it at least as likely as not (50 percent or greater) that the Veteran's acquired psychiatric disorder was caused by his diabetes mellitus? Why or why not? c) Is it at least as likely as not (50 percent or greater) that the Veteran's acquired psychiatric disorder was aggravated (made worse) by his diabetes mellitus? Why or why not? d) If aggravation is found, the examiner should identify a baseline level of severity of the acquired psychiatric disorder by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the diabetes mellitus. If such cannot be done, it should be explained why. 5. After the above, arrange for a VA examination of the Veteran to assess the Veteran's total disability picture as it relates to his ability to obtain and maintain substantially gainful employment based on all of his service-connected disabilities, to include any that are granted as a result of the development requested herein. A detailed explanation/rationale is required for all opinions provided including consideration of the Veteran's lay statements. Carole R. Kammel Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board H. Yoo, 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.