Citation Nr: 22015702 Decision Date: 03/18/22 Archive Date: 03/18/22 DOCKET NO. 17-54 404 DATE: March 18, 2022 REMANDED Entitlement to service connection for diabetes mellitus type II is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from August 1974 to August 1994. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a rating decision issued by the Department of Veterans Affairs (VA). The Board previously remanded claims of service connection for sinusitis and diabetes mellitus type II in December 2019. The agency of original jurisdiction (AOJ) was asked, among other things, to attempt to procure outstanding medical records, to include VA medical records from the Pensacola VA Medical Center (VAMC) and private medical records relevant to diabetes mellitus type II. The AOJ granted service connection for sinusitis and assigned a 50 percent rating from September 24, 2015. See Rating Decision Narrative, September 2020. This is considered a full grant of that issue. The matter is no longer within the Board's appellate purview. Grantham v. Brown, 114 F.3d 1156, 1158 (Fed. Cir. 1997). On remand, the AOJ requested outstanding medical records for the relevant period from the Pensacola VAMC on December 13, 2019. It also sent the Veteran a letter asking her to submit authorization for VA to obtain any outstanding medical records on December 16, 2019. The Veteran responded by submitting a VA Form 21-4142a authorizing VA to obtain records from the Pensacola VAMC. She later called the AOJ to clarify that her medical records are all at the Pensacola VAMC for the relevant time period, and stated that she had no further evidence to submit. On January 30, 2020, the Pensacola VAMC responded that it did not have records responsive to the request. It explained that records search inquiries were made to the relevant offices, but that all offices responded that there were "no records" consistent with the relevant requests. In October 2020, the AOJ sent the Veteran a letter explaining that the records from the relevant date range of September 1, 1994, to January 21, 2001, cannot be located and are unavailable for review. It explained that all efforts to obtain the needed information have been exhausted, and that further attempts to obtain the records would be futile. The Board concludes that the AOJ has substantially complied with its prior remand directives regarding outstanding medical records. See 38 U.S.C. § 5103A(c)(2). Nevertheless, the Board finds that additional development is needed before a final decision may be made on the merits of this claim. 1. Entitlement to service connection for diabetes mellitus type II is remanded. This matter must be remanded for an adequate medical opinion addressing whether the Veteran's diabetes mellitus type II had onset during or within a year of military service or is otherwise etiologically related to military service. See 38 U.S.C. § 5103A(d); Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (holding that, when VA provides a medical opinion, it must be adequate for decisional purposes). The Veteran underwent a VA examination in 2006. The examiner noted that the Veteran had been actively receiving treatment for Type II diabetes mellitus as early as 1999. She also observed that the Veteran was found to have glucose intolerance at the time of her service discharge in 1994. The clinical significance of these findings was not addressed. Rather, without additional discussion, the examiner opined that she "would have to resort to speculation to state that diabetes mellitus was due to or caused by military service." Such limits the probative value of the opinion. See Jones v. Shinseki, 23 Vet. App. 382 (2010) (indicating that the examiner must explain why the requested opinion would be speculative before the Board could rely on such a conclusion). Also, the examiner did not state whether it was a deficiency in her own knowledge or that of the medical community as a whole that rendered her unable to provide an opinion without resorting to speculation. An addendum opinion is necessary. The matter is REMANDED for the following action: Obtain an addendum medical opinion from a suitably qualified clinician regarding the etiology of the Veteran's diabetes mellitus type II. The clinician is asked to review the claims file and to opine on the following: (a) Is it at least as likely as not that the Veteran's diabetes mellitus type II had its initial onset during active service or is causally related to active service? (b) Is it at least as likely as not that the Veteran's diabetes mellitus type II began within one year of discharge from active service? A complete rationale should be provided for all opinions. The examiner is asked to consider and discuss relevant lay and medical evidence, to specifically include: Service medical records, including retirement physical examination showing elevated fasting blood sugars in 1994 VA examination report in June 1995 showing no diagnosis of diabetes mellitus type II Private medical records showing blood glucose readings in 1999 Private medical records from the White Wilson Medical Center, including an August 2017 note stating that the Veteran's diabetes has been ongoing for "many years" VA examination report in May 2006 Disability benefits questionnaire submitted by the Veteran in August 2015 Letter from Dr. M.S. dated July 24, 2006, describing his treatment of the Veteran's diabetes beginning on June 30, 1999 The clinician is reminded that the term "at least as likely as not," does not mean "within the realm of medical possibility," but rather that the evidence of record is so evenly divided that, in the clinician's expert opinion, it is as medically sound to find in favor of the proposition as it is to find against. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Reed, 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.