Citation Nr: 22017155 Decision Date: 03/24/22 Archive Date: 03/24/22 DOCKET NO. 15-28 016 DATE: March 24, 2022 REMANDED Entitlement to service connection for diabetes mellitus, type II, as secondary to a service-connected acquired psychiatric disability, is remanded. Entitlement to service connection for a heart condition, as secondary to a service-connected acquired psychiatric disability and/or claimed diabetes mellitus, type II, is remanded. Entitlement to service connection for vertigo, as secondary to a service-connected acquired psychiatric disability and/or claimed diabetes mellitus, type II, is remanded. Entitlement to service connection for a vision disability, as secondary to a service-connected acquired psychiatric disability and/or claimed diabetes mellitus, type II, is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1974 to October 1977. The Veteran appeared at a video conference hearing before the undersigned in December 2018. A transcript to the hearing is of record. These claims were previously before the Board in June 2019 and May 2021, at which time they were remanded for further development. Unfortunately, remand is again necessary. 1. Entitlement to service connection for diabetes mellitus, type II, as secondary to a service-connected acquired psychiatric disability, is remanded. In its May 2021 decision, the Board directed the agency of original jurisdiction (AOJ) to obtain an addendum opinion addressing the etiology of the Veteran's diabetes mellitus, type II, as the medical opinion of record lacked a complete analysis and rationale. In a June 2021 addendum opinion, the VA examiner opined that the Veteran's diabetes mellitus, type II, was not proximately due to or aggravated by his service-connected acquired psychiatric disability or the medicines used to treat it. While the VA examiner provided a thorough discussion of how diabetes mellitus, type II, develops, she did not adequately address why the Veteran's PTSD symptoms or medications would not aggravate his diabetes mellitus. On remand, an addendum opinion should be obtained. 2. Entitlement to service connection for a heart condition, as secondary to a service-connected acquired psychiatric disability and/or claimed diabetes mellitus, type II, is remanded. 3. Entitlement to service connection for vertigo, as secondary to a service-connected acquired psychiatric disability and/or claimed diabetes mellitus, type II, is remanded. In the May 2021 decision, the Board directed the AOJ to obtain an addendum opinion addressing the etiology of the Veteran's heart condition, as previous examinations lacked sufficient rationale and analysis to support the opinions provided. In the June 2021 VA addendum opinion, the VA examiner noted that the Veteran had numerous risk factors for coronary artery disease, including age, a history of tobacco abuse, history of hyperlipidemia, and a family history of hypercoagulable disease. She noted that, pathophysiologically, the Veteran's acquired psychiatric disability was not felt to be a "main" factor in his heart condition. However, the VA examiner's choice of terminology creates ambiguity as to whether the Veteran's service-connected acquired psychiatric disability was, in fact, a factor in the development of his heart condition, albeit not a "main" factor. On remand, another VA addendum opinion should be obtained that clarifies the medical question. In the November 2021 Appellant's Post-Remand Brief, the Veteran's representative asserted that the June 2021 VA medical opinion was inadequate as the examiner failed to afford due consideration to the Veteran's lay statements. During an October 2020 VA Ear Conditions examination, the Veteran reported that that beginning in the 1990s, after the commencement of cardiac medications, he began to experience regular dizzy spells that have progressively gotten worse. However, in the June 2021 VA addendum opinion, the VA examiner based her opinion on October 2006 VA treatment records indicating that, within the past month, the Veteran occasionally felt like his equilibrium was "off" without addressing the Veteran's prior lay statements regarding onset of his dizziness complaints. On remand, an additional addendum opinion should be sought that addresses the Veteran's lay statements regarding the timing of the onset of his symptoms. 4. Entitlement to service connection for a vision disability, as secondary to a service-connected acquired psychiatric disability and/or claimed diabetes mellitus, type II, is remanded. In October 2020, a VA examiner indicated his vision fluctuation was at least as likely as not related to his claimed diabetes mellitus, type II. As the Board is remanding the Veteran's diabetes claim for additional development, adjudication of the Veteran's vision disability claim at this time would be premature. As such, the matter is deferred. The matters are REMANDED for the following action: 1. Obtain medical opinions addressing the nature and etiology of the Veteran's claimed diabetes mellitus and vertigo disabilities with a clinician or clinicians other than examiner who performed the October 2020 VA examinations. The clinician(s) must receive a copy of and review the Veteran's claims file. Upon review of the record and examination of the Veteran, each examiner should respond to the appropriate questions below: (a.) Diabetes i. Is it at least as likely as not (50 percent or greater probability) that the Veteran's diabetes mellitus, type II, was aggravated by his service-connected psychiatric disability, and/or medications taken to treat his psychiatric disability? (b.) Heart Disability i. Is it at least as likely as not (50 percent or greater probability) that the Veteran's heart disability was caused or aggravated by his service-connected psychiatric disability, or medications taken to treat his psychiatric disability? ii. Is it at least as likely as not (50 percent or greater probability) that the Veteran's heart disability was caused or aggravated by his claimed diabetes mellitus, type II? (c.) Vertigo i. Does the Veteran have a stand-alone disability manifested by vertigo? If the Veteran's dizziness symptoms are simply a symptom or side-effect of another disability or medication, this should be made clear. ii. If the Veteran has a stand-alone vertigo disability, is it at least as likely as not (50 percent or greater probability) that such disability was caused or aggravated by any of the following: (1) his service-connected psychiatric disability, or medications taken to treat his psychiatric disability; (2) his diabetes, type II, or medications taken to treat diabetes; or (3) his heart disability, or medications taken to treat his heart disability? In answering the above questions, the examiner must discuss the Veteran's lay statements that the vertigo episodes he is claiming began in the 1990s following the commencement of medications for his heart. All opinions obtained should be supported by a medical explanation or rationale. If in the opinion of the reviewing clinician responses to the questions above cannot be provided without an in-person examination or interview, such should be scheduled. (Continued on Next Page) 2. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal. V. Chiappetta Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Bristow Williams, 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.