Citation Nr: 22018486 Decision Date: 03/29/22 Archive Date: 03/29/22 DOCKET NO. 19-17 225 DATE: March 29, 2022 REMANDED Entitlement to service connection of diabetes mellitus, type II, is remanded. Entitlement to service connection of a cardiac disorder, other than hypertension, is remanded. Entitlement to service connection of an eye disorder, diagnosed as cataracts, diabetic retinopathy, and corneal scar of the left eye, is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1960 to July 1964, and from September 1964 to October 1990. These claims were before the Board of Veterans' Appeals (Board) in August 2011. At that time, they were remanded for further development. 1. Entitlement to service connection of diabetes mellitus, type II, is remanded. The Veteran seeks service connection of diabetes mellitus, type II. In the August 2021 remand, the Board requested a VA opinion which considers any evidence of hyperlipidemia and hypertriglyceridemia or elevated blood sugar in the service treatment records. In a December 2021 VA opinion, the examiner noted that there is no evidence to show that diabetes mellitus and hyperlipidemia and hypertriglyceridemia manifested to a compensable degree while active in service or within one year of discharge from service. However, the examiner failed to specifically address the Veteran's service treatment records that show evidence of high triglycerides in February 1984 and July 1987, and a finding of high glucose in June 1990 as requested in the August 2021 remand directive. As such, a new VA opinion is necessary. 2. Entitlement to service connection of a cardiac disorder, other than hypertension, is remanded. Pursuant to the Board's August 2021 remand directive, the Veteran underwent an additional VA heart examination to determine the nature and etiology of his cardiac disorder, other than hypertension. The examiner opined that the Veteran's service treatment records do not reflect any evidence that the Veteran's cardiac disorder began during active service or manifested within one year after separation from active service. The examiner also noted there is no peer reviewed medical evidence to show relationship of the Veteran's heart disorder of 3rd degree heart block with bradycardia and hypertension. While the examiner addressed the relationship with the Veteran's hypertension, the examiner failed to address the private examiner's opinion that hypertriglyceridemia can lead to significant cardiac decompensation. As noted above, the Veteran was noted to have high triglycerides in February 1984 and July 1987. As such, a new VA opinion is necessary. 3. Entitlement to service connection of an eye disorder, diagnosed as cataracts, diabetic retinopathy, and corneal scar of the left eye, is remanded. The Veteran seeks service connection of an eye disorder, which has been variously diagnosed as cataracts, diabetic retinopathy, and a corneal scar of the left eye. Several of his diagnosed eye disorders may be considered secondary to his diabetes mellitus, type II, which has been remanded, above. As the outcome of that appeal may have a direct impact on the eye claims, the Board must remand this appeal as inextricably intertwined with the diabetes claim. The matters are REMANDED for the following action: 1. Forward the claims file to a VA examiner for an addendum opinion as to the nature and etiology of the Veteran's diabetes. The examiner should review the Veteran's claims file, to include his service treatment records. The examiner should then answer the following: Did the Veteran's diabetes mellitus begin in service or is otherwise related to the Veteran's service? Why or Why not? The examiner is specifically requested to address whether the high triglycerides finding February 1984 and July 1987, and a finding of high glucose in June 1990 documented in the Veteran's service treatment records constitute an early manifestation of the Veteran's current diabetes mellitus, type II. In providing the requested opinion, consider the Veteran's description of his in-service symptoms, as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's reported symptoms in service and thereafter represented the onset of his current disability, this should be noted. Stated another way, do the Veteran's reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? Provide a rationale to support the opinion. 2. Forward the claims file to a VA examiner for an addendum opinion as to the nature and etiology of the Veteran's cardiac disorder. The examiner should review the Veteran's claims file, to include his service treatment records. The examiner should then answer the following: Did the Veteran's cardiac disorder begin in service or is otherwise related to the Veteran's service? Why or Why not? The examiner is specifically requested to address whether the high triglycerides finding February 1984 and July 1987, and a finding of high glucose in June 1990 documented in the Veteran's service treatment records constitute an early manifestation of the Veteran's current cardiac disorder. In providing the requested opinion, consider the Veteran's description of his in-service symptoms, as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's reported symptoms in service and thereafter represented the onset of his current disability, this should be noted. Stated another way, do the Veteran's reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? (Continued on the next page) Provide a rationale to support the opinion. 3. After completing this development, readjudicate the issue of entitlement to service connection for eye disorder. Sarone Solomon Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. M. Donahue Boushehri, 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.