Citation Nr: 22018501 Decision Date: 03/29/22 Archive Date: 03/29/22 DOCKET NO. 17-36 929 DATE: March 29, 2022 REMANDED Entitlement to service connection for diabetes mellitus, type II, is remanded. Entitlement to service connection for a throat condition is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from November 1967 to September 1970. In June 2019, the Veteran testified at a Board hearing. The transcript is of record. The claims were previously remanded by the Board in October 2019. Since the previous remand, the claim for service connection for peripheral neuropathy of the lower extremities has been granted. This issue is no longer on appeal. See Grantham v. Brown, 114 F.3d. 1156 (Fed. Cir. 1997). 1. Entitlement to service connection for diabetes mellitus, type II, is remanded. This claim was previously remanded by the Board for a VA opinion that confirms whether or not the Veteran has a current disability of diabetes mellitus. While the July 2021 VA opinion found that the Veteran does not have a current diabetes mellitus, type II diagnosis, the corresponding e 2021 VA examination indicated that the Veteran has a current diagnosis of diabetes that is well controlled by diet. Accordingly, as it is still unclear whether or not the Veteran has a current diagnosis of diabetes, a remand is necessary. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding veterans are entitled to compliance with Board remand instructions). 2. Entitlement to service connection for a throat condition is remanded. The Board previously remanded this claim for an etiology opinion regarding the Veteran's symptoms of difficulty swallowing and breathing and whether it was related to his conceded herbicide exposure and exposure to contaminate water at Camp LeJeune. In July 2021, a VA examiner found his disorder was not related to service. The examiner reasoned, the Veteran states that he has occasional trouble swallowing and that it is not a consistent thing that happens. It was explained that the Veteran has seen numerous providers and numerous ear, nose and throat (ENT) specialties that cannot find a diagnosis. The examiner noted the Veteran has a diagnosis of dysphagia that is unspecified; but he also has a denial of throat problems in September 2003. Moreover, the Veteran has no record of any throat problems in his medical records during service, and his records show no problems related to swallowing in 2020. While his records show he had a neck abscess that was treated with medication on July 2018, there are no other neck /throat conditions listed in records. Moreover, he had a Barium swallow test that was done which was negative for any throat problems. He also had a CT scan of his neck that was negative and stated no explanation for dysphagia. During his examination, the Veteran had no swallowing problems exhibited or stated. Thus, with no medical records that show a throat condition during Veterans his service period and negative throat diagnostics as per record, there was not any etiology to service. An addendum opinion is needed as this opinion relies heavily on the absence of evidence without explaining its significance. See Fountain v. McDonald, 27 Vet. App. 258, 272-75 (2015) (indicating that a VA examiner may not generally rely on the absence of evidence as negative evidence). Moreover, the opinion does not address the conceded herbicide exposure per the Board's prior remand directives. See Stegall, supra. The matters are REMANDED for the following action: 1. Obtain updated VA and/or private treatment records. If such records are unavailable, the Veteran's claim file must be clearly documented to that effect and the Veteran notified in accordance with 38 C.F.R. § 3.159(e). 2. Obtain an addendum medical opinion from a medical professional with appropriate expertise. The examiner should review the Veteran's claims file. If the examiner determines that an opinion cannot be provided without an examination, the Veteran should be scheduled for one. Based on a review of the record, and a new examination if necessary, the examiner must address the following: (a.) The examiner should review the Veteran's claims file and conduct any appropriate evaluations, studies, and testing deemed necessary by the examiner in order to determine whether it is at least as likely as not that the Veteran has diabetes mellitus. Please reconcile the June 2021 VA examination with any current findings. 3. Obtain an addendum medical opinion from a medical professional with appropriate expertise. The examiner should review the Veteran's claims file. If the examiner determines that an opinion cannot be provided without an examination, the Veteran should be scheduled for one. Based on a review of the record, and a new examination if necessary, the examiner must address the following: (a.) Whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran's throat condition is related to active service or is caused by or aggravated by military service to include due to exposure to herbicide agents in Vietnam. The examiner is to note that herbicide exposure is conceded. Additionally, the examiner is to still consider the nature and etiology of the Veteran's throat condition even if a clinical diagnosis is unavailable beyond dysphagia. (Continued on the next page) The examiner should elicit a full history from the Veteran and consider and address his testimony of record regarding his onset of symptoms and current symptomology. If there is a medical basis to support or doubt the history provided, the examiner should provide a fully reasoned explanation. The examination report must include a complete rationale for all opinions expressed. If the examiner feels that a requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e. no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e. additional facts are required, or the examiner does not have the needed knowledge or training). G. A. WASIK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Wade 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.