Citation Nr: A26034026 Decision Date: 04/14/26 Archive Date: 04/14/26 DOCKET NO. 250721-566806 DATE: April 14, 2026 REMANDED Entitlement to service connection for diabetes mellitus (DM) is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from February 1973 to July 1984 and October 1986 to September 1995. This matter comes before the?Board of Veterans' Appeals?(Board) from an April 2025 Appeals Modernization Act (AMA) rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran timely appealed this decision to the Board in July 2025 by filing a notice of disagreement (NOD) in which he requested direct review.? As this is a?Direct Review?appeal under the AMA, the record closed on the date of notice (April 14, 2025) of the April 2025 rating decision.? Evidence was added to the claims file during a period of time when new evidence was not allowed. As the Board is remanding this claim for further development, this additional evidence will be considered by the RO in the adjudication of the claim. Entitlement to service connection for DM is remanded. The Veteran contends his DM had its onset in service or is secondary to a service-connected disability. For example, in February 2024 correspondence, the Veteran provided lay statements regarding the onset of his DM during service and symptoms thereafter. Service treatment records show instances of elevated blood glucose. For example, a lab report from March 1989 showed the Veteran's blood glucose was 119 MG/DL, which was above the reference range. Favorable findings from the April 2025 rating decision include the Veteran has a diagnosis of DM type II and his claimed primary disabilities, right leg status post fasciotomy, left shoulder rotator cuff, bilateral pes planus, and hearing loss, are service connected. Favorable findings made by the AOJ are binding on the Board unless evidence identifies a clear and unmistakable error in the favorable finding. 38 C.F.R. §§ 3.104(c), 20.801. The Board notes that prior to the rating decision on appeal, in February 2024 and January 2025 correspondence, the Veteran indicated his DM was secondary to a mental health disorder or sleep apnea. Although, the Veteran is now service connected for unspecified anxiety disorder and obstructive sleep apnea, service connection was granted and assigned effective dates after the rating decision on appeal. The Board finds that the Veteran should be afforded a VA examination with respect to?his?claim for entitlement to service connection?for?DM.? Under?McLendon, VA is obligated to provide an examination when the record contains (1) competent evidence of a current disability (or persistent or recurrent symptoms of a disability), (2) evidence establishing that an event, injury, or disease occurred in service, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service, but (4) there is insufficient competent medical evidence on file to decide the claim.??38?U.S.C. §?5103A(d);?McLendon v. Nicholson, 20?Vet. App.?79, 81 (2006). The evidence submitted prior to the decision on appeal, to include the Veteran's lay statements and service treatment records, indicates the Veteran has a diagnosis of DM that may have had its onset in service or is secondary to a service-connected disability. However, the Board cannot make a fully informed decision on this issue because no VA examiner has provided a medical opinion for the Veteran's DM. The Board finds the failure to obtain a VA medical opinion for the Veteran's DM constitutes a pre-decisional duty to assist error. 38 C.F.R. § 20.802. Thus, a remand is warranted. The matter is REMANDED for the following action: 1. Obtain an addendum opinion for the Veteran's diabetes mellitus (DM). The examiner must provide an opinion as to whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's DM: a) had its clinical onset during active service or is related to any in-service disease, event, or injury, to include relation through continuity of symptomatology. b) is proximately due to a service-connected disability (right leg status post fasciotomy, left shoulder rotator cuff, bilateral pes planus, and hearing loss), c) has been aggravated (worsened/underwent an incremental increase, regardless of permanence) by a service-connected disability (right leg status post fasciotomy, left shoulder rotator cuff, bilateral pes planus, and hearing loss). Specifically, would the Veteran's DM have been less severe but for one or more of his service-connected disabilities, either because there is a causal link or because one or more of his service-connected disabilities resulted in the inability to treat the DM? The term incremental increase in disability means additional impairment of earning capacity. Objective measurement, or numerical quantification, is not required to ascertain an increase in disability. Moreover, any incremental increase in disability need not be permanent. Please note that there is no temporal requirement that the primary condition (service-connected right leg status post fasciotomy, left shoulder rotator cuff, bilateral pes planus, and/or hearing loss) be service-connected, or even diagnosed, at the time the secondary condition (DM) was incurred. The examiner must specifically consider and address the instances of elevated blood glucose from the Veteran's service treatment records, to include his lab result of 119 MG/DL from March 1989, and his lay statements, to include those from February 2024 correspondence regarding his symptoms during and since service. The examiner is requested to provide a clear rationale and explain in detail the underlying reasoning for any opinions expressed. A discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an examiner cannot provide the requested opinion without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why an opinion cannot be made without resorting to speculation. TANYA SMITH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Papacalos, Angelic 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.