Citation Nr: 0812140 Decision Date: 04/11/08 Archive Date: 04/23/08 DOCKET NO. 07-10 008 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Hartford, Connecticut THE ISSUES 1. Entitlement to a disability rating greater than 20 percent for service-connected diabetes mellitus. 2. Entitlement to an initial disability rating greater than 10 percent for service-connected peripheral neuropathy of the left foot. 3. Entitlement to an initial disability rating greater than 10 percent for service-connected peripheral neuropathy of the right foot. 4. Entitlement to service connection for post-traumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: Connecticut Department of Veterans Affairs WITNESSES AT HEARING ON APPEAL Appellant and his spouse ATTORNEY FOR THE BOARD D. Orfanoudis, Counsel INTRODUCTION The veteran had active service from January 1971 to February 1972. This matter is before the Board of Veterans' Appeals (Board) on appeal from a May 2006 rating decision of the Department of Veterans Affairs (VA), Regional Office (RO), located in Hartford, Connecticut, which denied the veteran's claims for an increased disability rating for diabetes mellitus and for service connection for PTSD. During the pendency of this appeal, by rating action of the RO dated in February 2007, the RO awarded separate disability ratings for diabetic peripheral neuropathy of the lower extremities. In February 2008, the veteran and his spouse testified at a video conference hearing over which the undersigned Veterans Law Judge presided. A transcript of the hearing has been associated with the veteran's claims file. During the video conference hearing, the veteran withdrew his appeal of the claim for service connection for PTSD. See 38 C.F.R. § 20.204 (2007). Hence, the issue is no longer in appellate status. During the video conference hearing, the veteran also expressed disagreement with the assigned disability ratings for the service-connected peripheral neuropathy of the lower extremities. As these issues are part and parcel of the rating criteria of the issue of an increased disability rating for the service-connected diabetes mellitus already on appeal, the Board has included the issues as set forth above. The appeal is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the appellant if further action is required. REMAND Unfortunately, a remand is required in this case prior to further adjudication of this matter. Although the Board sincerely regrets the additional delay, it is necessary to ensure that there is a complete record upon which to decide the veteran's claims so that he is afforded every possible consideration. During his February 2008 video conference hearing, the veteran asserted that his service-connected diabetes mellitus had increased in severity since his last VA examination in March 2006. As it has been over two years since the veteran's last examination, the Board is of the opinion that a thorough and contemporaneous VA examination is warranted so that the nature and current severity of the veteran's service-connected diabetes mellitus can be ascertained. 38 U.S.C.A. § 5103A(d) (West 2002 & Supp. 2007); 38 C.F.R. § 3.159(c)(4) (2007). See Littke v. Derwinski, 1 Vet. App. 90 (1990). The veteran's service-connected diabetes mellitus has been rated as 20 percent disabling pursuant to the criteria set forth in Diagnostic Code 7913, which provides that compensable complications of diabetes mellitus are generally to be evaluated separately, with noncompensable complications to be considered as part of the diabetic process under Diagnostic Code 7913. See 38 C.F.R. § 4.119, Diagnostic Code 7913, Note (1) (2007). During his video conference hearing, the veteran has also asserted that his diabetes manifests in complications in the form of diabetic neuropathy and sexual dysfunction. While the veteran has been rated separately for peripheral neuropathy of the lower extremities, under Diagnostic Code 7913, the Board must determine whether compensable disability ratings can in fact be awarded for any complications associated with sexual dysfunction. This requires analysis of the severity of identified complications of diabetes mellitus, to ascertain whether such complications are compensable. Additionally, during the video conference hearing, the veteran indicated that he had been receiving VA outpatient treatment approximately every two months. Review of his claims file reveals that VA outpatient treatment records subsequent to February 2007 have not been associated with the evidence of record. As this matter is being remanded as set forth above, efforts should be undertaken to associate any additional VA outpatient treatment records of the veteran with his claims file. Accordingly, the case is REMANDED for the following action: 1. The RO/AMC shall make arrangements to obtain the veteran's complete VA medical records dated since February 2007. 2. The RO/AMC shall schedule the veteran for an appropriate VA examination, or examinations, so as to assess the current nature and severity of his service- connected diabetes mellitus and any associated complications. The claims file and a copy of this remand must be made available to and reviewed by the examiner(s) prior to the requested examination. The examiner(s) should indicate in the report that the claims file was reviewed. All necessary tests should be conducted and the examiner(s) should review the results of any testing prior to completion of the report. The examiner(s) is requested to opine as to whether the veteran requires insulin and/or a restricted diet. The extent, if any, to which his activities are regulated due to the diabetes mellitus should also be addressed. The examiner(s) should describe what, if any, complications attributable to the veteran's service-connected diabetes mellitus exist, to include any sexual dysfunction found on examination, and specifically describe the nature and severity of each. If the veteran does not suffer any such complications as a result of his diabetes mellitus, the examiner(s) should so state. The examiner(s) is also requested to opine as to whether the veteran's peripheral neuropathy of the lower extremities is manifested by mild, moderate, or severe incomplete paralysis; or by complete paralysis of the external popliteal nerve (common peroneal), to include whether there is foot drop, droop of the phalanges of the toes, loss of dorsiflexion of the foot, loss of extension of the proximal phalanges of the toes, loss of abduction, weakened adduction, or anesthesia covering the entire dorsum of the foot and toes. The examiner(s) must provide a comprehensive report including a complete rationale for all conclusions reached. 3. The RO/AMC will then review the veteran's claims file and ensure that the foregoing development actions have been conducted and completed in full, and that no other notification or development action, in addition to those directed above, is required. If further action is required, it should be undertaken prior to further claim adjudication. 4. The RO/AMC will then readjudicate the veteran's claims. If the benefits sought on appeal remain denied, the veteran and his representative should be provided with a Supplemental Statement of the Case, containing notice of all relevant actions taken on the claim, to include a summary of the evidence and applicable law and regulations considered pertinent to the issues currently on appeal. An appropriate period of time should be allowed for response. Thereafter, the case is to be returned to the Board, following applicable appellate procedure. The veteran need take no action until he is so informed. He has the right to submit additional evidence and argument on the matter or matters the Board has remanded to the RO. Kutscherousky v. West, 12 Vet. App. 369 (1999). The purposes of this remand are to obtain additional information and comply with all due process considerations. No inference should be drawn regarding the final disposition of this claim as a result of this action. This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2007). _________________________________________________ JONATHAN B. KRAMER Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (2007).