Citation Nr: 1006472 Decision Date: 02/22/10 Archive Date: 03/02/10 DOCKET NO. 08-32 304 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUE Entitlement to service connection for peripheral neuropathy of the upper and lower extremities. REPRESENTATION Appellant represented by: Florida Department of Veterans Affairs ATTORNEY FOR THE BOARD Jared Haynie, Associate Counsel INTRODUCTION The Veteran served on active duty from April 1966 to December 1968. This matter comes before the Board of Veterans' Appeals (Board) from an April 2008 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Board notes that in September 2008, the RO issued a statement of the case that listed, in addition to the issue listed on appeal here, the issue of entitlement to an initial rating in excess of 20 percent for type II diabetes mellitus with minimal diabetic retinopathy. The Veteran elected to appeal only the issue listed on appeal here. Therefore, the Board does not address the issue of increased initial rating for diabetes mellitus. 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 Additional development is needed prior to further disposition of the claim. The Veteran and his representative contend that the Veteran is entitled to service connection for peripheral neuropathy in bilateral upper and lower extremities. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303. Generally, to establish service connection, a veteran must show evidence of a current disability, evidence of in-service incurrence or aggravation of a disease or injury, and evidence of a nexus between the claimed in-service disease or injury and the present disability. 38 U.S.C.A. §§ 1110, 5107(a); 38 C.F.R. § 3.303; Barr v. Nicholson, 21 Vet. App. 303, 307 (2007). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303. Alternatively, service connection may be granted on a secondary basis. Any disability "proximately due to or the result of" a service-connected disease or injury is service- connected as if it were part of the original condition. 38 C.F.R. § 3.310(a). Here, the Veteran contends that the peripheral neuropathy in his upper and lower extremities developed secondary to his service-connected diabetes mellitus. The Veteran underwent a VA examination in February 2008. During that examination, he reported constant tingling, burning, and numbness in his feet and calves, as well as tingling in his bilateral fingers. He also indicated that these symptoms had become progressively worse over time. Physical examination of upper and lower extremities showed motor function impairment was within normal limits; sensory function was normal in every respect; and reflexes were normal. There was no muscle atrophy; no abnormal muscle tone or bulk; and no tremors, tics, or other abnormal movements. Electrodiagnostic testing showed compound muscle action potentials (CMAPs) with normal distal latency, amplitude, and conduction velocity; and sensory nerve action potentials (SNAPs) with normal peak latencies and amplitudes. The examiner noted that although there was no electrodiagnostic evidence of a polyneuropathy affecting the lower extremities, electrodiagnostics assess only the large fibers of the nerve and therefore cannot rule out a small fiber neuropathy. The examiner's primary diagnosis was "[n]o peripheral neuropathy in upper and lower extremities." The examiner also commented, however, that peripheral neuropathy of the upper and lower extremities was a "problem associated with the diagnosis" and that it had a significant effect on the Veteran's occupation due to the Veteran's decreased mobility. The examiner further opined that the peripheral neuropathy severely affected the Veteran's ability to do chores, go shopping, exercise, and participate in sports. The Board is unable to rely on the examination here because the diagnosis is unclear. VA-provided medical examinations must be legally "adequate." Barr v. Nicholson, 21 Vet. App. 303, 311-12 (2007). Among other things, an adequate examination must provide "sufficient detail" to enable the Board to make a "fully informed evaluation." Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The examination here appears to be internally inconsistent. Specifically, the Board is uncertain as to whether the Veteran is or is not diagnosed with peripheral neuropathy. Moreover, the examiner did not opine (it does not appear that the examiner was asked to opine) as to whether the Veteran's peripheral neuropathy, if so diagnosed, was caused or aggravated by his service- connected type II diabetes mellitus. For these reasons, the Board cannot make a decision on the claim at this time. Accordingly, the case is REMANDED to the AMC for the following action: 1. Return the claims folder to the same examiner that conducted the February 2008 VA examination for peripheral neuropathy. Ask the examiner to clarify the diagnosis regarding peripheral neuropathy. Specifically, ask the examiner to state whether or not the Veteran has peripheral neuropathy of the upper or lower extremities. If the Veteran is diagnosed with peripheral neuropathy of the upper or lower extremities, the examiner should opine as to (1) whether it is or was caused or aggravated by the Veteran's service-connected disabilities, particularly his service- connected type II diabetes mellitus; or, in the alternative, (2) whether it is causally related to his period of active service. The examination report should reflect that the examiner reviewed the claims folder. All opinions expressed by the examiner should be accompanied by a complete rationale, with citation to relevant medical findings and lay statements. Based on a review of the claims folder, the examiner should (1) clarify the February 2008 diagnosis regarding peripheral neuropathy of the upper or lower extremities and (2) if the Veteran is diagnosed with peripheral neuropathy, provide an opinion as to whether it is at least as likely as not that the peripheral neuropathy is/was caused or aggravated by the Veteran's service-connected disabilities- particularly his service-connected type II diabetes mellitus-or, in the alternative, whether the peripheral neuropathy is causally related to his period of active service. 3. Then, the AMC should readjudicate the claim. If the decision remains adverse to the Veteran, issue a supplemental statement of the case and allow the appropriate time for response before returning the case to the Board. The Veteran has the right to submit additional evidence and argument on the matter the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. All claims remanded by the Board, or by the U.S. Court of Appeals for Veterans Claims, for additional development or other appropriate action must be handled in an expeditious manner. 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2009). _________________________________________________ J. A. MARKEY Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the Board is appealable to the U.S. 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) (2009).