Citation Nr: 1320752 Decision Date: 06/27/13 Archive Date: 07/05/13 DOCKET NO. 12-21 599 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES 1. Entitlement to service connection for bilateral peripheral neuropathy of the upper extremities, including as due to service-connected type II diabetes mellitus and posttraumatic stress disorder (PTSD)-related alcohol dependence. 2. Entitlement to service connection for bilateral peripheral neuropathy of the lower extremities, including as due to service-connected type II diabetes mellitus and PTSD-related alcohol dependence. 3. Entitlement to service connection for erectile dysfunction, including as due to service connected type II diabetes mellitus and PTSD-related alcohol dependence. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States ATTORNEY FOR THE BOARD W.T. Snyder, Counsel INTRODUCTION Please note this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). 38 U.S.C.A. § 7107(a)(2) (West 2002). The Veteran served on active duty from April 1966 to April 1970. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2010 decision by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida, which-in pertinent part, denied the benefits sought on appeal. The Veteran's notice of disagreement specifically addressed only the claimed secondary disabilities. He did not dispute the assigned initial rating or effective date for his diabetes mellitus. Hence, that issue is not addressed in the action below. The Veteran's claim of entitlement to service connection was based solely on the asserted relationship between his peripheral neuropathy and erectile dysfunction and his diabetes. The Board, however, has expanded the claim to include potential PTSD-related pathology, to conform to the evidence of record. See Boggs v. Peake, 520 F.3d 1330 (Fed. Cir. 2008). The Veteran indicated on an attachment to his June 2012 Substantive Appeal (VA Form 9) that he desired a formal hearing before an RO decision review officer (DRO). In an August 2012 statement (VA Form 21-4138), however, he informed the RO that he did not desire a hearing before a DRO, but wanted his appeal certified to the Board as soon as possible. The Veteran has a Virtual claims file, which is a highly secured paperless repository, associated with his appeal. The Board has reviewed the documents in the Virtual file, and the documents in the Virtual file are duplicative of those in the paper claims file. The appeal is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the Veteran if further action is required. REMAND The April 2012 Disability Benefits Questionnaire (DBQ) reflects that the examiner conducted a review of the claims file as part of the examination of the Veteran. The examiner opined there was less than a 50-percent probability that the Veteran's bilateral upper and lower extremities peripheral neuropathy was the result of his diabetes mellitus. The examiner reasoned that the reported onset of the Veteran's symptoms was relatively recent, and his diabetes was under good control. Concerning the upper extremities, there also was the matter of the Veteran's diagnosis with bilateral carpal tunnel syndrome (CTS). Further, the Veteran had a long history of lumbar spine radiculopathy of the right lower extremity. The examiner opined further that it was not likely the diabetes mellitus aggravated the Veteran's neuropathy, as the diabetes was of relative short duration, and it was well controlled. The examiner noted the same rationale as the basis for his opinion regarding erectile dysfunction. However, that the examiner also noted the Veteran's history of alcohol involvement, and the fact that alcohol consumption is a known risk factor for both neuropathy and erectile dysfunction. The Board also notes a June 2009 entry in the VA outpatient records indicating a diagnosis of polyneuropathy, and the examiner noted the Veteran's risk factors included diabetes mellitus and alcohol consumption. The June 2009 entry included consideration of the EMG that showed bilateral CTS. The several VA examination reports in the claims file related to the Veteran's PTSD note the Veteran's longstanding reports that he abused alcohol to help him cope with his PTSD symptoms, which is rated 100 percent disabling. An October 1991 examination report notes a diagnosis of PTSD with alcohol dependence, and private medical reports note a diagnosis of PTSD and alcohol dependence. Recent VA outpatient records note the Veteran's reports of continued alcohol consumption. In light of these factors, it should be determined if in fact the Veteran's history of alcohol dependence is the result of his PTSD. If so, a neurologist should opine if there is at least a 50-percent probability that the Veteran's long history of alcohol consumption either caused or aggravates his neuropathy or his erectile dysfunction. Accordingly, the case is REMANDED for the following action: (Please note, this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). Expedited handling is requested.) 1. The AMC/RO will arrange a review of the claims file by an appropriate mental health examiner. Ask the examiner to opine if there is at least a 50-percent probability that the Veteran's diagnoses-of-record of alcohol dependence is due to his service-connected PTSD? If the above question is answered in the negative, then is there at least a 50-percent probability that the Veteran's PTSD aggravated (or aggravates), that is, chronically worsens, his alcohol dependence? If so, the examiner is asked to specify the permanent, measurable increase in severity of alcohol dependence that is due to the service-connected PTSD. The examiner should provide a full explanation of any opinion rendered. Should the examiner advise the requested opinion cannot be provided, a full explanation should provided as to why. Should the examiner advise the requested opinion cannot be rendered without an examination of the Veteran, the AMC/RO will arrange the examination. The claims file must be provided for review by the examiner as part of the examination. 2. If, and only if, the examiner opines there is a nexus between the Veteran's service-connected PTSD and his alcohol dependence, either directly or due to aggravation, the AMC/RO will send the claims file to a neurologist. Ask the neurologist to opine if there is at least a 50-percent probability that the Veteran's peripheral neuropathy of either the upper or lower extremities, or both, and/or his erectile dysfunction is due to his diagnosed PTSD-related alcohol dependence? If the above question is answered in the negative, then is there at least a 50-percent probability that the Veteran's PTSD-related alcohol dependence aggravates, that is, chronically worsens, either the peripheral neuropathy or erectile dysfunction? If so, the examiner is asked to specify the permanent, measurable increase in severity of either the peripheral neuropathy or erectile dysfunction that is due to the service-connected PTSD-related alcohol dependence. The examiner should provide a full explanation of any opinion rendered. Should the examiner advise the requested opinion cannot be provided, a full explanation should provided as to why. 3. After completion of all of the above, the AMC/RO should re-adjudicate the claims on appeal. If the decision remains in any way adverse to the Veteran, he and his representative should be provided with a Supplemental statement of the case (SSOC). The case should thereafter be returned to the Board, if in order. The Board intimates no opinion as to the ultimate outcome of this case. The Veteran need take no action unless otherwise notified. VA will notify him if further action is required on his part. He has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). 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. 2012). _________________________________________________ ERIC S. LEBOFF 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) (2012).