Citation Nr: 1321864 Decision Date: 07/09/13 Archive Date: 07/18/13 DOCKET NO. 11-28 530 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Paul, Minnesota THE ISSUES 1. Entitlement to service connection for peripheral neuropathy of the upper extremities. 2. Entitlement to service connection for peripheral neuropathy of the lower extremities. REPRESENTATION Veteran represented by: Minnesota Department of Veterans Affairs WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD M. G. Mazzucchelli, Counsel INTRODUCTION Pursuant to 38 C.F.R. § 20.900(c), the appeal has been advanced on the Board's docket. The Veteran, who is the appellant, served on active duty from March 1953 to January 1955. This matter is before the Board of Veterans' Appeals (Board) on appeal of a rating decision in September 2011 of a Department of Veterans Affairs (VA) Regional Office (RO). In June 2013, the Veteran appeared at a hearing before the undersigned Veterans Law Judge. A transcript of the hearing is in the Veteran's file. The appeal is REMANDED to the RO via the Appeals Management Center in Washington, DC. REMAND Whereas here the service treatment records are unavailable, there is a heightened obligation to assist the appellant in the development of the case, a heightened obligation to explain findings and conclusions, and a heightened duty to consider carefully the benefit of the doubt rule. Washington v. Nicholson, 19 Vet. App. 362, 369-70 (2005); O'Hare v. Derwinski, 1 Vet. App. 365, 367 (1991). The Veteran contends that he suffered cold injuries to his hands and feet in Korea in the winter in 1953 and 1954 that he has current residuals of peripheral neuropathy of the upper and lower extremities as a result of the cold injury. The Veteran served in Korea during the winter of 1953 and 1954. The Veteran testified he has been bothered with cold sensitivity of his hands and feet ever since service. The record shows that the Veteran was diagnosed with breast cancer in 2005 and was treated with chemotherapy. VA records note hand and foot syndrome following chemotherapy. In September 2011 on VA examination, the diagnosis was peripheral neuropathy of the hands and feet with hand and foot syndrome due to chemotherapy for metastatic breast cancer. The VA examiner expressed the opinion that the Veteran's current condition involving the hands and feet was not a result of frostbite in the military. The VA examiner stated that there was no objective medical evidence that the Veteran had chronic, ongoing residuals from frostbite. Given the heightened duty to assist, the Board finds that another VA examination, with nerve conduction studies and electromyography testing is needed in order to ascertain whether the current hand and foot pathology is consistent with either a cold injury or chemotherapy. Accordingly, the case is REMANDED for the following action: 1. Afford the Veteran a VA examination, including electromyography (EMG) and a nerve conduction study (NCS) of the upper and lower extremities, to determine whether the Veteran has: a). Peripheral neuropathy of the upper and lower extremities, and, if so, b). Whether it is more likely than not (probability greater than 50 percent), at least as likely as not (probability of 50 percent), less likely than not (probability less than 50 percent), that the current peripheral neuropathy is due to cold injury in Korea in the winter of 1953 and 1954? In formulating the opinion, the VA examiner is asked to address whether the current pathology, including electrodiagnostic testing, s consistent with residuals of cold injury, as opposed to residuals of chemotherapy. The Veteran's file must be made available to the VA examiner. 2. Following the above development, adjudicate the claims. If any benefit sought is denied, then provide the Veteran and his representative a supplemental statement of the case and return the case to the Board. The Veteran has the right to submit additional evidence and argument on the matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). The claims 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. 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012). _________________________________________________ George E. Guido Jr. 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).