Citation Nr: 18140699 Decision Date: 10/05/18 Archive Date: 10/05/18 DOCKET NO. 07-03 721 DATE: REMANDED Entitlement to a disability rating higher than 60 percent for service connected diabetes mellitus is remanded. Entitlement to a disability rating higher than 40 percent for service-connected diabetic neuropathy of the right lower extremity is remanded. Entitlement to a disability rating higher than 30 percent for service-connected diabetic neuropathy of the left lower extremity is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1967 until July 1970. He died in July 2017. His surviving spouse has been substituted as the appellant. In February 2006, the Veteran submitted a claim for increased ratings for diabetes mellitus and for his right lower leg disability. As was noted in the Board’s August 2017 remand, a claim of entitlement to a higher rating for left leg diabetic neuropathy has been found to be part of the claim of entitlement to an increased rating for diabetes mellitus. Hence, it is also on appeal. The Veteran’s bilateral lower extremity peripheral neuropathy was initially rated in a February 2002 rating decision under 38 C.F.R. § 4.124a, Diagnostic Code 8520. That Diagnostic Code evaluates paralysis of the sciatic nerve. In a July 2002 rating decision, however, the Veteran’s evaluation was increased to a 20 percent rating for each lower extremity under 38 C.F.R. § 4.124a, Diagnostic Code 8521. That Diagnostic Code evaluates paralysis of the external popliteal nerve (common peroneal). It is unclear to the Board, however, whether the Veteran’s sciatic nerve, popliteal nerve, or both that were affected by his diabetic peripheral neuropathy. While an October 2006 nerve conduction study found that right peroneal and sural sensory nerve action potentials could not be elicited, it did not indicate whether the left peroneal nerve was affected or whether there was also sciatic involvement. The Veteran’s prior VA examinations discuss the overall symptomatology of his lower extremity disorders, but do not specify the nerves affected. The Board therefore remands these issues in order to obtain a medical opinion from a qualified neurologist to address the exact nature of the Veteran’s lower extremity peripheral neuropathy. Additionally, the Veteran’s VA treatment records indicate that he was also receiving medical care for his diabetes from the Joslin Diabetes Center. VA has not yet made an attempt to obtain those private records. The appellant should be asked to submit these records or authorization to obtain these records prior to readjudication. The matters are REMANDED for the following action: 1. Send to the appellant and her representative a letter requesting that the appellant provide sufficient information and a signed and dated authorization, via a VA Form 21-4142 (Authorization and Consent to Release Information) to enable VA to obtain any additional relevant private medical records, to specifically include those pertaining to the Veteran’s treatment for diabetes mellitus from Joslin Diabetes Center. If the appellant provides new completed release forms authorizing VA to obtain these treatment records, then attempt to obtain them with at least one follow-up request if no reply is received. 2. Thereafter, secure a medical opinion from a neurologist addressing the nature and severity of the Veteran’s bilateral lower extremity peripheral neuropathy. The neurologist must be provided access to all files in Virtual VA/Legacy and VBMS. The neurologist must specify in the report that these records have been reviewed. Based on a review of the Veteran’s medical records, the neurologist is to address: Is it possible to identify, based on the medical evidence of record, exactly which lower extremity nerves were affected by diabetic peripheral neuropathy? For each nerve so affected, please provide an opinion addressing the severity of any peripheral neuropathy associated with that nerve. The neurologist should address the functional impact of Veteran's peripheral neuropathy. Please also discuss whether the Veteran had any lower extremity nerve impairment that was caused or aggravated by radiculopathy associated with his service-connected herniated disc disorder with degenerative arthritis. Please address whether these symptoms can be differentiated by his symptoms caused by diabetic peripheral neuropathy, and their respective severity. A complete and fully explanatory rationale must be provided for any opinion offered. If any opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge, i.e., no one could respond given medical science and the known facts, or by a deficiency in the record or the examiner, i.e., additional facts are required, or the examiner does not have the needed knowledge or training. DEREK R. BROWN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Mary E. Rude, Counsel