Citation Nr: 18142878 Decision Date: 10/17/18 Archive Date: 10/16/18 DOCKET NO. 15-38 629 DATE: October 17, 2018 REMANDED Entitlement to an initial disability rating in excess of 10 percent for peripheral neuropathy of the right lower extremity (RLE) is remanded. Entitlement to an initial disability rating in excess of 10 percent for peripheral neuropathy of the left lower extremity (LLE) is remanded. Entitlement to service connection for peripheral neuropathy of the right hand is remanded. Entitlement to service connection for peripheral neuropathy of the left hand is remanded. Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU). REASONS FOR REMAND The Veteran had active service in the United States Army from April 1965 to April 1968. These matters come to the Board of Veterans’ Appeals (Board) on appeal from a May 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina. By that rating action, the RO, in part, granted service connection for peripheral neuropathy of the right and left lower extremities; initial 10 percent disability ratings were assigned, effective, May 21, 2013--the date VA received the Veteran’s initial claim for compensation for these disabilities. The RO also denied service connection for peripheral neuropathy of the right and left hands and an acquired psychiatric disorder, to include PTSD. The Veteran appealed the May 2015 rating action and the RO’s determinations therein to the Board. In an August 2014 written argument to VA, the Veteran’s agent raised the issue of entitlement to TDIU. (See Veteran’s agent’s August 2014 written argument to VA). While the Veteran’s agent did not specifically indicate which service-connected disabilities had allegedly caused the Veteran’s inability to secure gainful employment, the Board will assume that it includes the service-connected peripheral neuropathy of the right and left lower extremities because the TDIU claim was raised during the appeal of these initial rating claims. Thus, the Board finds that there is an inferred claim for TDIU under Rice v. Shinseki, 22 Vet. App. 447 (2009). The Board notes that in a March 2015 Statement of the Case, the RO considered additional issues (i.e., entitlement to service connection for ischemic heart disease; hypertension; lumbar strain; and tinea pedis)) from the appealed May 2015 rating action. In his substantive appeal, the Veteran limited his appeal to the issues listed on the title page. Thus, the only issues that remain for appellate consideration are the ones listed on the title page. Prior to further appellate review of the initial rating, service connection and TDIU claims, additional substantive development is required. Specifically, to obtain a VA examination to determine the current severity of the service-connected peripheral neuropathy of the bilateral lower extremities and to obtain outstanding VA treatment records. The Board will discuss each reason for remand separately below. i) VA examination-Peripheral Neuropathy-RLE & LLE The Veteran seeks initial disability ratings in excess of 10 percent for peripheral neuropathy of the RLE and LLE. VA last examined the Veteran to determine the current (then) severity of these disabilities in December 2013. (See December 2013 Diabetic Sensory-Motor Peripheral Neuropathy Disability Benefits Questionnaire (DBQ), labeled as “Family Practice” and received into the Veteran’s Legacy Content Management Document (LCMD) electronic record on December 23, 2013)). At that examination, the Veteran was found to have had mild (italics added for emphasis) incomplete paralysis of the RLE and LLE. Id. at page (pg. 23). Since that examination, the Veteran has maintained that his peripheral neuropathy of the RLE and LLE are moderate in severity. (See Veteran’s agent’s November 2014 written argument to VA, labeled as “Third Party Correspondence” and received into the Veteran’s Veterans Benefits Management System (VBMS) electronic record on August 29, 2014)). Thus, in view of the Veteran’s assertions that the severity of his peripheral neuropathy of the RLE and LLE have worsened since the December 2013 VA examination, an additional examination is appropriate. VAOPGCPREC 11-95; Snuffer v. Gober, 10 Vet. App. 400 (1997). ii) VA treatment records-All Claims- VA has a duty to assist claimants to obtain evidence needed to substantiate a claim. 38 U.S.C. § 5103A (2012); 38 C.F.R. § 3.159(c) (2018). This includes making as many requests as are necessary to obtain relevant records from a Federal department or agency, including, but not limited to, military records, VA medical records, records from facilities with which the VA has contracted, and records from Federal agencies such as the Social Security Administration. 38 C.F.R. § 3.159(c)(2). VA will end its efforts to obtain records only where it concludes that the records sought do not exist or that further efforts to obtain those records would be futile, such as where the Federal department or agency advises VA that the requested records do not exist or the custodian does not have them. 38 C.F.R. § 3.159(c)(2). Here, the Veteran has indicated that he has continued to seek treatment for peripheral neuropathy of his hands and acquired psychiatric treatment, to include PTSD at a “local VAMC.” (See Veteran’s agent’s November 2014 written argument to VA at pg. 3). The Board notes that while the record includes scant treatment records, dated through January 2016 from the Cumberland County North Carolina VA clinic (see VA treatment records, dated from November 2015 to January 2016 labeled as “CAPRI” and received into the Veteran’s Legacy Content Manager Document (LCMD) electronic record on March 15, 2016)), more recent reports, to include those from a VA Medical Center (VAMC) are absent. Thus, as there appears to be outstanding VA treatment records that might disclose the etiology of any diagnosed peripheral neuropathy of the right and left hands and acquired psychiatric disorder, to include PTSD, as well as the current severity of the service-connected peripheral neuropathy of the RLE and LLE, they should be secured on remand. Bell v. Derwinski, 2 Vet. App. 611 (1992). iii) Inextricably Intertwined Claim-TDIU As the development of the initial rating and service connection claims may result in additional evidence that could affect a determination with respect to a TDIU, the issues are inextricably intertwined and the issue of entitlement to a TDIU must be remanded as well. Harris v. Derwinski, 1 Vet. App. 180 (1991). The matters are REMANDED for the following action: 1. Contact the appropriate VA Medical Center and obtain and associate with the claims file all outstanding records of treatment of the Veteran, dated from January 2016. 2. After any additional records are associated with the claims file, provide the Veteran with an appropriate examination to determine the severity of the service-connected peripheral neuropathy of the bilateral lower extremities. The electronic claims file must be made available to and be reviewed by the examiner. Any indicated tests and studies must be accomplished and all clinical findings must be reported in detail and correlated to a specific diagnosis. An explanation for all opinions expressed must be provided. The relevant DBQ must be utilized. The VA examiner must indicate all present symptoms and manifestations attributable to the Veteran’s service-connected residuals of peripheral neuropathy of the bilateral lower extremities. The examiner is requested to comment on the presence of any complete or incomplete paralysis of the sciatic nerve and, if present, characterize it as mild, moderate, moderately severe or severe with marked muscular atrophy. The examiner is also requested to comment on the presence of any complete paralysis of the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost. (Continued on the next page)   The examiner should also provide an opinion concerning the impact of the service-connected peripheral neuropathy of the bilateral lower extremities on the Veteran’s ability to obtain and maintain substantially gainful employment. THOMAS H. O'SHAY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Carole Kammel, Counsel