Citation Nr: 18143141 Decision Date: 10/18/18 Archive Date: 10/17/18 DOCKET NO. 15-06 149 DATE: October 18, 2018 REMANDED Entitlement to service connection for malaria is remanded. Entitlement to service connection for peripheral neuropathy of the bilateral upper extremities, to include as due to exposure to herbicide agents is remanded. Entitlement to service connection for peripheral neuropathy of the bilateral lower extremities, to include as due to exposure to herbicide agents is remanded. REASONS FOR REMAND The Veteran had active military service from October 1965 to January 1969. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In June 2018, the Veteran testified at a hearing. The transcript of the hearing is of record. The Board’s review of the claims file reveals that further action on the claims of entitlement to service connection for malaria and peripheral neuropathy of the bilateral upper and lower extremities is needed. Specifically, regarding malaria, the Veteran attested that he was not treated for malaria in service. The Veteran also admitted that his malaria was not confirmed in a blood test. See June 2018 Hearing Testimony. See also February 2015 CAPRI. However, the Veteran alleged that he has chills as a result of his malaria. The Veteran stated that he received treatment from Sharpe Hills Care. No treatment records from Sharpe Hills Care are associated with the claims file. As such, the Board finds that a remand is necessary to obtain these documents. As for the peripheral neuropathy of the bilateral upper and lower extremities, the Veteran alleged that his neuropathies are related to his exposure to herbicide agents and not due to diabetes. See June 2018 Hearing Testimony. The Veteran stated that he had neuropathy for over 25 years whereas his diabetes was diagnosed about six to seven years ago. Although a review of the treatment records shows that the Veteran was diagnosed with peripheral neuropathy prior to his diagnosis of diabetes mellitus, the records also show that the Veteran was diagnosed with diabetic neuropathy. See August 2018 Medical Treatment Record – Government Facility. However, the medical record that shows that the Veteran has diabetic neuropathy was only on a list of active health condition from Sharp Reese-Stealy Medical Group with no treatment records associated with the list. As such, the Board finds that a remand is necessary to obtain these missing treatment records. Additionally, the Board finds that an addendum opinion is required to address diabetic neuropathy. In the January 2014 VA examination, the examiner noted that the Veteran’s numbness and pain in his bilateral feet occurred in 2006 after an epidural injection for a low back pain. The examiner further noted that diabetes was not considered a cause of the Veteran’s neuropathy as the neuropathy predates the diabetes diagnosis. The examiner indicated that the Veteran’s alcoholism may have been a contributing factor in the Veteran’s neuropathy. The Board finds the examiner’s assessment incomplete as the examiner did not address the impact that the Veteran’s diabetes mellitus has on the peripheral neuropathy of the bilateral lower extremities as the Veteran was later diagnosed with diabetic neuropathy. See August 2018 Medical Treatment Record – Government Facility. As such, the Board finds that a remand is necessary. The matters are REMANDED for the following action: 1. Obtain all outstanding VA and private medical records and associate them with the claims file. Specifically obtain records from Sharpe Hills Care, Sharpe Reese Stealy Medical Group, and Corey Marco, M.D. All efforts to obtain these records must be documented in the claims file. Such efforts should continue until they are obtained, it is reasonably certain that they do not exist, or that further efforts would be futile. 2. Obtain an addendum medical opinion from an appropriate medical professional. The claims file must be made available to be reviewed by the examiner. All indicated diagnostic tests should also be completed. Peripheral neuropathy of the bilateral upper and lower extremities – the examiner must also determine if it is at least as likely as not (a fifty percent probability or greater) that the Veteran’s neuropathy of the bilateral upper and lower extremities were (a) caused by or have been (b) aggravated (permanently worsened beyond the natural progress of the disorder) by the Veteran’s diabetes mellitus. In rendering this opinion, the examiner must address the diabetic neuropathy noted in the claims file. If aggravation is found, please identify to the extent possible the baseline level of disability prior to the aggravation and determine what degree of additional impairment is attributable to aggravation of the neuropathy of the bilateral upper or lower extremities by diabetes mellitus. A detailed rationale for the opinion must be provided. If the examiner is unable to offer the requested opinion, it is essential that he or she offer a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 3. Thereafter, readjudicate the Veteran’s claims based on the entirety of the evidence. If any claim remains denied, the Veteran and his representative should be issued a supplemental statement of the case. An appropriate period of time should be allowed for response. S. HENEKS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD P. Noh, Associate Counsel