Citation Nr: 18143578 Decision Date: 10/23/18 Archive Date: 10/19/18 DOCKET NO. 15-02 807 DATE: October 23, 2018 REMANDED Entitlement to service connection for hypertension, to include as secondary to service-connected diabetes mellitus is remanded. Entitlement to service connection for peripheral neuropathy, left hand, to include as secondary to service-connected diabetes mellitus is remanded. Entitlement to service connection for peripheral neuropathy, right hand, to include as secondary to service-connected diabetes mellitus is remanded. Entitlement to service connection for peripheral neuropathy, left foot, to include as secondary to service-connected diabetes mellitus is remanded. Entitlement to service connection for peripheral neuropathy, right foot, to include as secondary to service-connected diabetes mellitus is remanded. REASONS FOR REMAND The Veteran had active duty service from February 1969 to February 1971, to include service in Vietnam. Entitlement to service connection for hypertension, to include as secondary to service-connected diabetes mellitus is remanded. The Veteran seeks entitlement to service connection for hypertension, to include ase secondary to service-connected diabetes mellitus. Service connection may be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc); see also 38 C.F.R. § 3.310(b). The Board notes that the Veteran’s service treatment records are silent as to any complaints of or treatment for hypertension. The Board further observes that the Veteran has received some VA and private treatment for his hypertension. The Veteran has alleged that he first sought treatment for hypertension shortly after his discharge from service, but the doctor who treated him is now deceased and the records may be unobtainable. An April 2013 VA diabetes mellitus examination noted hypertension was first diagnosed 25 years ago, in approximately 1988. It appears that his VA medical records document treatment for hypertension in as early as 1998. The Board also observes that there is evidence in the Veteran’s medical record to suggest that his hypertension pre-dates his diabetes mellitus. However, the Veteran has never received a VA hypertension examination and corresponding medical opinion. Given the above, a VA examination would be of considerable assistance in resolving this issue. He should also be offered the opportunity to submit any relevant treatment records, which is discussed below. Finally, the Veteran also contends hypertension is related to Agent Orange. Although current VA regulations do not provide hypertension as a presumptive disability associated with herbicide exposure, the National Academy of Sciences (NAS), in 2006 and 2008 updates, concluded that there was "limited or suggestive evidence of an association" between hypertension and herbicide exposure. See 75 Fed. Reg. 32,540, 32,549 (June 8, 2010); 75 Fed. Reg. 81,332, 81,333 (December 27, 2010). Entitlement to service connection for peripheral neuropathy, left hand; right hand; left foot; and right foot, to include as secondary to service-connected diabetes mellitus are remanded. The Veteran seeks entitlement to service connection for peripheral neuropathy of the bilateral hands and feet. The Board notes that the Veteran’s service treatment records are silent as to any complaints of or treatment for peripheral neuropathy. The Board further notes that the Veteran has received VA treatment for diabetic peripheral neuropathy. The Veteran underwent a VA diabetic peripheral neuropathy examination in April 2013. Curiously, the VA examiner declined to diagnose the Veteran with diabetic peripheral neuropathy. Instead, the examiner commented that any neurological symptoms preceded his diagnosis of diabetes mellitus. In a September 2018 Informal Hearing Presentation, the Veteran, through his representative, challenged the adequacy of the prior VA examiner. Specifically, the Veteran stated that the VA examiner never examined HIM or ran any test to prove he did not have neuropathy in my feet and hands. Considering the above, the Board finds the April 2013 VA examination and opinion to be inadequate for rating purposes. Thus, a new VA peripheral neuropathy examination is warranted. As noted above, the Veteran has received VA treatment for his claimed conditions. His most recent VA treatment records are from approximately 2017. He has also claimed that any medical records pertaining to hypertension may be unavailable. The Board finds it would be prudent for VA to obtain any outstanding treatment records, including any private treatment records from around the time of his discharge from service. The matters are REMANDED for the following action: 1. With the assistance of the Veteran as necessary, identify and obtain any outstanding, relevant treatment records, and associate them with the Veteran’s electronic claims file. If the Agency of Original Jurisdiction (AOJ) cannot locate or obtain such records, it must specifically document the attempts that were made to locate or obtain them, and explain in writing why further attempts to locate or obtain any government records would be futile. The AOJ must then: (a) notify the claimant of the specific records that it is unable to obtain; (b) explain the efforts VA has made to obtain that evidence; and (c) describe any further action it will take with respect to the claim. All attempts to obtain records should be documented in the Veteran’s electronic claims file. 2. Then, after pertinent records are obtained, but whether or not records are obtained, schedule the Veteran for VA examination(s) with a VA examiner(s) of appropriate expertise to determine the nature and etiology of his claimed hypertension and peripheral neuropathy of the bilateral hands and feet. The examiner(s) is/are to be provided access to the Veteran’s electronic claims file and must specify in the report that these records have been reviewed. Following a review of the full record, the appropriate examiner(s) should respond to the following: (a) Did the Veteran’s hypertension and/or peripheral neuropathy of the bilateral hands and feet manifest within one year of his separation from service? (b) Is it at least as likely as not (50 percent or higher degree of probability) that the Veteran’s hypertension and/or peripheral neuropathy of the bilateral hands and feet had its onset in, or is otherwise related to, the Veteran’s military service? As to hypertension, the examiner's attention is directed to the aforementioned NAS studies indicating "limited or suggestive evidence of an association" between hypertension and herbicide exposure, which is presumed based on the Veteran’s Vietnam service. (c) If not directly related to service, please offer an opinion as to whether it is at least as likely as not (50 percent or higher degree of probability) that the Veteran’s hypertension and/or peripheral neuropathy of the bilateral hands and feet was caused by his service-connected diabetes mellitus. (d) The examiner should then opine whether the hypertension and/or peripheral neuropathy of the bilateral hands and feet is aggravated (i.e., permanently worsened beyond the normal progression of that disease) by his service-connected diabetes mellitus. The examiner(s) should provide a complete rationale for any opinions expressed, based on the examiner’s clinical experience, medical expertise, and established medical principles. If an opinion cannot be made without resort to speculation, the examiner(s) should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made. The examiner(s) should also address and reconcile any prior reports, as well as any other pertinent evidence of record. 3. After the development requested has been completed, the AOJ should review any report to ensure that it is in complete compliance with the directives of this remand. If the report is deficient in any manner, the AOJ must implement corrective procedures at once. N. RIPPEL Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Miller, Associate Counsel