Citation Nr: 18144595 Decision Date: 10/25/18 Archive Date: 10/24/18 DOCKET NO. 15-01 354 DATE: October 25, 2018 REMANDED ISSUES Entitlement to service connection for peripheral neuropathy of the right upper extremity, to include as secondary to service-connected diabetes mellitus type II, is remanded. Entitlement to service connection for peripheral neuropathy of the right upper extremity, to include as secondary to service-connected diabetes mellitus type II, is remanded. REASONS FOR REMAND The Veteran had active service from July 1968 to April 1970. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2011 rating decision. The Veteran claims that he has peripheral neuropathy of the right and left upper extremities as a result of his service-connected diabetes mellitus type II. The Veteran is service-connected for diabetes mellitus type II, effective from May 2003. Service connection may be granted on a secondary basis for a disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310. The evidence must show: (1) that a current disability exists; and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated (permanently worsened in severity beyond its natural progress) by a service-connected disability. Id.; Allen v. Brown, 7 Vet. App. 439, 44849 (1995). In a July 2003 VA medical treatment record, the examiner noted that the Veteran complained of paresthesia in the right arm and the finger tips and that he experienced the symptoms every two weeks. A July 2010 VA treatment record reflects that the Veteran complained of paresthesias and burning in the hands. In the November 2010 VA Compensation and Pension Exam Report, a diagnosis of peripheral neuropathy of the bilateral lower extremities was advanced. The examiner did not indicate whether the Veteran exhibited an upper extremity disability. The tests, however, showed normal findings for left and right upper extremities in the median nerve area. The examiner noted that the claims file was reviewed but it does not appear that he took into account the Veteran’s complaints of tingling and burning of the hands. VA treatment records and progress notes dated from 2012 to 2015 mention numerous times, as part of the history of present illnesses, that the Veteran was diagnosed with peripheral neuropathy. A January 2014 VA treatment record shows that the Veteran had complained of bilateral hand tingling, and that he experienced tingling for 6 years. In addition, the records reflect that the Veteran may exhibit median neuropathy. The medical records also reflect that the Veteran is on medication for gabapentin for his peripheral neuropathy, but does not specify the location of his neuropathy. In the September 2018 informal hearing presentation, the Veteran’s representative requested that the Veteran be afforded another VA Compensation and Pension Examination to clarify whether the Veteran exhibits peripheral neuropathy of the right and left upper extremities. VA has a duty to assist the Veteran in the development of a claim. This duty includes providing an examination when necessary. 38 U.S.C. § 5103A (West 2014); 38 C.F.R. § 3.159 (2015). Here, the Veteran’s medical records show that the Veteran is diagnosed with peripheral neuropathy, but the records are unclear as to whether he exhibits neuropathy in his lower extremity only or both his upper and lower extremities. Therefore, a medical examination should be afforded to clarify whether the Veteran exhibits peripheral neuropathy of his right and/or left upper extremities. Accordingly, the matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination to clarify whether the Veteran exhibits peripheral neuropathy of the right or left upper extremity. The electronic claims file must be reviewed by the examiner, and a note that it was reviewed should be included in the report. All tests and studies, deemed necessary, including any imaging, should be conducted. 2. If a diagnosis of peripheral neuropathy of the right or left upper extremity is advanced, then the examiner should answer the following questions: (a.) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s peripheral neuropathy of the right or left upper extremity was caused by his service-connected diabetes mellitus type II? (b.) If not, is it at least as likely as not (50 percent probability or greater) that the Veteran’s peripheral neuropathy of the right or left upper extremity was aggravated (worsened beyond its natural progression) by his service-connected diabetes mellitus type II? If aggravation is found, please identify to the extent possible the baseline level of disability prior to the aggravation of the Veteran’s peripheral neuropathy of the right or left upper extremity and determine what degree of additional impairment is attributable to aggravation of the peripheral neuropathy of his right or left upper extremity due to his service-connected diabetes mellitus type II. A detailed rationale for the opinion must be provided. If the examiner is unable to offer the requested opinion, it is essential that the examiner 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. The examiner is reminded that the term “as likely as not” does not mean “within the realm of medical possibility,” but rather that the evidence of record is so evenly divided that, in the examiner’s expert opinion, it is as medically sound to find in favor of the proposition as against it. TANYA SMITH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Lee, Associate Counsel