Citation Nr: 18146899 Decision Date: 11/02/18 Archive Date: 11/01/18 DOCKET NO. 18-29 187 DATE: November 2, 2018 ORDER New and material evidence having been submitted, the claim of entitlement to service connection for a tingling feeling in the left arm is reopened. REMANDED Entitlement to service connection for a nerve disability of the left upper extremity, to include as secondary to type II diabetes mellitus, is remanded. Entitlement to service connection for a nerve disability of the right upper extremity, to include as secondary to type II diabetes mellitus, is remanded. Entitlement to service connection for an eye disability, claimed as a visual disturbance, to include as secondary to type II diabetes mellitus, is remanded. Entitlement to service connection for a vitamin D deficiency, to include as secondary to type II diabetes mellitus, is remanded. Entitlement to a disability rating in excess of 10 percent for posttraumatic stress disorder (PTSD) is remanded. FINDINGS OF FACT 1. A June 1997 rating decision denied entitlement to service connection for a tingling feeling in the left arm based on the determination the condition did not happen in military service nor was it aggravated or caused by service. The Veteran was notified of that decision, but did not initiate an appeal, and new and material evidence was not received within one year of the rating decision. 2. Since the June 1997 rating decision, entitlement to service connection for type II diabetes mellitus was granted in an April 2010 rating decision. In the April 2014 claim, the Veteran contends he has peripheral neuropathy of the left upper extremity related to his diabetes. Accordingly, the Board finds this new evidence is material as it indicates the Veteran’s tingling of the left arm may be secondary to a service-connected disability, and therefore raises a reasonable possibility of substantiating the claim of service connection for tingling of the left arm. CONCLUSIONS OF LAW 1. The June 1997 rating decision, which denied the Veteran’s claim of entitlement to service connection for a tingling feeling in the left arm, is final. 38 U.S.C. § 7105(c) (2012); 38 C.F.R. §§ 3.104, 3.156, 20.201, 20.302, 20.1103 (2017). 2. The additional evidence received since the June 1997 rating decision is new and material, and the claim of entitlement to service connection for a tingling feeling in the left arm loss is reopened. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156 (2017). REASONS FOR REMAND In the April 2014 claim, the Veteran stated he seeks service connection for peripheral neuropathy of the bilateral upper extremities. The medical evidence of record includes complaints of numbness and tingling in the hands and fingers, and a prescription medication for neuropathic pain. The Board has recharacterized the issues as entitlement to service connection for nerve disabilities of the left and right upper extremities to afford the Veteran a broader scope of review. See Browkowski v. Shinseki, 23 Vet. App. 79 (2009); see also Clemons v. Shinseki, 23 Vet. App. 1 (2009). 1. Entitlement to service connection for a nerve disability of the left upper extremity, to include as secondary to type II diabetes mellitus, is remanded. 2. Entitlement to service connection for a nerve disability of the right upper extremity, to include as secondary to type II diabetes mellitus, is remanded. A February 2015 VA examination and November 2017 QTC examination did not indicate a current diagnosis of peripheral neuropathy of the left or right upper extremities. However, neither examiner addressed the medical evidence of record indicating neurologic symptoms in the left and right upper extremities prior to the appeal period, or the VA treatment records indicating a prescription for gabapentin for neuropathic pain has remained active throughout the appeal period. See, e.g., May 2018 VA primary care note; August 2014 VA primary care note; September 2011 VA primary care note; August 2009 VA primary care note; April 2009 VA psychiatry note; February 2009 VA primary care note; June 2007 Dr. A.H.K. examination report (associated with SSA records); September 2003 Orthopedic Care & Sports Medicine Center note (associated with SSA records); March 2003 Physician’s Health Center note (associated with SSA records). A remand is required to afford the Veteran a VA examination to determine the nature and etiology of any current nerve disability of the left and/or right upper extremities. 3. Entitlement to service connection for an eye disability, to include as secondary to type II diabetes mellitus, is remanded. A November 2017 QTC examiner opined that the Veteran’s bilateral cataracts are related to age. However, the examiner did not address an article submitted in February 2017 that indicates cataracts may be a complication of diabetes, and occur more frequently in diabetic patients. Further, neither the November 2017 QTC examiner nor a February 2015 VA examiner addressed whether the Veteran’s cataracts are aggravated by his service-connected diabetes. On remand, an addendum medical opinion should be obtained regarding the nature and etiology of the Veteran’s current eye disability. 4. Entitlement to service connection for a vitamin D deficiency, to include as secondary to type II diabetes mellitus, is remanded. A February 2015 VA examiner opined that the Veteran’s current vitamin D deficiency is less likely as not caused or aggravated by his service-connected diabetes. However, the VA examiner did not address direct service connection, despite the Veteran’s report to the examiner that he was claiming the vitamin D deficiency may also be related to Agent Orange exposure. On remand, an addendum opinion should be obtained regarding the nature and etiology of the Veteran’s vitamin D deficiency. 5. Entitlement to a disability rating in excess of 10 percent for PTSD is remanded. The Veteran’s VA treatment records indicate his PTSD has worsened since he was last afforded a VA examination in March 2015, as the Veteran resumed VA psychiatric treatment in April 2017 for increasing symptoms. A remand is required to afford the Veteran the opportunity to report for a VA examination to determine the current severity and manifestations of his PTSD. As VA examinations and opinions are necessary, the Veteran’s updated VA treatment records should also be obtained. The matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from May 2018 to the present. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any current nerve disability of the left and/or right upper extremities. After a review of the claims file, and interview and examination of the Veteran, the examiner is asked to respond to the following inquiries: a) Please identify with specificity all nerve disabilities of the left and right upper extremities which are currently manifested, or which have been manifested at any time since April 2014. The examiner should specifically address the Veteran’s prior complaints of numbness and tingling in his hands and fingers, to include as recently as 2011. The examiner should also address the Veteran’s continuing VA prescription for gabapentin for neuropathic pain. b) For each nerve disability of the left and/or right upper extremity, is it at least as likely as not (i.e. probability of 50 percent or greater) that the Veteran’s current disability was caused by his diabetes mellitus? c) For each nerve disability of the left and/or right upper extremity, is it at least as likely as not (i.e. probability of 50 percent or greater) that the Veteran’s current disability is aggravated by his diabetes mellitus? Aggravation indicates a worsening of the underlying condition as compared to an increase in symptoms. If aggravation is found, the examiner should attempt to identify the baseline level of the disability that existed before aggravation by the service-connected disability occurred. d) For each nerve disability of the left and/or right upper extremity, is it at least as likely as not (i.e. probability of 50 percent or greater) that the Veteran’s current disability is related to his active duty service, to include exposure to an herbicide agent? 3. Obtain an addendum opinion from an appropriate clinician to determine the nature and etiology of the Veteran’s current eye disability. It is up to the discretion of the clinician as to whether a new examination is necessary to provide an adequate opinion. After a review of the claims file, and examination of the Veteran if deemed necessary by the clinician, the clinician is asked to respond to the following inquiries: a) Is it at least as likely as not (i.e. probability of 50 percent or greater) that the Veteran’s current eye disability was caused by his diabetes mellitus? The clinician should specifically address the article submitted in February 2017 indicating cataracts may be a complication of diabetes, and occur more frequently in diabetic patients. b) Is it at least as likely as not (i.e. probability of 50 percent or greater) that the Veteran’s current eye disability is aggravated by his diabetes mellitus? Aggravation indicates a worsening of the underlying condition as compared to an increase in symptoms. If aggravation is found, the examiner should attempt to identify the baseline level of the disability that existed before aggravation by the service-connected disability occurred. 4. Obtain an addendum opinion from an appropriate clinician to determine the nature and etiology of the Veteran’s current vitamin D deficiency. It is up to the discretion of the clinician as to whether a new examination is necessary to provide an adequate opinion. After a review of the claims file, and examination of the Veteran if deemed necessary by the clinician, the clinician is asked to opine whether it is at least as likely as not (i.e. probability of 50 percent or greater) that the Veteran’s current vitamin D deficiency is related to his active duty service, to include exposure to an herbicide agent. 5. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected PTSD. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. The examiner must attempt to elicit information regarding the severity, frequency, and duration of symptoms. To the extent possible, the examiner should identify any symptoms and social and occupational impairment due to PTSD alone. (Continued on the next page)   6. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal. If any benefit sought is not granted to the Veteran’s satisfaction, send the Veteran a supplemental statement of the case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. DONNIE R. HACHEY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Delhauer, Counsel