Citation Nr: 18149438 Decision Date: 11/09/18 Archive Date: 11/09/18 DOCKET NO. 16-45 344 DATE: November 9, 2018 REMANDED Entitlement to service connection for peripheral neuropathy of the right lower extremity, secondary to diabetes mellitus, is remanded. Entitlement to service connection for peripheral neuropathy of the left lower extremity, secondary to diabetes mellitus, is remanded. REASONS FOR REMAND The Veteran served in the U.S. Marine Corps on active duty from October 1963 to October 1967. Entitlement to service connection for peripheral neuropathy of both the right and left lower extremities, secondary to diabetes mellitus, is remanded. When examined by VA in January 2009, the Veteran reported symptoms of peripheral neuropathy. A central nerve examination was also conducted and showed deep tendon reflexes were within normal limits. Based upon this evidence, the examiner opined that peripheral neuropathy is not caused by or the result the Veteran’s service connected diabetes because the Veteran reported peripheral neuropathy symptoms, prior to a diagnosis of diabetes mellitus. Ultimately, the examiner’s opinion reflects a belief the Veteran has peripheral neuropathy of his lower extremities, but simply that the diagnosis precedes a diagnosis for diabetes. In August 2010, the Veteran was treated by VA for leg pain. The examiner found that the origin of the Veteran’s leg pain was peripheral vascular disease (PVD) and that the Veteran did not have peripheral neuropathy. See August 31, 2010 Birmingham VAMC Treatment Record. In September 2011, the treating VA examiner noted the Veteran’s leg pain was due to a combination of PVD, being overweight, and early neuropathy. See September 6, 2011 Birmingham VAMC Treatment Record. The Veteran was again examined by VA in June 2012, and the examiner reported the Veteran did not have peripheral neuropathy. In August 2014, a VA treating physician told the Veteran the burning in his feet could be due to PVD, his ethanol consumption or his diabetes mellitus. However, an August 2014 nerve conduction study showed no electrophysiologic evidence of a large fiber polyneuropathy. See August 2014 Electromyography Report. In February 2015 the Veteran received a high foot-risk screening from his treating VA physician, which showed a normal bilateral feet pulse and sensory examination. In March 2016, the Veteran’s treating VA physician provided him with a neurological examination that showed normal motor strength, preserved sensation and a negative Babinski test. In October 2016, the Veteran was examined by VA and diagnosed with diabetic peripheral neuropathy which the examiner opined was caused by the Veteran’s diabetic mellitus. In November 2016, the Veteran was again examined by VA and that examiner diagnosed the Veteran with peripheral neuropathy of the bilateral upper and lower extremities. Lastly, in March 2017, a VA addendum medical opinion was requested to provide clarity to the question of whether the Veteran has a diagnosis of peripheral neuropathy of his lower extremities. The March 2017 VA examiner opined that the “Veteran does not have peripheral neuropathy of [the] lower extremities [and] multiple examination[s] have shown he does not have this problem (see prior examinations).” See March 2017 VA Addendum Medical Opinion. Although the examiner failed to address several of the examinations which show the Veteran does have a diagnosis of peripheral neuropathy. Given the above, the evidence of record remains unclear as to whether the Veteran suffers from peripheral neuropathy, as well as whether it is the result of his service-connected diabetes mellitus. A remand is necessary to assist the Veteran in learning the origin of his symptoms, and whether they are caused or aggravated by his service-connected diabetes. The matters are REMANDED for the following action: (Please note, this appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900 (c). Expedited handling is requested.) 1. Obtain any and all relevant up to date VA treatment records and associated them with the claims file. 2. Schedule the Veteran for an examination with the appropriate physician to determine the nature and origin of the Veteran’s lower bilateral extremity symptoms. The examiner shall determine the following: (a.) Does the Veteran currently have a diagnosis of peripheral neuropathy of the left and/or right lower extremity? (b.) If yes, is the Veteran’s peripheral neuropathy at least as likely as not (50 percent or greater probability) caused by or aggravated by the service-connected diabetes mellitus (the opinion MUST specifically discuss the concept of aggravation, and “aggravation” means the disability increased in severity beyond its natural progression) by his service-connected diabetes mellitus. If the examiner finds that the Veteran’s peripheral neuropathy was not caused, but was aggravated by his diabetes mellitus, the examiner should specify, to the extent possible, the degree of disability (pathology/impairment) that is due to this aggravation. If the examiner finds the Veteran does not have a diagnosis of peripheral neuropathy of the left and/or right lower extremity, please explain why. The examiner is asked to address all of the opinions in the Veteran’s medical history which conclude he has a diagnosis of peripheral neuropathy. Include a rationale for all opinions and conclusions offered. (c.) Is the Veteran’s peripheral vascular disease at least as likely as not (50 percent or greater probability) caused by or aggravated by his service-connected diabetes mellitus (the opinion MUST specifically discuss the concept of aggravation, and “aggravation” means the disability increased in severity beyond its natural progression) by his service-connected diabetes mellitus. If the examiner finds that the Veteran’s peripheral vascular disease was not caused, but was aggravated by his diabetes mellitus, the examiner should specify, to the extent possible, the degree of disability (pathology/impairment) that is due to this aggravation. The examiner shall fully and completely review the Veteran’s claims file, and include a copy of this REMAND in the examination report. All opinions and conclusions provided shall include a clear and concise rationale. The examiner shall review the entire claims file, and include a copy of this REMAND in the examination report. 3. Thereafter, readjudicate the issues on appeal. If any benefit sought on appeal remains denied, provide the Veteran and his representative with a supplemental statement of the case and allow an appropriate period of time for response before the case is returned to the Board. MARJORIE A. AUER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. N. Shannon, Associate Counsel