Citation Nr: 18153184 Decision Date: 11/27/18 Archive Date: 11/27/18 DOCKET NO. 15-02 348 DATE: November 27, 2018 REMANDED Entitlement to a rating in excess of 20 percent for peripheral neuropathy of the left lower extremity is remanded. Entitlement to a rating in excess of 10 percent for peripheral neuropathy of the right lower extremity is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1965 to December 1967. This matter comes before the Board of Veterans’ Appeals (Board) from a rating decision issued in August 2013 by a Department of Veterans Affairs (VA) Regional Office. During the appeal, the Veteran requested a Board hearing before a Veterans Law Judge. However, he failed to report for the Board videoconference hearing scheduled for him in October 2018. The Board did not receive a timely request for postponement, and the Veteran has not indicated that he wished to reschedule the hearing. Therefore, the Board considers the hearing request withdrawn. See 38 C.F.R. § 20.704(d). Entitlement to increased ratings for peripheral neuropathy of the left and right lower extremities is remanded. The Veteran seeks increased ratings for his service-connected peripheral neuropathy of the left and right lower extremities. The Veteran’s peripheral neuropathy of the right lower extremity is currently rated 10 percent disabling, and his peripheral neuropathy of the left lower extremity is currently rated 20 percent disabling. A Diabetic Sensory-Motor Peripheral Neuropathy Disability Benefits Questionnaire (DBQ) was completed in June 2013. During the June 2013 examination, the Veteran reported pain with walking, numbness in feet, and inability to feel bug bites. The July 2013 examiner noted mild constant pain in the right lower extremity and moderate constant pain in the left lower extremity. The July 2013 examiner also noted mild numbness in the right lower extremity and moderate numbness in the left lower extremity. Additionally, the July 2013 examiner noted decreased light touch or monofilament testing results bilaterally in the ankle/lower leg and foot/toes. Finally, the July 2013 examiner noted decreased position sense, vibration sensation, and cold sensation. In support of his claim, the Veteran thereafter noted he could no longer walk more than one-fourth of a mile without pain in both feet and reported that he had large cracks on the bottom of both feet, of which he was unaware of until he saw the blood in his socks. See August 2013 Notice of Disagreement. The Board notes the Agency of Original Jurisdiction (AOJ) adjudicated the latter symptoms in a separate rating decision. Consequently, a DBQ was completed in January 2015. During the January 2015 examination, the Veteran reported complete and total numbness of the bilateral lower extremities from the knees down and total loss of sensory in bilateral lower extremities with clear demarcation at the distal knees. The January 2015 examiner opined that the Veteran had mild, incomplete paralysis of both the right and left lower extremities. Under symptoms, the January 2015 examiner reported moderate right and left lower extremity numbness. The January 2015 examiner noted decreased deep tendon reflexes of the ankle. The January 2015 examiner noted an October 2014 treatment record that reported “no loss of protection sensation” and “monofilament category 0”. Additionally, the examiner found the Veteran’s subjective complaints during the examination appeared out of proportion to objective exam findings because he reported total sensory loss that is well and clearly demarcated to the distal knees (down to the toes) which is not typical of an organic cause to include diabetic peripheral neuropathy. The Board notes that when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). For VA purposes, the examination from January 2015 is insufficient. The Board notes the examiner stated the Veteran had moderate numbness in the right and left lower extremities, but noted no other symptoms associated with the Veteran’s bilateral lower extremity peripheral neuropathy. The Board finds the examiner’s characterization of the severity of the Veteran’s peripheral neuropathy is inconsistent with the prior findings regarding his current symptomatology. While the Board recognizes that the examiner did indicate that the Veteran’s reported subjective complaints during the examination appeared out of proportion to objective exam findings. Further, the Board finds it significant that the examination report shows “no response provided” for light touch/monofilament testing, position sense, vibration sensation, or cold sensation. In this respect, it is unclear whether the Veteran denied such symptoms or that the examiner did not include any results for such. Therefore, the Board finds the examination is incomplete and inadequate for purpose of rating the Veteran’s disabilities on appeal. Accordingly, remand is necessary to afford the Veteran a new examination to determine the current nature and severity of his diabetic peripheral neuropathy of the right and left lower extremities. The matters are REMANDED for the following action: 1. Obtain and associate with the claims file any VA treatment records not already of record. If the VA records are unavailable, the Veteran must be notified in accordance with 38 C.F.R. §3.159(e). (Continued on the next page)   2. After receiving all available records, schedule the Veteran for an appropriate VA examination to determine the current nature and severity of his service-connected peripheral neuropathy of the left lower extremity and the right lower extremity. The electronic claims file must be made available to the examiner for review in connection with the examination. All indicated tests should be conducted, including all diagnostic tests, and the reports of any such studies incorporated into the examination reports to be associated with the claims file. The AOJ should ensure that the report includes all information needed for rating purposes. The Veteran’s lay assertions and his statements in support of claim, including but not limited to the aforementioned Notice of Disagreement, as to symptomology should be recorded and considered. The examiner is asked to reconcile any conflicting evidence of record regarding the severity of the Veteran’s right and left lower extremity peripheral neuropathy, including the findings and conclusions provided in previous Diabetic Sensory-Motor Peripheral Neuropathy DBQ report. M. M. CELLI Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Aoughsten, Associate Counsel