Citation Nr: 18154852 Decision Date: 11/30/18 Archive Date: 11/30/18 DOCKET NO. 14-25 415A DATE: November 30, 2018 ORDER Service connection for left lower extremity peripheral neuropathy, secondary to service-connected diabetes mellitus type II, is granted. Service connection for right lower extremity peripheral neuropathy, secondary to service-connected diabetes mellitus type II, is granted. REMANDED Service connection for left upper extremity peripheral neuropathy, secondary to service-connected diabetes mellitus type II, is remanded. Service connection for right upper extremity peripheral neuropathy, secondary to service-connected diabetes mellitus type II, is remanded. FINDINGS OF FACT 1. The Veteran is service connected for diabetes mellitus type II. 2. The Veteran is currently diagnosed with left and right lower extremity peripheral neuropathy. 3. The Veteran’s left and right lower extremity peripheral neuropathy are caused by the service-connected diabetes mellitus type II. CONCLUSIONS OF LAW The criteria for service connection for left lower extremity peripheral neuropathy, secondary to diabetes mellitus type II, have been met. 38 U.S.C. § 1110; 38 C.F.R. § 3.310. The criteria for service connection for right lower extremity peripheral neuropathy, secondary to diabetes mellitus type II, have been met. 38 U.S.C. § 1110; 38 C.F.R. § 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served honorably in the United States Army from June 1969 to June 1971. This appeal arises from a September 2009 rating decision, which denied service connection for left and right lower and upper extremity peripheral neuropathy. Duties to Notify and to Assist Neither the Veteran nor the representative has raised any issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to duty to assist argument). For these reasons, the Board finds VA has fulfilled the duties to notify and assist the Veteran. 38 U.S.C. §§ 5103, 5103A. Service Connection Legal Criteria Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Service connection may also be granted on a secondary basis for a disability which is “proximately due to or the result of a 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). Service Connection for Lower Extremity Peripheral Neuropathy The Veteran claims service connection for left and right lower extremity peripheral neuropathy. The Veteran contends this disease is caused by the service-connected diabetes mellitus type II. The Board initially notes that the service treatment records do not document any complaints, treatment, or diagnosis lower extremity peripheral neuropathy during active service. As there is no contention or evidence that the Veteran’s current lower extremity peripheral neuropathy first manifested during active service, service connection on a direct basis is not warranted for these disorders. See 38 C.F.R. § 3.303. The Board has considered the Veteran’s claims on a secondary basis herein. See 38 C.F.R. § 3.310. Initially, the Board finds the Veteran currently has left and right lower extremity peripheral neuropathy. In a November 2017 medical note, the doctor wrote that the Veteran has severe neuropathy. At a September 2017 medical examination, the doctor prescribed medication to treat neuropathy in the feet. A separate doctor noted that the Veteran has “burning in his feet with classic neuropathy-type symptoms.” See April 2017 Medical Exam. The Veteran has consistently complained of pain in the lower extremities. See, e.g., 2016 Private Medical Note. Next, the Board finds the evidence shows that the left and right lower extremity peripheral neuropathy is caused by the service-connected diabetes mellitus type II. The Veteran presently suffers from “non-insulin-dependent diabetes with neuropathy.” See September 2017 Medical Note. The doctor wrote that, “keeping blood sugar within normal limits is the only way to decrease [the Veteran’s] neuropathic pain.” Id. The Veteran currently takes gabapentin for neuropathic pain, which is “likely” caused by diabetes. See February 2018 Neurology Note. Moreover, the Veteran has had discussions with the doctor about being prescribed Cymbalta to combat neuropathic symptoms. See 2009 Private Medical Note. Cymbalta can be used to treat diabetic peripheral neuropathic pain. See Timothy Smith & Robert A. Nicholson, Review of duloxetine in the management of diabetic peripheral neuropathic pain, 3 Vascular Health & Risk Mgmt. 833, 834-44 (2007). Consequently, service connection for bilateral lower extremity peripheral neuropathy, as secondary to the service-connected diabetes mellitus type II, is warranted. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 3.310. As service connection is being granted on a secondary basis, there is no need to discuss entitlement to service connection on any other basis, as other theories of service connection have been rendered moot, leaving no question of law or fact to decide. See 38 U.S.C. § 7104. REASONS FOR REMAND Service connection for left upper extremity peripheral neuropathy, secondary to service-connected diabetes mellitus type II, is remanded. Service connection for right upper extremity peripheral neuropathy, secondary to service-connected diabetes mellitus type II, are remanded. Although the 2009 VA C&P Examination found no diagnosis of any type of neuropathy, subsequent private medical examinations have indicated neuropathy throughout various parts of the body. See, e.g., September 2017 Medical Note; April 2017 Medical Exam. None of these medical examinations has addressed whether the Veteran specifically has upper extremity peripheral neuropathy or whether claimed bilateral upper extremity peripheral neuropathy is secondarily caused by the service-connected diabetes mellitus type II. Therefore, a new examination is necessary to help clarify the diagnosis. The matter is REMANDED for the following action: Schedule a VA examination for upper extremity peripheral neuropathy. The examiner is asked to offer the following opinions: Does the Veteran have upper extremity peripheral neuropathy? What is the most likely cause of the symptoms claimed as upper extremity peripheral neuropathy? If so, is upper extremity peripheral neuropathy as likely as not caused by the service-connected diabetes mellitus type II? (Continued on the next page)   Provide a rationale for all medical opinions with reference to the relevant evidence of record, a discussion of the facts of the case, and the medical principles used to make determinations. J. PARKER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R. Dye, Associate Counsel