Citation Nr: 19115296 Decision Date: 03/05/19 Archive Date: 03/01/19 DOCKET NO. 15-13 701 DATE: March 5, 2019 REMANDED The appeal for a rating greater than 20 percent for right upper extremity peripheral neuropathy is remanded. The appeal for a compensable initial rating for left upper extremity peripheral neuropathy is remanded. The appeal for an initial rating greater than 10 percent for left lower extremity peripheral neuropathy is remanded. The appeal for an initial rating greater than 10 percent for right lower extremity peripheral neuropathy is remanded. The appeal for a total disability rating due to individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran had active service from May 1968 to June 1971. The Veteran testified before the undersigned Veterans Law Judge during a September 2018 videoconference hearing, the transcript of which is included in the file. 1. Entitlement to higher initial ratings for peripheral neuropathy of the bilateral upper and lower extremities. A remand is required for the following reasons: (1) the August 2014 VA examination report is remote, and the Veteran has since alleged worsening symptoms; and (2) pertinent VA treatment records were added to the record following the most recent statement of the case issued in March 2015. During the Veteran’s hearing before a Decision Review Officer in January 2015, the Veteran reported that there were deficiencies in the August 2014 VA peripheral neuropathy examination. Regarding the upper extremities, he reported that the examiner did not examine the Veteran’s hands or perform any of the physical tests such as knocking or touching that she did to the lower extremities. He also reported that that the examiner did not record the Veteran’s complaints regarding pain in all his extremities. See January 2015 DRO hearing transcript. The Board also notes that the examination report was incomplete with respect to an objective finding regarding the severity of the incomplete paralysis in the lower extremities. See August 2014 VA examination report. Moreover, during the Veteran’s hearing before the Board, he reported that symptoms in all his extremities have worsened since the August 2014 VA examination. See Board Hearing Transcript page 4. The Veteran’s wife also submitted a statement noting her observations of the Veteran’s worsening neuropathy. See Veteran’s wife’s September 2014 statement. She reported that the Veteran could no longer be on his feet for extended periods of time. She reported observing that the Veteran’s feet would become purple or blue in color and that he complained of burning needle and stabbing pain that was worse than normal. She also reported that when he cut himself or had an abrasion he did not appear to feel it or realize it. She reported his complaints that his hands became numb and he had sharp burning needle/stabbing pain in hands. She reported that if she pinched the Veteran’s hands or arms, he did not appear to feel it. See September 2014 statement. VA treatment records dated in 2016 confirm the Veteran’s reports that his lower extremity pain was worse and that his legs felt weak. See VA treatment records dated in August 2016 and October 2016. VA treatment records also indicate that the Veteran suffers from nonservice-connected lumbar radiculopathy in addition to his lower extremity peripheral neuropathy. Thus, further development is required to determine whether the Veteran’s lower extremity symptoms and limitations are caused by service-connected peripheral neuropathy or non-service connected lumbar radiculopathy. Based on the foregoing, the Board finds that a more contemporaneous examination is needed. See 38 C.F.R. § 5103A; 38 C.F.R. § 3.159; Snuffer v. Gober, 10 Vet. App. 400, 403 (1997). See also Green v. Derwinski, 1 Vet. App. 121, 124 (1991) (VA has a duty to provide a veteran with a thorough and contemporaneous medical examination). While on remand, any outstanding VA treatment records dated since July 2017 should be obtained. 2. Entitlement to a TDIU. The Veteran’s appeal for TDIU is intertwined with the appeals for higher initial ratings for the Veteran’s upper and lower extremities. As it is unclear whether the Veteran’s reported functional impairment associated with the lower extremities is due to service-connected peripheral neuropathy or nonservice-connected lumbar radiculopathy, the claim for TDIU is deferred pending further development indicated above. See Parker v. Brown, 7 Vet. App. 116 (1994) and Harris v. Derwinski, 1 Vet. App. 180, 183 (issues are “inextricably intertwined” when a decision on one issue would have a “significant impact” on a veteran's claim for the second issue). The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records dated since July 2017. 2. Afford the Veteran a VA examination to evaluate the severity of the Veteran’s peripheral neuropathy. All indicated tests and studies should be conducted. The examiner is asked to address the following: (a.) Assess the severity of peripheral neuropathy in each extremity and address the functional effects of the Veteran’s peripheral neuropathy in the upper and lower extremities. Consider the Veteran’s reported complaints of numbness and loss of grip strength in the hands, dropping things, as well as feelings of burning, needles, and stabbing pain in the feet, and inability to walk long distances. The examiner should comment upon the impact these disabilities have on his ability to work. (b.) If possible, offer an opinion as to the severity or progression of the peripheral neuropathy in each upper and lower extremity since November 2012. (c.) Please indicate whether the Veteran’s symptoms associated with service-connected peripheral neuropathy are distinguishable from any symptoms associated with nonservice-connected lumbar radiculopathy. (d.) Rationale should be provided for any opinion offered. (Continued on Next Page) 3. Readjudicate the Veteran’s claims for higher initial ratings for each extremity as well as entitlement to TDIU, considering all the evidence received since the March 2015 statement of the case. V. Chiappetta Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Donna D. Ebaugh, Counsel