Citation Nr: 20004593 Decision Date: 01/21/20 Archive Date: 01/21/20 DOCKET NO. 19-11 351 DATE: January 21, 2020 ORDER Entitlement to service connection for peripheral vascular disease is granted. REMANDED Entitlement to service connection for left lower extremity neuropathy is remanded. Entitlement to service connection for left upper extremity neuropathy is remanded. Entitlement to service connection for right lower extremity neuropathy is remanded. Entitlement to service connection for right upper extremity neuropathy is remanded. Entitlement to service connection for retinopathy is remanded. FINDING OF FACT The Veteran has peripheral vascular disease secondary to his service-connected diabetes mellitus. CONCLUSION OF LAW The criteria for entitlement to service connection for peripheral vascular disease have been met. 38 U.S.C. §§ 1110, 1131, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.303, 3.304, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION 1. Entitlement to service connection for peripheral vascular disease Service connection will be granted if it is shown that the veteran suffers from a disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty, during active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d); see also Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). Additionally, service connection may be granted, on a secondary basis, for a disability which is proximately due to or the result of an established service-connected disorder. 38 C.F.R. § 3.310. The Veteran has claimed that he has peripheral circulatory disease secondary to his diabetes mellitus. The record reflects that service connection for diabetes mellitus was granted in a January 2020 rating decision. In an October 2015 letter, the Veteran’s private doctor stated that he has treated the Veteran for diabetes mellitus since 2007, and the Veteran has peripheral circulatory disease secondary to his diabetes mellitus. In August 2019, the Veteran underwent a VA compensation and pension diabetes mellitus examination. The examination report indicates that the Veteran has peripheral vascular disease as a complication of his diabetes mellitus. Based on the forgoing, the Board finds that service connection for peripheral vascular disease is warranted. REASONS FOR REMAND The Veteran has claimed he has upper and lower extremity peripheral neuropathy and retinopathy as secondary to his service-connected diabetes mellitus. Although the Board regrets the additional delay, a remand is required to further develop the record. Currently of record is an August 2015 letter by the Veteran’s private doctor indicating that he has treated the Veteran for diabetes mellitus since 2007 and the Veteran has neuropathy and retinopathy secondary to his diabetes mellitus. In August 2019, the Veteran underwent a VA compensation and pension diabetes mellitus examination at which the examiner did not indicate that the Veteran has peripheral neuropathy or retinopathy as complications of his diabetes mellitus. The Veteran did not undergo VA examinations specifically for neuropathy or his eyes and no opinion has been obtained that discusses the August 2015 opinion of the Veteran’s private doctor that the Veteran has both neuropathy and retinopathy secondary to his diabetes mellitus. The Board notes that the Veteran did undergo a central nervous system and neuromuscular disease VA examination in August 2019. The report of that examination indicates that the Veteran has partial blindness in his right eye and lower limb weakness as residuals of a 1999 stroke, which the examiner stated was caused by atherosclerosis buildup in the carotid arteries caused by hyperglycemia that had gone unchecked for years. The Board finds that on remand the Veteran should be afforded peripheral neuropathy and eye examinations and an opinion obtained as to whether the Veteran has peripheral neuropathy of any of his extremities or an eye disability caused or aggravated by his service-connected diabetes mellitus. The Board notes additional medical treatment records may also prove relevant to the issue. Currently associated with the Veteran’s claims file are VA treatment records through August 2017 from the Jacksonville VA clinic. On remand, the VA must associate with the Veteran’s claims file all more recent VA treatment records from any VA facility where the Veteran has been treated. Also, as the evidence reflects that the Veteran has received private medical treatment for his diabetes mellitus, the Veteran should be asked to submit all relevant treatment records or provide the VA a release form to obtain those records on his behalf. The matters are REMANDED for the following action: 1. Obtain the Veteran’s VA medical treatment records since August 2017. 2. Request that the Veteran identify all private providers who have treated him for diabetes mellitus, neuropathy, or retinopathy and either submit those records himself or complete a release form to allow the VA to obtain those records on his behalf. 3. After the records requested above have been obtained, arrange for the Veteran to undergo a VA eye examination. The examiner should opine whether it is at least as likely as not that the Veteran has an eye condition, to include retinopathy, that is secondary to or aggravated by his diabetes mellitus. A full rationale for all opinions expressed must be provided. The examiner should discuss the August 2015 letter by the Veteran’s private doctor that the Veteran has diabetic retinopathy. The examiner should also discuss the August 2019 VA central nervous system and neuromuscular disease examination that suggests that the Veteran has partial right eye blindness as a residual of a stoke caused by atherosclerosis buildup in the carotid arteries caused by hyperglycemia. 4. After the records requested above have been obtained, arrange for the Veteran to undergo a VA neurological examination of his upper and lower extremities. The examiner should opine whether it is at least as likely as not that the Veteran has neuropathy of his upper or lower extremities that is secondary to or aggravated by his diabetes mellitus. The examiner should discuss the August 2015 letter by the Veteran’s private doctor that the Veteran has diabetic neuropathy. The examiner should also discuss the August 2019 VA central nervous system and neuromuscular disease examination that suggests that the Veteran has lower extremity weakness as a residual of a stoke caused by atherosclerosis buildup in the carotid arteries caused by hyperglycemia. H. SEESEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Christensen The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.