Citation Nr: 20005812 Decision Date: 01/24/20 Archive Date: 01/23/20 DOCKET NO. 10-07 283 DATE: January 24, 2020 REMANDED Entitlement to service connection for peripheral neuropathy of the bilateral lower extremities, to include as due to exposure to herbicide agents and secondary to service-connected type II diabetes mellitus (“diabetes mellitus”), is remanded. REASONS FOR REMAND The Veteran had active military service from May 1967 to May 1970. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2009 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In January 2014, the Veteran testified at a Board hearing. The transcript of the hearing is of record. However, the Veterans Law Judge (VLJ) who conducted the hearing is no longer available to participate in the Veteran’s appeal. The Veteran was given another opportunity to appear at a hearing before a VLJ who would decide the claim. See August 2017 BVA Letter. However, the Veteran did not invoke his right to appear at an additional hearing, and as such, the Board will proceed with adjudication. See November 2017 Hearing Request. By way of background, in June 2014, the Board reopened the Veteran’s claim for entitlement to service connection for peripheral neuropathy of the bilateral lower extremities and remanded the issue for further evidentiary development. In January 2018, the Board again remanded the issue to obtain an opinion on whether the Veteran’s service-connected diabetes mellitus aggravated and/or caused the Veteran’s peripheral neuropathy of the bilateral lower extremities. The Board finds that additional remand is required to the Agency of Original Jurisdiction (AOJ), as the medical opinion from the VA examiner is incomplete. Accordingly, the Board remands this case for further evidentiary development and adjudication. 1. Entitlement to service connection for peripheral neuropathy of the bilateral lower extremities, to include as due to exposure to herbicide agents and secondary to service-connected diabetes mellitus, is remanded. The Board’s review of the claims file reveals that further action on the claim of entitlement to service connection for peripheral neuropathy of the bilateral lower extremities is needed. In the January 2014 hearing, the Veteran attested that he sought treatment for his peripheral neuropathy of the bilateral lower extremities sometime between 2006 and 2011. The Veteran stated that his peripheral neuropathy of the bilateral lower extremities is due to his diabetes mellitus. The Veteran also stated that he was exposed to herbicide agents. The Board notes that the Veteran was service connected for diabetes from May 1, 2009 to January 1, 2012 until service connection was severed. A review of the records shows that the Veteran was afforded VA examinations in September 2009, October 2010, and August 2018. The September 2009 examiner determined that the Veteran did not have diabetes mellitus. The October 2010 examiner also determined that the Veteran did not have diabetes mellitus and as such diagnosed the Veteran with lumbar spinal stenosis with radiculopathy of bilateral lower extremities. Despite the September 2009 and October 2010 examiners’ assessment, the medical evidence of record shows that the Veteran was prescribed glucose test strip in February 2009 and his diabetes mellitus was treated with Glipizide in May 2009. See October 2011 CAPRI. In March 2010, the Veteran was diagnosed with diabetes mellitus with diabetic neuropathy. The August 2018 examiner determined that the Veteran does not have a diabetic peripheral neuropathy of the lower extremities and opined that the Veteran’s claimed condition is less likely than not incurred in or caused by the claimed in-service injury, event or illness. The examiner explained that the Veteran’s symptoms are consistent with bilateral cubital tunnel syndrome and lumbar radiculopathy. The examiner further explained that peripheral neuropathy is only considered to be a condition presumably associated with herbicide exposure if the condition is 10 percent disabling within one year of exposure. As the Veteran did not report the onset of peripheral neuropathy until 2007, the Veteran’s claimed peripheral neuropathy is less likely than not attributable to herbicide exposure in service. Additionally, the examiner opined that the Veteran’s claimed condition is less likely than not proximately due to or the result of the Veteran’s service-connected diabetes mellitus as the Veteran’s diabetes mellitus is well-controlled. Further, the examiner stated that although an electromyography (EMG) study noted polyneuropathy in the small fibers, which can be seen in diabetic neuropathy, the Veteran’s claimed peripheral neuropathy is consistent with bilateral cubital tunnel syndrome and lumbar radiculopathy. As such, the Veteran’s condition is less likely than not proximately due to or the result of the Veteran’s service-connected diabetes mellitus from May 2009 to January 2012. For the same reasons, the examiner also opined that it is less likely than not that the Veteran’s claimed peripheral neuropathy was aggravated beyond its natural progression by diabetes mellitus from May 2009 to January 2012. The Board finds that the August 2018 examiner’s opinion is incomplete. The matter is REMANDED for the following action: Obtain an addendum to the August 2018 VA examination report. The claims file must be made available to be reviewed by the examiner. The Veteran should be scheduled for a physical examination if determined necessary. The examiner must state whether it is at least as likely as not (a fifty percent probability or greater) that the Veteran’s peripheral neuropathy of the bilateral lower extremities was (a) caused by or has been (b) aggravated (worsened beyond the natural progress of the disorder) by diabetes mellitus from May 1, 2009 to January 1, 2012. In particular, if the examiner concludes that the Veteran’s condition is consistent with bilateral cubital tunnel syndrome and lumbar radiculopathy, then the examiner must provide a thorough rationale/explanation as to why. The Board is seeking clarification as to the rationale for the August 2018 VA examiner’s statement: While the EMG noted polyneuropathy in the small fibers which can be seen in diabetic neuropathy, the Veteran’s claimed peripheral neuropathy is consistent with bilateral cubital tunnel syndrome and lumbar radiculopathy and it is less likely than not that the Veteran’s claimed peripheral neuropathy was aggravated beyond its natural progression by Diabetes Mellitus from May 1, 2009 to January 1, 2012. Specifically, it would be helpful to the Board if the examiner can address the diagnostic testing/support for the conclusion that the Veteran has bilateral cubital tunnel syndrome and lumbar radiculopathy. (Continued on the next page)   A detailed rationale for all opinions must be provided. If the examiner is unable to offer the requested opinion, it is essential that the examiner offer a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. S. HENEKS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board P. Noh, Associate Counsel 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.