Citation Nr: 20006235 Decision Date: 01/24/20 Archive Date: 01/24/20 DOCKET NO. 17-28 732 DATE: January 24, 2020 REMANDED Entitlement to service connection for left lower extremity peripheral neuropathy secondary to service-connected diabetes mellitus, type II is remanded. Entitlement to service connection for left upper extremity peripheral neuropathy secondary to service-connected diabetes mellitus, type II is remanded. Entitlement to service connection for right lower extremity peripheral neuropathy secondary to diabetes mellitus, type II is remanded. Entitlement to service connection for right upper extremity peripheral neuropathy secondary to diabetes mellitus, type II is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1969 to November 1970. 1. Entitlement to service connection for left lower extremity peripheral neuropathy secondary to service-connected diabetes mellitus, type II is remanded. 2. Entitlement to service connection for left upper extremity peripheral neuropathy secondary to service-connected diabetes mellitus, type II is remanded. 3. Entitlement to service connection for right lower extremity peripheral neuropathy secondary to diabetes mellitus, type II is remanded. 4. Entitlement to service connection for right upper extremity peripheral neuropathy secondary to diabetes mellitus, type II is remanded. The Veteran contends that he has a current diagnosis of left and right lower and upper extremity peripheral neuropathy secondary to his service-connected diabetes mellitus disability. A May 2016 VA diabetic sensory-motor peripheral neuropathy Disability Benefits Questionnaire (DBQ) reflects that the Veteran has a diagnosis of diabetes mellitus as well as diabetic peripheral neuropathy. His dominant hand was noted to be his right hand. The examiner indicated the symptoms attributable to diabetic peripheral neuropathy were moderate constant pain in both the lower and upper extremities, mild intermittent pain in the right lower extremity, severe intermittent pain in the left lower extremity, mild paresthesias and/or dysesthesias in the left upper extremity, mild numbness in the left upper extremity, moderate numbness in the right lower extremity, and severe numbness in the left lower extremity. The examiner noted the Veteran had a gunshot wound on the right wrist which, according to the claims file, occurred in May 2009. Deep tendon reflexes were absent in the right and left biceps and left ankle, decreased in the left knee, and normal in the right knee. Muscle atrophy was noted in the right hypothenar muscle (right hand). The examiner noted the Veteran had mild incomplete paralysis of the right and left radial nerve and moderate incomplete paralysis of the sciatic nerve. The examiner ordered an electromyography (EMG) of all four extremities. A July 21, 2016 EMG consult response shows findings of all four extremities were consistent with distal sensory-motor peripheral neuropathy of the lower extremities, severe right ulnar neuropathy probably partly due to a previous gunshot wound to the right wrist and partly due to entrapment of the nerve at the elbow, and mild right distal sensory-motor peripheral neuropathy probably secondary to the previous gunshot wound. During an August 2016 VA diabetic sensory-motor peripheral neuropathy DBQ shows that the Veteran reported having tingling and numbness in both upper and lower extremities for the past 10 years. He also stated that he had a gunshot wound to the right wrist in approximately 2009, as well as cervical stenosis surgery in the 1990’s. His left hand was noted to be his dominant hand. The examiner stated the Veteran did not have, nor did he ever have, a diagnosis of diabetic peripheral neuropathy. The examiner noted the July 2016 EMG results and the interpretation at the time that showed severe right ulnar neuropathy, which was noted to be probably partly due to the previous gunshot wound to the right wrist and partly due to entrapment of the nerve at the elbow. The EMG also showed mild right distal sensory-motor peripheral neuropathy that was also noted to be probably secondary to the previous gunshot wound. The examiner stated the Veteran reported symptoms of tingling and numbness in his extremities many years prior to the onset of diabetes and the Veteran’s diabetes is very well controlled and hence not likely a complication of diabetes. Unfortunately, the Board finds the August 2016 VA examiner’s opinion to be inadequate. First, there is a conflict between the May 2016 DBQ which showed the Veteran has a diagnosis of bilateral upper and lower diabetic peripheral neuropathy and the August 2016 VA examiner’s finding of no diagnosis of diabetic peripheral neuropathy. The August 2016 VA examiner went so far as to state the Veteran never had a diagnosis of diabetic peripheral neuropathy. Additionally, the August 2016 VA examiner’s opinion was speculative based on the July 2016 EMG finding that any neuropathy shown was probably partly due to the previous gunshot wound to the right wrist and/or partly due to entrapment of the nerve at the elbow. Establishing service connection on a secondary basis requires evidence sufficient to show that a current disability exists and that the current disability was either proximately caused by or proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439 (1995). The opinion provided by the August 2016 VA examiner was not responsive to the issue of whether the Veteran has a diagnosis of left lower extremity peripheral neuropathy secondary to service-connected diabetes mellitus, type II. Where 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 (2007). As the examination and opinion report is inadequate, it cannot serve as the basis of a denial of entitlement to service connection. Therefore, the Board finds that a new examination and opinion is necessary to determine whether the Veteran has a left lower extremity peripheral neuropathy disability that was caused or aggravated by his service-connected diabetes mellitus, type II. The matters are REMANDED for the following action: 1. Obtain and associate any outstanding VA treatment records pertinent to the issues on appeal. 2. Thereafter, schedule the Veteran for a VA examination with an appropriate examiner to determine if the Veteran has a diagnosis of lower left, upper left, lower right, and upper right peripheral neuropathy, and if so, whether it is caused by or aggravated by the Veteran’s service-connected diabetes mellitus, type II disability. The examiner must review the record and should note that review in the report. A rationale for all opinions should be provided. The examiner should provide the following opinions: (Continued on the next page)   a) Opine whether it is at least as likely as not (50 percent probability or greater) that any diagnosed lower left, upper left, lower right, or upper right peripheral neuropathy was caused by the Veteran’s service-connected diabetes mellitus, type II. b) Opine whether it is at least as likely as not (50 percent probability or greater) that any diagnosed lower left, upper left, lower right, or upper right peripheral neuropathy was aggravated by the Veteran’s service-connected diabetes mellitus, type II. Thomas H. O'Shay Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Mitchell, 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.