Citation Nr: 20044575 Decision Date: 07/02/20 Archive Date: 07/02/20 DOCKET NO. 16-42 747 DATE: July 2, 2020 REMANDED Entitlement to service connection for a right upper extremity nerve disorder, to include as secondary to a service-connected disability, is remanded. Entitlement to service connection for a left upper extremity nerve disorder, to include as secondary to a service-connected disability, is remanded. REASONS FOR REMAND The Veteran had active service from August 1966 to June 1968, to include service in Vietnam. In May 2019, the Veteran provided sworn testimony at a hearing before the undersigned Veterans Law Judge (VLJ). This matter returns to the Board following a September 2019 remand which directed the AOJ to accord the Veteran a VA examination and obtain a medical opinion concerning the diagnoses and etiologies of the Veteran’s claimed peripheral neuropathy. During the pendency since the remand, the RO granted service connection for left and right lower extremity peripheral neuropathy, and those issues are no longer on appeal. The issues of left and right upper extremity diabetic peripheral neuropathy have returned to the Board for adjudication. Service connection for a left and right upper extremity nerve disorder The Veteran contends that he has upper left and right extremity diabetic peripheral neuropathy secondary to service-connected diabetes mellitus. The Board finds there is insufficient evidence to adjudicate these claims. Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110. Generally, the evidence must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 505 (1995). Service connection may be established for any disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310. To prevail on the issue of entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) nexus evidence establishing a connection between the service-connected disability and the current disability. Wallin v. West, 11 Vet. App. 509, 512 (1998). On VA examination in December 2019, the examiner indicated that there was no evidence of upper extremity diabetic peripheral neuropathy. However, an EMG showed mild left ulnar neuropathy at the elbow and wrist. The examiner stated that these findings do not suggest a diabetic neuropathy due to the isolate location of the findings. Diabetes mellitus does not cause carpal tunnel syndrome; this results from abnormalities in the flexor retinaculum. Ulnar neuropathy was not noted on physical examination as sensation was intact along the ulnar nerve dermatomal planes. The examiner further opined that there was no objective evidence of diabetic peripheral neuropathy. On VA examination in April 2020, the examiner found that the Veteran exhibited no symptoms of upper extremity diabetic peripheral neuropathy. While the December 2019 opinion notes that the Veteran’s upper extremity nerve conditions are not related to his diabetes, there is no discussion in any opinion as to whether the Veteran’s upper extremity nerve conditions are directly related to his active service or are secondary to any other service-connected disability. The Board recognizes that, while the Veteran’s claim must be specific as to the nature of his claimed disability, he is not required to know its exact diagnosis and etiology when seeking service connection. While he has claimed his upper extremity nerve condition as diabetic peripheral neuropathy, the fact that a VA examiner has determined his condition is not diabetic neuropathy, but another nerve condition, does not excuse VA from its duty to assist the Veteran by obtaining an opinion as to the etiology of that upper extremity nerve condition. The Board has recharacterized the Veteran’s claims, above, to reflect a more-broad consideration of his diagnosed nerve conditions as discussed in his December 2019 VA examination, to include carpal tunnel syndrome. As such, a remand is necessary in order to obtain an additional medical opinion concerning the Veteran’s left and right upper extremity nerve conditions. These matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records regarding the Veteran, particularly concerning the Veteran’s upper extremity nerve conditions. Contact the Veteran to determine whether there are any additional relevant private treatment records and obtain any necessary authorizations for such records. 2. Return the claims file, to include a copy of this remand, to the examiner who conducted the April 2020 VA examination, or another qualified examiner, to render an opinion on the appropriate diagnoses and etiologies of the Veteran’s upper extremity nerve condition(s). The examiner should review the claims file and indicate such on the examination report. The Veteran may be recalled for examination if deemed necessary. The examiner should address the nature and etiology of the Veteran’s current diagnosed upper extremity nerve condition(s), to include carpal tunnel syndrome, and whether any such diagnosed disorder(s) is(are) as likely as not (50 percent probability or better) related to his active service or have been caused or aggravated by any of his service-connected disabilities. A complete rationale for any opinion expressed must be provided. THERESA M. CATINO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M.E. Lee 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.