Citation Nr: 20048084 Decision Date: 07/17/20 Archive Date: 07/17/20 DOCKET NO. 14-21 918 DATE: July 17, 2020 REMANDED Entitlement to a disability rating in excess of 20 percent for diabetes mellitus, type II, is remanded. Entitlement to a disability rating in excess of 20 percent for peripheral neuropathy of the right upper extremity is remanded. Entitlement to a disability rating in excess of 20 percent for peripheral neuropathy of the left upper extremity is remanded. Entitlement to a disability rating in excess of 10 percent for peripheral neuropathy of the right lower extremity is remanded. Entitlement to a disability rating in excess of 10 percent for peripheral neuropathy of the left lower extremity is remanded. Entitlement to a total disability rating due to individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran had active service from January 1968 to January 1970. This current appeal comes before the Board of Veterans’ Appeals (Board) on appeal from a December 2010 rating decision. The Veteran died in October 2017 while these matters were pending, and the Appellant is his surviving spouse who has been accepted as a substitute claimant. In April 2018, the Board remanded this appeal. The Appellant seeks increased ratings for the Veteran’s diabetes, bilateral upper extremity peripheral neuropathy, bilateral lower extremity peripheral neuropathy, as well as a TDIU. Also relevant to this appeal is the fact that the Veteran is service connected for diabetic retinopathy in both eyes and diabetic nephropathy. The code governing the compensation for diabetes code contemplates an analysis of complications from diabetes. 38 U.S.C. § 1155; 38 C.F.R. § 4.119, Diagnostic Code 7913. Under this code, increased compensation for diabetes itself can affect the propriety of separate compensation for complications of diabetes. Id. Thus, these conditions cannot be resolved without a complete understanding of the Veteran’s diabetic complications. Accordingly, all issues on appeal must be decided or remanded together. Prior to the Veteran’s death, the most recent VA examination performed was conducted in April 2014 and appears to indicate that the only complication from diabetes that the Veteran suffered at that time was peripheral neuropathy. This appears to conflict with his award of service connection for retinopathy and nephropathy. Additionally, toward the end of the Veteran’s life, he began to suffer from osteomyelitis in his toes and macular edema in his eyes, and VA treatment records appear to indicate that these conditions are the result of his diabetes. As this information appears to conflict with the most recent VA examination report, a remand is required for an opinion as to whether these conditions are related to the Veteran’s diabetes. In particular, the Veteran’s macular edema was one of two conditions that appears to have been instrumental in his decision to discontinue working according to an October 2017 VA treatment note. Accordingly, these matters are REMANDED for the following actions: 1. Obtain an addendum opinion from an appropriate clinician as to whether the Veteran’s macular edema and osteomyelitis are at least as likely as not related to his service-connected diabetes mellitus, type II. (a.) With respect to the Veteran’s macular edema, in the event that the clinician determines that this condition is related to the Veteran’s diabetes, the examiner should identify to what extent the Veteran’s visual impairment was the result of his macular edema and diabetic retinopathy rather than nonservice connected visual disabilities. (b.) In the event that the clinician determines that either or both of these conditions (macular edema and osteomyelitis) is(are) at least as likely as not related to the Veteran’s diabetes, the clinician should comment, to the extent possible, on the Veteran’s ability to work or function in a worklike setting prior to his death. 2. Then, and after any other indicated development has been completed, readjudicate the issues on appeal. If the benefits sought are not granted to the Appellant’s satisfaction, send the Appellant a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. THERESA M. CATINO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Steven Johnston, 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.