Citation Nr: 21000389 Decision Date: 01/05/21 Archive Date: 01/05/21 DOCKET NO. 16-45 146 DATE: January 5, 2021 REMANDED Entitlement to a rating in excess of 10 percent for peripheral neuropathy, right hand (claimed as carpal tunnel) is remanded. Entitlement to a rating in excess of 10 percent for peripheral neuropathy, left hand (claimed as carpal tunnel) is remanded. Entitlement to service connection for peripheral neuropathy right lower extremity to include as secondary to service-connected diabetes mellitus type II is remanded. Entitlement to service connection for peripheral neuropathy left lower extremity to include as secondary to service-connected diabetes mellitus type II is remanded. Entitlement to service connection for rosacea (claimed as skin condition) to include as secondary to service-connected diabetes mellitus type II is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1965 to November 1968. The issues are on appeal from a June 2014 rating decision. Although the RO adjudicated and denied the service connection claims in a July 2012 rating decision, the Board finds this determination did not become final with regard to the service connection issues on appeal because in a subsequent September 2012 statement, received by the RO within one year of the July 2012 rating decision, the Veteran stated that he missed VA examinations due to being in Florida during the winter months and requested that they be rescheduled. Therefore, the initial claims remained pending at the time of the April 2014 request for examinations. In August 2020, the Veteran testified at a virtual Board hearing before the undersigned Veteran’s Law Judge (VLJ). A copy of the transcript is of record. 1. Entitlement to a rating in excess of 10 percent for peripheral neuropathy, right hand (claimed as carpal tunnel) is remanded. 2. Entitlement to a rating in excess of 10 percent for peripheral neuropathy, left hand (claimed as carpal tunnel) is remanded. The Veteran’s testimony during the August 2020 Board hearing reflects that his upper extremity peripheral neuropathy has worsened since the last VA examination conducted in 2014. Considering the indications of worsening, and that six years have passed since his last VA Peripheral Neuropathy examinations, the Veteran should be afforded new VA examinations to assess the current severity of his service-connected peripheral neuropathy of the upper extremities. 3. Entitlement to service connection for peripheral neuropathy right lower extremity to include as secondary to service-connected diabetes mellitus type II is remanded. 4. Entitlement to service connection for peripheral neuropathy left lower extremity to include as secondary to service-connected diabetes mellitus type II is remanded. The Veteran contends that he has peripheral neuropathy of the lower extremities related to his active service, including as due to exposure to herbicide agents in the Republic of Vietnam. As an initial matter, the Board notes that the Veteran served in the Republic of Vietnam during the Vietnam War era and is presumed to have been exposed to herbicides during that service. The Veteran was afforded a VA examination in May 2014. According to the May 2014 VA examination report, it was noted that the Veteran had a nerve conduction study that does not demonstrate a peripheral sensory neuropathy because of his paraplegia, specifically that there were no physical or nerve conduction study findings. However, subsequent VA treatment records indicate the Veteran has poor sensation in his feet. It is unclear whether the examiner was opining that the Veteran does not have sensory neuropathy in his lower extremities or that such neuropathy is not related to his active service and/or diabetes mellitus type II. Additionally, according to a private physician report dated in October 2011, the Veteran’s private physician, K. Y., M.D., concluded that the Veteran has lower neuropathy related to diabetes and exposure to toxins. Thus, a remand is warranted for an addendum opinion regarding the Veteran’s claimed lower extremity peripheral neuropathy. 5. Entitlement to service connection for rosacea to include as secondary to service-connected diabetes mellitus type II is remanded. The Veteran contends that he has a skin condition related to his active service which began shortly after his active service. The Veteran was afforded a VA examination in May 2014. At that time the examiner noted that there was no evidence of a skin dermatitis or rosacea, but also noted that rosacea was not caused by diabetes. However, according to a June 2014 VA treatment record, the Veteran was observed to have seborrheic keratosis on the left cheek as well as redness of the skin on the feet and small poorly raised lesion which reportedly bleeds on occasion. While a December 2018 VA examination reflects diagnoses of non-healing stage 3 pressure ulcer and cellulitis and right heel ulcer which are associated with his service-connected diabetes mellitus, no further evaluation or opinion has been provided regarding the noted seborrheic dermatitis. Additional VA treatment records reflect that the Veteran is prescribed hydrocortisone cream for a skin condition. Thus, a remand is warranted for an addendum opinion regarding the Veteran’s claimed skin condition. The matters are REMANDED for the following actions: 1. Schedule the Veteran for a VA examination to assess the current nature and severity of his peripheral neuropathies of the bilateral upper and lower extremities, associated with diabetes mellitus. The claims folder must be provided to and reviewed by the examiner as part of the examination. All tests, studies, and evaluations should be performed as deemed necessary by the examiner, and the results of any testing must be included in the examination report. The examiner is asked to describe the current nature and severity of the Veteran’s peripheral neuropathies in detail in accordance with VA rating criteria. The rationale for all opinions expressed must be provided. 2. Return the claims file to the VA examiner who performed the May 2014 VA examination (or a suitable substitute) for an addendum medical opinion regarding the nature and etiology of the Veteran’s claimed lower extremity peripheral neuropathy. The entire claims file must be made available to, and be reviewed by, the VA examiner. Another examination is not required; however, if the VA examiner indicates that he cannot respond to the Board’s questions without examination of the Veteran, another examination should be afforded to the Veteran Following examination of the Veteran and review of the claims file, the examiner must indicate whether the Veteran has had peripheral neuropathy involving either lower extremity at any point on appeal. The examiner should opine whether any identified peripheral neuropathy of either lower extremity found at least as likely as not (50 percent or greater probability) began in or are otherwise related to the Veteran’s active military service, to include his in-service herbicide agent exposure. A negative opinion based solely on the fact that the Veteran does not have the type of peripheral neuropathy that is presumptively associated with exposure to herbicide agents is not sufficient. Alternatively, the examiner should opine whether the Veteran’s claimed lower extremity peripheral neuropathy is at least as likely as not either (a) caused by; or (b) aggravated (i.e., chronically worsened) by the Veteran’s service-connected diabetes mellitus. All findings should be reported in detail and all opinions must be accompanied by a clear rationale. The examiner is asked to take into consideration the Veteran’s lay statements, the full service treatment records, and post-service medical evidence including the October 2011 opinion by K.Y., M.D. and reconcile any conflicting opinions. 3. Return the claims file to the VA examiner who performed the May 2014 VA examination (or a suitable substitute) for an addendum medical opinion regarding the nature and etiology of the Veteran’s skin condition. The entire claims file must be made available to, and be reviewed by, the VA examiner. Another examination is not required unless deemed necessary by the VA examiner. Following review of the claims file, the examiner should opine whether the Veteran’s skin condition, to include seborrheic keratosis, at least as likely as not (50 percent or greater probability) began in or is otherwise related to the Veteran’s military service, to include his in-service herbicide agent exposure. A negative opinion based solely on the fact that the Veteran’s skin condition is not presumptively associated with exposure to herbicide agents is not sufficient. Alternatively, the examiner should opine whether the Veteran’s claimed skin condition is at least as likely as not either (a) caused by; or (b) aggravated (i.e., chronically worsened) by the Veteran’s service-connected diabetes mellitus. All findings should be reported in detail and all opinions must be accompanied by a clear rationale. The examiner is asked to take into consideration the Veteran’s lay statements, the full service treatment records, and post-service medical evidence including a June 2014 VA treatment record noting seborrheic keratosis on the left cheek. Cynthia M. Bruce Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Williams, 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.