Citation Nr: 21002043 Decision Date: 01/12/21 Archive Date: 01/12/21 DOCKET NO. 16-48 164 DATE: January 12, 2021 REMANDED Entitlement to service connection for a cervical spine disability is remanded. Entitlement to service connection for a left shoulder disability is remanded. Entitlement to service connection for a right shoulder disability is remanded. Entitlement to service connection for type II diabetes mellitus is remanded. Entitlement to service connection for left upper extremity peripheral neuropathy, to include as secondary to type II diabetes mellitus, is remanded. Entitlement to service connection for right upper extremity peripheral neuropathy, to include as secondary to type II diabetes mellitus, is remanded. Entitlement to service connection for left lower extremity peripheral neuropathy, to include as secondary to type II diabetes mellitus, is remanded. Entitlement to service connection for right lower extremity peripheral neuropathy, to include as secondary to type II diabetes mellitus, is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1984 to January 2008, with an additional period of active duty for training (ADT) from November 1979 to May 1980. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued in April 2016 by a Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded the issues on appeal in October 2020 for further development. The requested medical opinions were obtained in October 2020, and therefore the directives have been substantially complied with and the matter is again properly before the Board. D’Aries v. Peake, 22 Vet. App. 97, 105 (2008); Stegall v. West, 11 Vet. App. 268, 271 (1998). In October 2020, the Board also denied entitlement to an increased rating for hypertension, which the Veteran did not appeal. 38 U.S.C. § 7266. As such, that issue is no longer on appeal. 38 C.F.R. § 20.1100. In October 2020 the Board also remanded the claims of service connection for a low back disability, a right knee disability, and left and right hip disabilities. While on remand, service connection for these claimed disabilities was granted in a rating decision issued in November 2020. As this constitutes a full grant of the benefits sought with respect to those issues, they are no longer part of the current appeal. Ab v. Brown, 6 Vet. App. 35 (1993). 1. Entitlement to service connection for a cervical spine disability, left and right shoulder disabilities, and type II diabetes mellitus. In accordance with the October 2020 Board remand, the RO obtained medical opinions concerning the etiology of the cervical spine disability, left and right shoulder disabilities and type II diabetes mellitus. The examiner provided negative nexus opinions for each claimed disability. However, as a supporting rationale for each negative opinion the examiner only stated that there was no evidence of treatment for the claimed disabilities either in service or following separation from service. A medical opinion based solely on the absence of documentation in the record is inadequate. Dalton v. Peake, 21 Vet. App. 23 (2007). As such, the Board must remand the claims so that another opinion concerning the etiology of the claimed cervical spine disability, left and right shoulder disabilities and type II diabetes mellitus can be obtained. Id. 2. Entitlement to service connection for bilateral upper and lower extremity peripheral neuropathy and entitlement to a TDIU. Concerning entitlement to service connection for bilateral upper and lower extremity peripheral neuropathy, being claimed as secondary to diabetes mellitus, and entitlement to a TDIU, the Board finds that any determinations with respect to the remanded claims would materially affect a determination concerning the claims for service connection for peripheral neuropathy and a TDIU. As such, they are inextricably intertwined with the service connection claims being remanded and must therefore be remanded as well. Harris v. Derwinski, 1 Vet. App. 180 (1991) (two issues are “inextricably intertwined” when they are so closely tied together that a final Board decision on one issue cannot be rendered until the other issue has been considered). 1. Obtain a medical opinion concerning the etiology of the Veterans cervical spine disability, left and right shoulder disabilities, and type II diabetes mellitus. The examiner should answer the following: a) Is it at least as likely as not (a fifty percent probability or greater) that the cervical spine disability is causally related to the Veteran’s active service? b) Is it at least as likely as not (a fifty percent probability or greater) that the left shoulder disability is causally related to the Veteran’s active service? c) Is it at least as likely as not (a fifty percent probability or greater) that the right shoulder is causally related to the Veteran’s active service? d) Is it at least as likely as not (a fifty percent probability or greater) that the type II diabetes mellitus is causally related to the Veteran’s active service? A detailed rationale for the opinion must be provided. The examiner is reminded that the term “as likely as not” does not mean “within the realm of medical possibility,” but rather that the evidence of record is so evenly divided that, in the examiner’s expert opinion, it is as medically sound to find in favor of the proposition as against it. LESLEY A. REIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Wendell, 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.