Citation Nr: 21062888 Decision Date: 10/12/21 Archive Date: 10/12/21 DOCKET NO. 12-20 208 DATE: October 12, 2021 REMANDED An initial rating in excess of 20 percent for diabetic peripheral neuropathy of the left lower extremity is remanded. An initial rating in excess of 20 percent for diabetic peripheral neuropathy of the right lower extremity is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1968 to May 1971 and from August 1971 to August 1977. This current matter was previously before the Board of Veterans Appeals (Board) in November 2014, when it was remanded for further development. Then, in February 2018, the Board denied an initial rating greater than 10 percent for diabetic peripheral neuropathy of the bilateral lower extremities. The Veteran then appealed that decision to the United States Court of Appeals for Veterans Claims (Court), and, in a January 2019 Joint Motion for Remand (JMR), the Court vacated the November 2018 Board decision and remanded the matter for further development. In July 2019, the Board granted an initial rating of 20 percent, but no higher, for the diabetic peripheral neuropathy of the Veteran's bilateral lower extremities. The Veteran then appealed that decision to the Court, and, in an April 2021 Memorandum Decision, the Court remanded the matter for further development. Specifically, the Court found that the Board did not provide adequate reasons and bases because it failed to discuss the Veteran's use of medication and any ameliorative effects of that use. Regrettably, for the reasons discussed below, the Board finds that another remand is necessary in order to adjudicate this appeal. The Veteran's most recent VA examination for his diabetic peripheral neuropathy occurred in October 2015, nearly 6 years ago. The Board finds that the October 2015 VA examination lacks necessary medical evidence needed to decide the claim. Thus, it is inadequate for rating purposes. Specifically, the Board notes that the October 2015 VA examination report fails to mention any medications the Veteran takes for his diabetic peripheral neuropathy. His VA treatment records show that, throughout the course of the appeal, he has been prescribed the medication gabapentin to treat his diabetic peripheral neuropathy. Significantly, the Board notes that the Veteran was initially prescribed to take 300 milligrams (mg) once a day in January 2009. In September 2009, that dosage was increased to 300mg twice a day. Then, in April 2015, the dosage was increased to 300mg three times a day. As the October 2015 VA examiner did not discuss the Veteran's medication use, it is unclear whether the examiner considered how any ameliorative effects of the Veteran's medications may impact the severity of his diabetic peripheral neuropathy. Additionally, the October 2015 VA examination does not comment on whether the diabetic peripheral neuropathy of the Veteran's lower extremities results in non-sensory manifestations, such as difficulty standing, walking, running, and/or squatting. While the medical evidence of record reflects that the Veteran has sensory deficits due to his diabetic peripheral neuropathy, it is unclear whether such deficits results in functional impairment beyond "wholly sensory" symptoms. Furthermore, review of the Veteran's VA treatment records shows that, since his last VA examination, he has reported experiencing an increase in pain, burning, tingling, and numbness sensations in his feet and toes bilaterally. Further, in August 2018, he was prescribed a new medication, lidocaine gel, for his peripheral neuropathy pain. See June 2021 CAPRI records. The Board sincerely regrets the additional delay but finds that a remand is warranted to obtain a new VA examination to assess the current severity of the diabetic peripheral neuropathy of the Veteran's lower extremities. Accordingly, these matters are REMANDED for the following action: Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of the service-connected diabetic peripheral neuropathy of his lower extremities. The Veteran's electronic claims file must be made available to the examiner in conjunction with this examination, and the examiner's review of the folder should be annotated in the examination report. All testing deemed necessary by the examiner should be performed, including any pertinent nerve conduction studies, and the results should be reported in detail. The examiner should provide a full description of the service-connected diabetic peripheral neuropathy of the Veteran's lower extremities, including whether nerve involvement is wholly sensory, and report all signs and symptoms associated with these disorders. The examiner should specifically assess the current severity of paralysis of each nerve involved, identify whether any incomplete nerve paralysis is mild, moderate, moderately severe, or severe. To the extent possible, the examiner's assessment of the current severity of the Veteran's bilateral diabetic peripheral neuropathy should discount the ameliorative effects of any medication the Veteran is taking. In other words, what is the current severity of the Veteran's bilateral diabetic peripheral neuropathy if he were not taking medication? The examiner is advised that the Veteran is competent to report his symptoms and history and that such reports must be acknowledged and considered in formulating any opinion. If his reports are discounted, the examiner should provide a reason for doing so. A clear rationale for all requested opinions shall be provided. A discussion of the facts and medical principles involved would be of considerable assistance to the Board. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why. No action is required of the Veteran until he is notified by VA. However, he is advised of his obligation to cooperate in ensuring the duty to assist is satisfied. Kowalski v. Nicholson, 19 Vet. App. 171 (2005). His failure to report for a VA medical examination may impact the determination made. 38 C.F.R. § 3.655. The Veteran is also advised that he has the right to submit additional evidence and argument with respect to this matter. Kutscherousky v. West, 12 Vet. App. 369 (1999). This appeal must be afforded prompt treatment. THERESA M. CATINO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Benson, 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.