Citation Nr: 21065353
Decision Date: 10/25/21	Archive Date: 10/25/21

DOCKET NO. 13-30 930A
DATE: October 25, 2021

REMANDED

Entitlement to service connection for peripheral neuropathy, left upper extremity, as secondary to service-connected diabetes mellitus type II is remanded.

Entitlement to service connection for peripheral neuropathy, right upper extremity, as secondary to service-connected diabetes mellitus type II is remanded.

REASONS FOR REMAND

The Veteran served on active duty from January 1965 to December 1984. He testified before the undersigned Veteran's Law Judge in January 2017; a transcript of the hearing is associated with the record. The appeal was most recently remanded in June 2021. There has not been substantial compliance with the remand directives and the claims must be remanded again. Stegall v. West, 11 Vet. App. 268 (1998).

1. Peripheral neuropathy, left upper extremity, as secondary to service-connected diabetes mellitus type II is remanded.

2. Peripheral neuropathy, right upper extremity, as secondary to service-connected diabetes mellitus type II is remanded.

The claims must be remanded again because the July 2021 VA medical opinion obtained after the most recent Board remand is inadequate. The examiner concluded that the Veteran's symptoms are related to a nonservice-connected cervical spine disability, but that opinion appears to be based on a recitation and review of prior medical opinions, without independent consideration by this opinion provider. The examiner did not address private treatment records that diagnosed the Veteran with diabetic neuropathy and polyneuropathy in November 2016.  The opinion is further inadequate as to whether the diagnosed disability is secondary to the Veteran's service-connected diabetes as it is based on an incorrect standard of aggravation.

The matters are REMANDED for the following action:

1. Obtain an addendum opinion from an appropriate clinician regarding the likely etiology of the diagnosed upper extremity neurological disabilities. Copies of all pertinent records must be made available to the examiner for review. If the examiner determines that an opinion cannot be provided without an examination, one should be scheduled. The examiner must answer the following questions:

(a) Identify any upper extremity neurological diagnosis since 2011.  The examiner must specifically discuss the significance of the 2017 EMG finding of mild upper extremity peripheral neuropathy. 

(b) Is it at least as likely as not that any identified upper extremity neurological disability is (i) caused by the service-connected diabetes mellitus or (ii) aggravated by (defined as any increase in disability) the service-connected diabetes mellitus?  Why or why not?

The examiner must provide a full rationale for each opinion given and cannot merely cite to previous VA examinations. If the examiner is unable to provide an opinion without resort to speculation, he or she should explain why this is so and what, if any, additional evidence would be necessary before an opinion could be rendered.

2. Confirm that the VA medical opinion provided comports with this remand, specifically that the standard for the secondary aggravation opinion is any increase in disability, not the standard of beyond the natural progression as noted on the examination form itself. If not, get an addendum.

 

M.E. Larkin

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	T. Jarman, 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.