Citation Nr: 21067299 Decision Date: 11/03/21 Archive Date: 11/03/21 DOCKET NO. 16-61 446 DATE: November 3, 2021 REMANDED Entitlement to service connection for right lower extremity peripheral neuropathy (PN) claimed as secondary to service-connected diabetes mellitus type II (DM) is remanded. Entitlement to service connection for left lower extremity peripheral neuropathy claimed as secondary to service-connected diabetes mellitus type II is remanded. Entitlement to service connection for right upper extremity peripheral neuropathy claimed as secondary to service-connected diabetes mellitus type II is remanded. Entitlement to service connection for left upper extremity peripheral neuropathy claimed as secondary to service-connected diabetes mellitus type II is remanded. Entitlement to service connection for bilateral foot ulcers claimed as secondary to service-connected diabetes mellitus type II is remanded. Entitlement to service connection for erectile dysfunction (ED) claimed as secondary to diabetes mellitus type II is remanded. Entitlement to special monthly compensation (SMC) based on loss of use of feet and hands is remanded. Entitlement to special monthly compensation (SMC) based on loss of use of fa creative organ is remanded. REASONS FOR REMAND The Veteran had active duty service with the U.S. Army from March 1968 to March 1970. This case comes before the Board of Veteran's Appeals (Board) on appeal from an August 2013 rating decision of the Department of Veterans Affairs (VA) agency of original jurisdiction (AOJ). In June 2021, the Veteran had a Board hearing before the undersigned Veterans Law Judge (VLJ). A transcript of that hearing is of record. Bilateral Upper/Lower Extremity PN In July 2016, the Veteran was afforded a VA examination. The VA examiner opined that the Veteran's claimed conditions were less likely than not (less than 50 percent probability) proximately due to or the result of the Veteran's service-connected condition. She noted that the medical records documented decades of long chronic thrombophlebitis which had caused severe stasis dermatitis, recurrence ulceration, recurrent deep vein thrombosis (DVT), and numbness. She noted that these all were well documented symptoms of chronic thrombophlebitis. The Board notes that the examiner only provided a causation rationale as to whether his condition was related to his service-connected disability. The examiner did not address whether his service-connected disability aggravated his disability. Therefore, the Board finds this opinion inadequate. In June 2021, the Veteran testified that he had some leg and arm pain prior to his diagnosis of DM. He stated that he had DVT, and this started the problems with his legs and having blood clots. He testified that his DM inflamed his conditions a little bit more. In a June 2021 private opinion, Dr. DMM noted that the Veteran had been a patient of hers since 1988. She wrote that he had a history of DM. She opined that she felt that the Veteran's neuropathy was directly related to his history of DM. The Board notes that the examiner did not provide a rationale explaining her opinion. Thus, remand is required to obtain a sufficient opinion with rationale. Bilateral Foot In July 2016, the Veteran was afforded a VA examination. The VA examiner opined that the Veteran's claimed conditions were less likely than not (less than 50 percent probability) proximately due to or the result of the Veteran's service-connected condition. The examiner noted that the May 2002 medical record documented chronic thrombophlebitis of the bilateral feet since age 20, with chronic coumadin the last 12 years, and with no history of DM at that time. She noted that the Veteran was diagnosed with DM in December 2011, 43 years after a motorcycle accident which resulted in chronic thrombophlebitis. She concluded that the Veteran's claimed condition was not related to DM. The Board notes that the examiner only provided a causation rationale as to whether his condition was related to his service-connected disability. The examiner did not address whether his service-connected disability aggravated his disability. Therefore, the Board finds this opinion inadequate. In June 2021, the Veteran testified that he believed that his disability was brought on by his DVT. However, he indicated that his service-connected DM aggravated his disability. Thus, remand is required to obtain a sufficient opinion with rationale. Erectile Dysfunction On August 2013 DM disability benefits questionnaire, documented that he was diagnosed with DM. Dr. DM opined that the Veteran's ED was at least as likely as not (at least 50 percent probability) due to DM. In July 2016, the Veteran was afforded a VA examination. The VA examiner opined that the Veteran's claimed condition was less likely than not (less than 50 percent probability) proximately due to or the result of the Veteran's service-connected condition. She noted that the 2011 medical records documented that he had a history of erection dysfunction and he was on testosterone injections. She indicated that this suggested that his ED was not related to his service-connected DM. The Board notes that the examiner only provided a causation rationale as to whether his condition was related to his service-connected disability. The examiner did not address whether his service-connected disability aggravated his disability. Therefore, the Board finds this opinion inadequate. In June 2021, he testified that he was diagnosed with ED by his private physician in 2011. However, he did not notice issues with an erection until 2015. On June 2021 Dr. DM opinion, she noted that the Veteran had been a patient of hers since 1988. She wrote that he had a history of DM. She opined that the Veteran's ED was related to his DM. The Board notes that the examiner did not provide a rationale explaining her opinion. Thus, remand is required to obtain a sufficient opinion with rationale. SMC The remaining claim of entitlement to SMC based on the loss of use of left and right feet, the left and right hands, and also creative organ for the erectile dysfunction. SMC is "inextricably intertwined" with the claim of entitlement to service connection for bilateral upper/lower peripheral neuropathy, bilateral foot disability, and ED. See Harris v. Derwinski, 1 Vet. App. 180 (1991). Therefore, consideration of this SMC claim must be deferred until resolution of the inextricably intertwined claim concerning the bilateral upper/lower peripheral neuropathy, bilateral foot disability, and ED. Harris, 1 Vet. App. at 183 (where a claim is inextricably intertwined with another claim, the claims must be adjudicated together, rather than piecemeal, since the claims have common parameters). The matters are REMANDED for the following action: 1. Contact the Veteran and request properly executed releases for any private care providers who have treated him for any claimed conditions, to include underlying thrombophlebitis or DVT, in particular Dr. DMM. Upon receipt of such, VA must take appropriate action to contact the identified providers and request complete treatment records. The Veteran should be informed that in the alternative he may obtain and submit the records himself. 2. Obtain updated VA treatment records and associate with the claims file. 3. Schedule the Veteran for a VA peripheral neuropathy examination. The claims folder must be reviewed in conjunction with the examination. The examiner must identify all currently diagnosed bilateral lower/upper extremity peripheral neuropathy and opine as to whether any such are at least as likely as not caused or aggravated his service-connected diabetes melitis type II. The examiner should describe the current functional limitations of the hands and feet, to include whether the Veteran would be equally well served by amputation and use of a prosthetic. A complete rationale for any opinion expressed should be provided. 4. Schedule the Veteran for a VA skin diseases examination. The claims folder must be reviewed in conjunction with the examination. The examiner must identify all currently diagnosed bilateral foot ulcers and opine as to whether any such are at least as likely as not caused or aggravated his service-connected diabetes melitis type II. A complete rationale for any opinion expressed should be provided. 5. Schedule the Veteran for a VA male reproductive organ conditions examination. The claims folder must be reviewed in conjunction with the examination. The examiner must opine as to whether the Veteran's ED is at least as likely as not caused or aggravated his service-connected diabetes melitis type II. A complete rationale for any opinion expressed should be provided. 6. Then readjudicate the claims on appeal. If any benefit sought on appeal remains denied, issue a supplemental statement of the case, and, after appropriate time period for response, return the matter to the Board. WILLIAM H. DONNELLY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Baxter 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.