Citation Nr: 21068672 Decision Date: 11/12/21 Archive Date: 11/12/21 DOCKET NO. 20-06 125 DATE: November 12, 2021 REMANDED Entitlement to service connection for peripheral neuropathy of the left upper extremity is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1963 to January 1966. He had service in the Republic of Vietnam. This appeal to the Board of Veterans' Appeals (Board) arose from a November 2018 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). 1. Entitlement to service connection for peripheral neuropathy of the left upper extremity is remanded. The Veteran contends that he has peripheral neuropathy of the left upper extremity that is either related to Agent Orange exposure or is secondary to his service-connected diabetes mellitus, type 2 (DM2). Private EMG testing in March 2019 and April 2019 showed "severe and chronic peripheral polyneuropathy that is mainly axonal and mixed (sensory and motor) with chronic denervation. There was also bilateral chronic and severe CTS (carpal tunnel syndrome) without denervation. There was no evidence of radiculopathy, plexopathy, or myopathy." On the Veteran's notice of disagreement in January 2019, he reported that he injured his left hand in service and underwent surgery. He was not sure if his current neuropathy symptoms were related to that incident. The service treatment records show that in October 1963 the Veteran was seen with a swollen and tender left third finger following a laceration six days earlier. Tenosynovitis with staphylococcus infection was found, and he underwent incision and drainage of the wound. (The Board notes that the Veteran has a separate claim for service connection for left hand disability that is not currently on appeal.) An April 2019 private clinic record included a diagnosis of diabetic polyneuropathy associated with DM2. However, the notes from that clinic also mention that the Veteran reported that neurologic symptoms in his left hand began after a 1975 injury and surgery. The Veteran underwent a VA examination in January 2020. The examiner stated that the Veteran did not have diabetic neuropathy, but rather had "mixed neuropathy including carpal tunnel syndrome and polyneuropathy of unclear etiology." The Veteran's representative has argued that the January 2020 VA examiner did not provide a rationale reconciling his statement that the Veteran did not have diabetic neuropathy with his description of polyneuropathy of unclear etiology. The representative also cited a Mayo Clinic report that discussed an increased risk of carpal tunnel syndrome from diabetes mellitus. A remand is required to obtain a clarifying nexus opinion. The matters are REMANDED for the following action: Return the file to the January 2020 VA examiner for an addendum opinion. If that examiner is not available, an opinion must be obtained from an appropriate medical professional. The examiner should review the pertinent evidence as well as the summary provided above. a) The examiner is asked to reconcile the statements in the January 2020 report that the Veteran does not have diabetic neuropathy but rather has a mixed neuropathy including carpal tunnel syndrome and polyneuropathy of unclear etiology. Specifically, the examiner is to explain why, if the etiology is unclear, he was able to rule out diabetic neuropathy. Stated another way, do the Veteran's reports about his symptoms and the objective clinical evidence align with how diabetic peripheral neuropathy is known to develop? In answering this question, the examiner is to consider and specifically address the private medical record referencing 'polyneuropathy associated with diabetes mellitus' in April 2019. b) The examiner is also asked to comment on the likelihood of a causal relationship between the Veteran's diagnosed left upper extremity carpal tunnel syndrome (CTS) and his service-connected diabetes mellitus. Is it at least as likely as not that the Veteran's left upper extremity CTS is either caused or aggravated by his service-connected DM2? In providing a rationale, the examiner should address the Mayo Clinic report referenced in the November 2021 Informal Hearing Presentation (Appellate Brief). c) A fully-explained rationale (formulated upon supporting factual data and sound medical principles, and that considers the Veteran's lay statements and reported history of symptom manifestation) must be provided for all opinions. (i) If there is any medical reason to accept or reject the proposition that the Veteran's reported symptoms in service and thereafter represented the onset of his current left upper extremity polyneuropathy and/or left upper extremity CTS, this should be noted. (ii) If there is any medical reason to accept or reject the proposition that the Veteran's current left upper extremity polyneuropathy and/or left upper extremity CTS are neither caused nor aggravated (i.e., worsened beyond its natural progression) by his service-connected diabetes mellitus, type 2, this should be noted. D. JOHNSON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. G. Mazzucchelli, 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.