Citation Nr: 21069951 Decision Date: 11/22/21 Archive Date: 11/22/21 DOCKET NO. 17-17 489 DATE: November 22, 2021 REMANDED Entitlement to an initial compensable rating for erectile dysfunction is remanded. Entitlement to an initial rating in excess of 20 percent for type 2 diabetes mellitus is remanded. Entitlement to an initial rating in excess of 10 percent (prior to February 18, 2021) and in excess of 20 percent (from February 18, 2021) for left lower extremity diabetic peripheral neuropathy is remanded. Entitlement to an initial rating in excess of 10 percent (prior to February 18, 2021) and in excess of 20 percent (from February 18, 2021) for right lower extremity diabetic peripheral neuropathy is remanded. Entitlement to an initial rating in excess of 20 percent (prior to February 18, 2021) and in excess of 30 percent (from February 18, 2021) for left upper extremity median and ulnar nerve diabetic neuropathy is remanded. Entitlement to an initial rating in excess of 20 percent (prior to February 18, 2021) and in excess of 40 percent (from February 18, 2021) for right upper extremity median and ulnar nerve diabetic neuropathy is remanded. Entitlement to an initial rating in excess of 60 percent for diabetic nephropathy is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1966 to January 1969. In January 2019, the case was remanded by another Veterans Law Judge for additional development. Thereafter, the Agency of Original Jurisdiction (AOJ) increased the ratings for the Veteran's left and right upper extremity median and ulnar nerve diabetic neuropathy (in December 2020 and April 2021 rating decisions), for his diabetic nephropathy (in a February 2021 rating decision), and for his left and right lower extremity diabetic peripheral neuropathy (in an April 2021 rating decision). Because these awards did not represent a total grant of benefits sought on appeal for these issues, the claims for increase remain before the Board. AB v. Brown, 6 Vet. App. 35 (1993). The case has now been assigned to the undersigned Veterans Law Judge. 1. Entitlement to an initial compensable rating for erectile dysfunction. 2. Entitlement to an initial rating in excess of 20 percent for type 2 diabetes mellitus. 3. Entitlement to an initial rating in excess of 10 percent (prior to February 18, 2021) and in excess of 20 percent (from February 18, 2021) for left lower extremity diabetic peripheral neuropathy. 4. Entitlement to an initial rating in excess of 10 percent (prior to February 18, 2021) and in excess of 20 percent (from February 18, 2021) for right lower extremity diabetic peripheral neuropathy. 5. Entitlement to an initial rating in excess of 20 percent (prior to February 18, 2021) and in excess of 30 percent (from February 18, 2021) for left upper extremity median and ulnar nerve diabetic neuropathy. 6. Entitlement to an initial rating in excess of 20 percent (prior to February 18, 2021) and in excess of 40 percent (from February 18, 2021) for right upper extremity median and ulnar nerve diabetic neuropathy. 7. Entitlement to an initial rating in excess of 60 percent for diabetic nephropathy. The Board cannot make a fully-informed decision on these issues at this time because the record reflects that there are outstanding treatment records not currently associated with the claims file that may be pertinent to these claims on appeal. Specifically, the Veteran's VA treatment records indicate that he received a non-VA prescription from Heritage Health Solutions for Losartan [a blood pressure medication which can slow kidney damage] in August 2017, and that he received a non-VA prescription from Nationwide Pharmaceutical for Pregabalin [a nerve pain medication] in May 2019. However, there are currently no private treatment reports of record in the claims file. On remand, all outstanding treatment records must be associated with the claims file. In addition, a February 2010 VA treatment record noted the following: "Hold Metformin [a diabetes medication], will provide SSI ACHS for coverage." A July 2021 Social Security Administration (SSA) inquiry revealed "Y" [for yes] with regard to the Veteran's Title II Status, indicating that he may be in receipt of SSA disability benefits. On remand, all records pertaining to any applications for and awards of SSA disability benefits should be obtained and associated with the claims file. See Murincsak v. Derwinski, 2 Vet. App. 363 (1992). Furthermore, regarding the Veteran's claim for an initial compensable rating for erectile dysfunction, he has alleged throughout the appeal period (including in his February 2014 notice of disagreement, on his March 2017 VA Form 9, and in a March 2021 written submission) that he has penis deformity. However, the record reflects that his penis was not examined at any of his VA genitourinary examinations during the appeal period which were conducted in March 2013, October 2019, August 2020, and April 2021. On remand, a new genitourinary examination should be scheduled with a medical opinion specifically addressing whether the Veteran has penis deformity associated with his service-connected erectile dysfunction. The matters are REMANDED for the following actions: 1. Ask the Veteran to complete a VA Form 21-4142 for all private providers who have treated him for his claimed disabilities during the appeal period, including Heritage Health Solutions and Nationwide Pharmaceutical. Make two requests for the authorized records from each identified provider, unless it is clear after the first request that a second request would be futile. 2. Obtain the Veteran's VA treatment records from the Maryland VA Health Care System (for the period from December 2020 to the present) and from the Lebanon, Pennsylvania VA Medical Center (for the period from August 2021 to the present). 3. Request and obtain from the SSA all relevant documents pertaining to any applications by the Veteran for SSA disability benefits, including any decisions and/or determinations, and supporting medical documentation utilized in rendering any relevant decision or determination. Any negative search result should be noted in the record and communicated to the Veteran. 4. After all requested records have been associated with the claims file, schedule the Veteran for an examination by an appropriate clinician (or a telehealth interview if an in-person examination is not feasible) to determine the current severity of his service-connected erectile dysfunction. The electronic claims file must be made available to the examiner for review in conjunction with the examination. All necessary tests should be performed, and the results reported. The examiner must examine the Veteran's penis and provide a medical opinion specifically addressing whether the Veteran has penis deformity associated with his service-connected erectile dysfunction. A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular clinician. M. SORISIO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. B. Yantz, Counsel The Board's decision in this case is binding only with respect to the instant matter(s) decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.