Citation Nr: 21072728 Decision Date: 12/06/21 Archive Date: 12/06/21 DOCKET NO. 08-14 131 DATE: December 6, 2021 REMANDED Entitlement to a rating higher than 20 percent for type II diabetes mellitus with cataracts is remanded. Entitlement to a rating higher than 10 percent for diabetic neuropathy in the upper right extremity for the period prior to March 28, 2012 is remanded. Entitlement to a rating higher than 20 percent for diabetic neuropathy in the upper right extremity for the period beginning March 28, 2012 is remanded. Entitlement to service connection for a right shoulder condition, to include as secondary to service-connected disabilities is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from February 1968 to February 1972. These matters come before the Board of Veterans' Appeals (Board) on appeal from a May 2007 rating decision of the Department of Veterans' Affairs (VA) Regional Office (RO) in Montgomery Alabama. In June 2011, the Veteran testified before the undersigned Veterans Law Judge at a Traval Board hearing held at the Montgomery RO. The hearing transcript is associated with the claims folder. While further delay is regrettable, the Board finds that remand of the appeal is warranted for further evidentiary development to adequately evaluate the Veteran's claims. Increased Rating for Type II Diabetes with Cataracts The Veteran is seeking a rating higher than 20 percent for type II diabetes with cataracts. In the February 2021 Board remand, the Board instructed the RO to afford the Veteran a VA examination to determine the current severity of the Veteran's diabetes. In March 2021, the Veteran underwent evaluation for his diabetes. However, upon remand, no VA examiner discussed the clinical significance of the Veteran's cataracts, if any. As noted in the previous remand, the Veteran's recent treatment records indicate ongoing treatment, to include surgery for his cataracts. Therefore, an updated evaluation is necessary to determine if the severity of the Veteran's cataracts warrants a separate compensable rating. Increased Rating for Diabetic Neuropathy of the Right Upper Extremity The Veteran is seeking increased staged ratings for his service-connected diabetic neuropathy of the right upper extremity. The Board notes that the Veteran has also been diagnosed with comorbid conditions related to his right arm, to include service-connected residuals of cerebrovascular accident with mild right side muscle weakness and non-service-connected carpal tunnel syndrome. Throughout the appeal period, the Veteran has manifested symptoms of pain, numbness, weakness, loss of grip, diminished reflexes, and diminished sensation. To date, however, no treating physician or examiner has differentiated between the symptoms attributable each disability. In order to accurately evaluate the Veteran's neuropathy and avoid impermissible pyramiding, the Board finds that remand is required to obtain an opinion that determines the distinct symptoms attributable to the Veteran's diabetic neuropathy. Service Connection for Right Shoulder In response to the February 2021 Board remand, the Veteran was afforded a VA orthopedic shoulder examination in May 2021 to address the secondary service connection contentions related to the right shoulder arthritis. In the examination report, the examiner found that while the Veteran has cervical radiculopathy that "further complicates the Veteran's shoulder condition, this condition is a separate and unrelated entity from the diagnosed condition of right shoulder osteoarthritis." The examiner further found that the Veteran's shoulder arthritis was less likely than not caused by his service-connected disabilities. In so finding, the examiner found that the right shoulder arthritis was a separate entity entirely from each disability and medical literature failed to demonstrate a causal relationship. The Board finds the May 2021 nexus opinion to be problematic for several reasons. First, the examiner's opinions that the right shoulder arthritis is unrelated to the service-connected disabilities, without more, is conclusory at best and does not assist the Board in making an accurate determination. Moreover, the examiner's opinion appears to be internally inconsistent. Specifically, the examiner notes that the right arm neuropathy symptoms complicate the right shoulder condition but then concludes that the disabilities are unrelated. Finally, while the examiner discussed causation, the examiner failed to discuss whether the right shoulder arthritis was aggravated by the service-connected disabilities. Accordingly, remand is required to obtain an adequate opinion. The matters are REMANDED for the following action: 1. Obtain all updated records (i.e., those not already of record) of VA and adequately identified private treatment the Veteran has received for the disabilities remaining on appeal. 2. Schedule the Veteran to be examined by an ophthalmologist to determine the current severity of his cataracts. Based on an examination, review of the record, and any tests or studies deemed necessary (to include testing for visual fields), the examiner should describe all pathology, symptoms (frequency and severity), and associated functional impairment associated with cataracts in sufficient detail to allow for application of the pertinent rating criteria. 3. Schedule the Veteran for a VA examination with an appropriate examiner to evaluate the Veteran's diabetic neuropathy of the right upper extremity. Based on examination of the Veteran and review of the record, to include any tests and studies during the appeal period, the examiner should describe all pathology, symptoms (frequency and severity), and associated functional impairment associated with diabetic neuropathy of the right upper extremity in sufficient detail to allow for application of the pertinent rating criteria. The examiner should identify the nerve root(s) affected by the diabetic neuropathy. The examiner must indicate whether it is possible, by clear evidence, to distinguish the symptoms and impairment attributable to service-connected diabetic neuropathy of the right upper extremity from those attributable to service-connected CVA with right side muscle weakness and non-service-connected carpal tunnel syndrome. If so, the examiner is asked to identify the symptoms and impairment attributable to each. If it is felt that both diagnoses contribute to any particular symptoms or impairment, the examiner should indicate whether it is possible to identify the PORTION of such impairment that is attributable ONLY to the service-connected diabetic neuropathy of the right upper extremity. If so, the examiner is asked to identify that portion and provide an opinion as to the specific impairment attributable solely to the Veteran's diabetic neuropathy of the right upper extremity. 4. Forward the Veteran's claims file to an appropriate examiner to determine the nature and etiology of the Veteran's right shoulder condition. Upon review of the claims folder, the examiner should opine as to the following: (a.) Is it at least as likely as not (50 percent probability or greater) that the Veteran's right shoulder arthritis was either caused by a service-connect disability; OR (b.) Is it at least as likely as not (50 percent probability or greater) that a service-connected disability results in any additional functional impairment associated with his right shoulder arthritis (e.g., a medically discernable increase in frequency, duration, and/or severity, even if temporary, above the degree associated with that expected from his baseline right shoulder condition alone). (continued on the next page) The examiner is requested to discuss whether the underlying service-connected disorders are medically capable of causing or aggravating a right shoulder arthritis and, if so, whether the Veteran's right shoulder arthritis has been caused or aggravated based on the particular facts of this case. T. MAINELLI Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Orie, 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.