Citation Nr: 21074095 Decision Date: 12/14/21 Archive Date: 12/14/21 DOCKET NO. 18-19 264 DATE: December 14, 2021 REMANDED Entitlement to service connection for peripheral neuropathy of the right upper extremity is remanded. Entitlement to service connection for peripheral neuropathy of the left upper extremity is remanded. Entitlement to service connection for peripheral neuropathy of the right lower extremity is remanded. Entitlement to service connection for peripheral neuropathy of the left lower extremity is remanded. REASONS FOR REMAND The Veteran served on active duty in the Army from June 1955 to March 1957. He also had additional service in the Michigan Air National Guard. This matter is before the Board of Veterans' Appeals (Board) on appeal of an April 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO), that denied service connection for peripheral neuropathy of the right upper extremity (listed as right upper extremity peripheral neuropathy due to a cold injury); peripheral neuropathy of the left upper extremity (listed as left upper extremity peripheral neuropathy due to a cold injury); peripheral neuropathy of the right lower extremity (listed as right lower extremity peripheral neuropathy due to a cold injury); and for peripheral neuropathy of the left lower extremity (listed as left lower extremity peripheral neuropathy due to a cold injury). The Board notes that a July 2016 RO decision reopened and denied the Veteran's claims for service connection for peripheral neuropathy of the right upper extremity (listed as right upper extremity peripheral neuropathy due to a cold injury); peripheral neuropathy of the left upper extremity (listed as left upper extremity peripheral neuropathy due to a cold injury); peripheral neuropathy of the right lower extremity (listed as right lower extremity peripheral neuropathy due to a cold injury); and for peripheral neuropathy of the left lower extremity (listed as left lower extremity peripheral neuropathy due to a cold injury). The Board notes, however, that a prior April 2014 RO decision that denied service connection for those disorders is not final. The Veteran essentially expressed disagreement with that decision and continued to submit evidence as to those issues within one year of that decision. Consequently, the April 2014 RO decision is not final, and the Veteran's claims have been pending since that time. See 38 C.F.R. § 3.156(b); Bond v. Shinseki, 659 F.3d 1362, 1367-8 (Fed. Cir. 2011); see also Turner v. Shulkin, 29 Vet. App. 207 (2017). The Veteran contends that he has peripheral neuropathy of the right upper extremity; peripheral neuropathy of the left upper extremity; peripheral neuropathy of the right lower extremity; and peripheral neuropathy of the left lower extremity, that are all related to service. He specifically maintains that he suffered severe cold injuries to his bilateral upper and lower extremities while serving in Korea, which caused paresthesias and polyneuropathies of his right and left upper extremities, and his right and left lower extremities. The Veteran reports that he spent two winters serving in Korea in sub-zero temperatures, as well as in inclement weather conditions. He maintains that he had extensive risk of exposure to cold weather while sleeping in tents next to his battery. The Veteran essentially asserts that he suffered cold weather injuries to his bilateral upper and lower extremities during service, and that he has had residual symptoms in his bilateral upper and lower extremities since service. The Veteran's available service personnel records indicate that he served in Inchon, Korea. Notably, the Veteran's service treatment records are essentially unavailable and were apparently destroyed in the 1973 fire at the National Personnel Records Center (NPRC). Post-service private and VA treatment records show treatment for peripheral neuropathy of a lower limb; peripheral neuropathy; neuropathy/difficulty walking; sensory fiber neuropathies of the hands and feet; sensory peripheral neuropathies of the legs and feet; and bilateral lower extremity peripheral polyneuropathy. A June 2014 statement from G.C., M.D., notes that the Veteran had tingling affecting his lower extremities. Dr. G.C. indicated that the Veteran had longstanding paresthesias affecting his lower extremities, and that his symptoms started when he was in the service. Dr. G. C. reported that he understood that the Veteran was exposed to extreme temperatures during service, and that such exposure occurred when he was stationed in Korea. Dr. G. C. stated that since that time, the Veteran had been having paresthesias affecting his lower extremities. It was noted that the Veteran denied any weakness in his lower extremities. Dr. G. C. related that the Veteran complained of tightness in his upper extremities, but that he reported that he had no paresthesias affecting his upper extremities. The impression included peripheral neuropathy. Dr. G. C. maintained that the Veteran had evidence of peripheral neuropathy in his lower extremities, and that his symptoms were longstanding. Dr. G. C. reported that the Veteran stated that his symptoms began when he was exposed to extreme cold during his period of service. Dr. G. C. indicated that in view of the temporal relationship between cold exposure and the onset of neuropathy symptoms, it was his opinion that such symptoms were more likely than not causally related. The Board observes that Dr. G. C. did not specifically address the etiology of the Veteran's claimed peripheral neuropathy of the right and upper extremity. Additionally, the Board notes that there is no indication that Dr. G. C. reviewed the Veteran's claims file. Although claims file review is not necessary, the probative value of a medical opinion is based on its reasoning and its predicate in the record so that the opinion is fully informed. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). A September 2017 statement from S. B., D.C., notes that the Veteran served in the Army from 1955 to 1957, in the 50th AAA Battery stationed in Korea. Dr. S. B. stated that the Veteran's duties included loading and maintaining 50-caliber machine guns mounted on a half-track. Dr. S. B. reported that the Veteran indicated that he spent two sub-zero winters working and sleeping in tents next to his battery, and that the weather inhibited him from ever warming up. Dr. S. B. stated that the Veteran related that he had become increasingly intolerant to the cold, and that his hands, feet, and lower legs would ache, burn, tingle, and change colors, with the slightest change in weather or when it was cold outside. It was noted that the Veteran reported that the sensations in his hands inhibited him from gripping, and that he presently had to have assistance with his activities of daily living. As to an assessment, Dr. S. B. indicated that as to the Veteran's cold sequela injuries, exposure to extreme cold temperatures and inclement weather was clinically proven to cause Raynaud's syndrome; cold sensitization; sensory fiber neuropathies in the hands and feet, and sensory peripheral neuropathies of the legs and feet. Dr. S. B. maintained that such were all symptoms that the Veteran was currently experiencing and that the symptoms were consistent with the history of his service in the extreme cold and inclement weather in Korea. The Board observes that there is no indication that Dr. S. B. reviewed the Veteran's claims file. See Nieves-Rodriguez, 22 Vet. App. at 295. Additionally, the Board notes that Dr. S. B.'s statement and opinion contradict the findings of an examiner, pursuant to VA examination reports, discussed below. A June 2016 VA cold injury residuals examination report includes a notation that the Veteran's claims file was reviewed. The Veteran reported that he was in Korea from November 1955 to March 1957, and that he spent two winters assigned to guard duty. He stated that his guard duty was usually two hours at a time, and that sometimes three or four people were rotated during the guard duty. He indicated that after his guard duty ended, he went to a tent, and then to a Quonset tent, and that there was heat in those locations. The Veteran maintained that he was in weather 30 degrees below zero, but that he did not suffer a freeze injury at that time. He stated that he would become very cold during his two hours of guard duty. It was noted that the Veteran denied that he saw any doctors for cold injuries while on active duty. The Veteran reported that his symptoms of cold injuries began approximately seven years earlier when his feet started to feel sunburned. He stated that over the years, the burning sensation had progressed to his knees, and that presently, both his legs felt numb all the way down to his knees, and that his legs also felt hot. The Veteran maintained that seven years earlier, he was seen by physicians that thought his problem was due to his nerves, and that he was told to stay out of the sun. It was noted that the Veteran denied any hand problems such as neuropathy, and that he stated that his hands were not affected with the burning sensation like his feet. The Veteran reported that he drank alcohol all of his life, but that he had not had alcohol for the previous two years. He stated that he usually liked beer, and that he would have three to four beers a day, or, if not having beer, he would drink three glasses of wine per day. The Veteran indicated that his occupation was in sales, and that he entertained and drank with his clients. The examiner reported that the Veteran's wife of twenty-five to thirty years stated that his legs first started becoming a problem ten to fifteen years ago. It was noted that she stated that the Veteran was started on Galantamine for his neuropathy many years earlier. As to a diagnosis, the examiner indicated that the Veteran did not presently have, and never had been diagnosed with, any cold injuries. A June 2016 VA peripheral nerves conditions examination report, performed by the same examiner who conducted the June 2016 VA cold weather injuries examination, includes a notation that the Veteran's claims file was reviewed. The Veteran's reported history was the same as listed in the June 2016 VA cold weather injuries examination report. The diagnosis was bilateral lower extremity peripheral polyneuropathy. The examiner stated that, as to the Veteran's service treatment records, there was only a March 1954 enlistment examination of record. It was noted that a May 2008 VA memorandum indicated that the Veteran's service treatment records were unavailable. The examiner discussed the Veteran's reported history in some detail. The examiner indicated that, according to the Veteran, his cold injury residual symptoms of burning in the feet started seven years earlier, but his wife stated that the symptoms started about ten to fifteen years earlier. The examiner maintained that, thus, the claimed cold injury in Korea happened about forty-five to fifty years before any major symptoms, such as burning in the feet, first started. The examiner referred to medical treatise evidence and stated that there were five categories of cold injuries. The examiner maintained that the Veteran would be classified as a possibly mild cold injury. It was noted that up-to-date resources show that prolonged cold exposure could cause polyneuropathy, which was usually axonal in type. The examiner indicated that the long gap of forty-five to fifty years between the cold exposure and the first symptoms of polyneuropathy made a cold injury cause for the neuropathy very unlikely. The examiner reported that a potential explanation for the cause of the polyneuropathy was excess consumption of alcohol and referred to medical treatise evidence. The examiner stated that, in addition, the Veteran had evidence of pre-diabetes, and that pre-diabetes had been reported to be associated with peripheral neuropathy. The examiner indicated that, therefore, it was less than 50 percent likely that the Veteran's cold injury residual peripheral polyneuropathy of the feet/legs was proximately due to his cold exposure in Korea while on active duty. The Board observes that the examiner found that it was less than 50 percent likely that the Veteran's cold injury residual peripheral polyneuropathy of the feet/legs was proximately due to his cold exposure in Korea while on active duty. The Board notes, however, that the examiner's opinion contradicts the above opinions from Dr. G. C. and Dr. S. B., respectively. Additionally, the examiner reported that the Veteran stated that his cold weather injury residual symptoms began seven years prior to the examination, but Dr. G. C., specifically indicated that the Veteran had longstanding paresthesias affecting his lower extremities, and that his symptoms started when he was in the service. The Board further observes that the examiner stated that a potential explanation for the cause of the Veteran's polyneuropathy was excess consumption of alcohol. The Board notes that it is unclear what was the basis for such statement other than that the Veteran reporting that he drank alcohol all of his life. In light of the above, the Board finds that the Veteran should be afforded a VA examination with the opportunity to obtain responsive etiological opinions, following a thorough review of the record, as to his claims for service connection for peripheral neuropathy of the right upper extremity; peripheral neuropathy of the left upper extremity; peripheral neuropathy of the right lower extremity; and for peripheral neuropathy of the left lower extremity. Such an examination must be accomplished on remand. 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79 (2006); Stefl v. Nicholson, 21 Vet. App. 120, 125 (2007). The matters are REMANDED for the following action: 1. Ask the Veteran to identify all medical providers who have treated him for peripheral neuropathy of the right upper extremity; peripheral neuropathy of the left upper extremity; peripheral neuropathy of the right lower extremity; and for peripheral neuropathy of the left lower extremity, since November 2021. After receiving this information and any necessary releases, obtain copies of the related medical records which are not already in the claims folder. Document any unsuccessful efforts to obtain the records, inform the Veteran of such, and advise him that he may obtain and submit those records himself. 2. Notify the Veteran that he may submit lay statements from himself and from other individuals who have first-hand knowledge, and/or were contemporaneously informed of his in-service and post-service symptomatology regarding his claimed peripheral neuropathy of the right upper extremity; peripheral neuropathy of the left upper extremity; peripheral neuropathy of the right lower extremity; and peripheral neuropathy of the left lower extremity. Such may include statements clarifying when the Veteran's symptoms of his claimed peripheral neuropathy of the bilateral upper and lower extremities began. The Veteran may also submit additional opinions of medical experts as to the etiology of his claimed disabilities. The Veteran should be provided an appropriate amount of time to submit this lay evidence. 3. Schedule the Veteran for an appropriate VA examination (or telehealth interview, review of the record, etc. if an in-person examination is not feasible) to determine the onset and/or etiology of his claimed peripheral neuropathy of the right upper extremity; peripheral neuropathy of the left upper extremity; peripheral neuropathy of the right lower extremity; and peripheral neuropathy of the left lower extremity. The claims file must be reviewed by the examiner. The examiner must specifically indicate if the Veteran has currently diagnosed peripheral neuropathy of the right upper extremity; peripheral neuropathy of the left upper extremity; peripheral neuropathy of the right lower extremity; and peripheral neuropathy left lower extremity, and/or any other diagnosed cold weather injuries of the bilateral upper and lower extremities. Then, the examiner must opine as to whether it is at least as likely as not that any currently diagnosed peripheral neuropathy of the right upper extremity; peripheral neuropathy of the left upper extremity; peripheral neuropathy o the right lower extremity; and peripheral neuropathy left lower extremity, and/or any other diagnosed cold weather injuries of the bilateral upper and lower extremities, are related to, and/or had their onset during, the Veteran's period of service. The examiner must specifically acknowledge and discuss any reports of the Veteran of symptoms he thought were due to peripheral neuropathy of the right and left upper extremities, and right and left lower extremities, or due to cold weather injuries of the bilateral upper and lower extremities, during service and since service. The examiner must specifically comment on the June 2014 statement from G. C., M.D., and the September 2017 statement from S. B., D.C. Jarrette A. Marley Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. D. Regan, 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.