Citation Nr: A21020141 Decision Date: 12/16/21 Archive Date: 12/16/21 DOCKET NO. 200320-77306 DATE: December 16, 2021 REMANDED Entitlement to service connection for type II diabetes mellitus is remanded. Entitlement to service connection for right upper extremity peripheral neuropathy is remanded. Entitlement to service connection for left upper extremity peripheral neuropathy is remanded. Entitlement to service connection for a skin disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1963 to May 1967. These matters are before the Board of Veterans' Appeals (Board) on appeal of a February 2020 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran submitted a March 2020 Decision Review Request: Board Appeal (Notice of Disagreement) and elected to appear at a hearing before a Veterans Law Judge. The Veteran appeared at a hearing before the undersigned in August 2021. The Board may only consider the evidence of record at the time of the February 2020 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or her representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302 (a). Entitlement to service connection for type II diabetes mellitus is remanded. In September 2019 a VA examiner found that the Veteran did not have a diagnosed type II diabetes mellitus, in part on the basis that the Veteran's two "most recent" hemoglobin A1c readings in March 2017 and March 2019 were below 6.5. However, a private treatment record notes a July 2019 hemoglobin A1c reading of 6.7. While relevant records do not reflect an explicit diagnosis of diabetes mellitus, the September 2019 VA examination report is inadequate because it is based on an inaccurate factual premise. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993). Failure to obtain an adequate VA examination constitutes a pre-decisional duty to assist error requiring remand. Entitlement to service connection for right and left upper extremity peripheral neuropathies is remanded. In September 2019 a VA examiner diagnosed the Veteran with bilateral upper extremity peripheral neuropathy, but not with "early-onset peripheral neuropathy" for purposes of presumptive service connection under 38 C.F.R. § 3.309 (e). The examiner provided no medical opinion regarding whether the Veteran's diagnosed upper extremity peripheral neuropathy was directly related to in-service herbicide exposure as the Veteran contends. Records available at the time of the February 2020 rating decision on appeal demonstrate that the Veteran was stationed at Ubon Air Force Base and Udorn Air Force Base in Thailand during active service. Moreover, the Veteran competently and credibly described that his duties during service involved regular activities at the base perimeter. See September 2019 statement. In-service herbicide exposure was therefore demonstrated at the time of the February 2020 rating decision. Where VA provides the veteran with an examination in a service connection claim, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). As the September 2019 VA examiner failed to provide a medical opinion as to whether right and left upper extremity peripheral neuropathy were directly related to in-service herbicide exposure, that examination report is inadequate to inform the Board's judgment on this matter. Failure to obtain an adequate VA examination constitutes a pre-decisional duty to assist error requiring remand. Entitlement to service connection for a skin disorder is remanded. The Veteran has not been afforded a VA examination to consider the nature and etiology of his claimed skin disorder. In September 2019 the Veteran described developing a skin rash and irritation on his arms and chest following exposure to herbicides in service, with ongoing symptoms thereafter. In January 2020 he described experiencing current skin breakouts. As discussed above, the evidence available at the time of the February 2020 rating decision demonstrated in-service exposure to herbicides. This evidence suggests that the Veteran has current skin symptoms which may be related to in-service herbicide exposure. Accordingly, the Veteran must be provided a VA examination to address this issue. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). Failure to obtain a VA examination was a pre-decisional duty to assist error requiring remand. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of diabetes mellitus. The examiner should state: a. Has type II diabetes mellitus been present at any time since September 3, 2019? The examiner should address the private treatment record noting a hemoglobin A1c reading of 6.7 in July 2019. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of right and left upper extremity peripheral neuropathies. The examiner should state: a. What diagnosed right and left upper extremity peripheral neuropathies have been present at any time since September 3, 2019? b. For each diagnosed right and left upper extremity peripheral neuropathy: is it at least as likely as not related to an illness, event, or injury in service, to include in-service herbicide exposure? For the purpose of this opinion, please assume the Veteran was exposed to herbicide. 3. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of a skin disorder. The examiner should state: a. What diagnosed skin disorders have been present at any time since September 3, 2019? (Continued on the next page) b. For each such skin disorder: is it at least as likely as not related to an illness, event, or injury in service, to include in-service herbicide exposure? For the purpose of this opinion, please assume the Veteran was exposed to herbicide and address his report of onset in service. LAURA E. COLLINS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Bametzreider, Paul J. 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.