Citation Nr: 21005924 Decision Date: 02/02/21 Archive Date: 02/02/21 DOCKET NO. 17-59 256 DATE: February 2, 2021 REMANDED The issues of entitlement to effective dates earlier than December 22, 2014 for the awards of (1) separate compensable ratings for residuals of cerebrovascular accident (CVA), including difficulty swallowing, impaired sphincter control, and voiding dysfunction; (2) service connection for peripheral neuropathy of the bilateral upper extremity and erectile dysfunction as secondary to diabetes mellitus; (3) a 20 percent rating for left lower extremity neuropathy; and, (4) special monthly compensation based on loss of use of a creative organ, are remanded. REASONS FOR REMAND The Veteran served on active duty from January 1966 to January 1968. This matter is before the Board following his appeal of a June 2015 rating decision. In September 2020, the Veteran testified before the undersigned Veterans Law Judge. Unfortunately, the Board finds that remand is necessary prior to adjudicating the Veteran’s claims of entitlement to an effective date earlier than December 22, 2014 for various awards. Initially, the Veteran contends that he is entitled to an effective date earlier than December 22, 2014 for the award of separate ratings for the CVA residuals, and it does not appear that all residuals were considered at the time of the grant of service connection. Parenthetically, the Board observes that in September 2013, the Veteran filed a valid Notice of Disagreement with the August 2013 rating decision that established service connection for CVA residuals and assigned an initial 10 percent rating. As such, the appeal is essentially entitlement to an increased initial rating for CVA residuals, and effective dates for CVA residuals back to the initial date of service connection for the CVA may be assignable if otherwise supported by the record. However, due to memory issues, the Veteran is uncertain as to the exact date of onset of his various residuals, and it appears from his Board testimony and available treatment records that there may still be outstanding relevant treatment records. See, e.g., October 2010 and June 2011 Treatment Notes. As such, the Board finds that remand is necessary to request any outstanding records, and to obtain a retrospective opinion based on a review of the medical record as to the nature and onset of the Veteran’s CVA residuals, to include difficulty swallowing, impaired sphincter control, and voiding dysfunction. Next, the Veteran contends that he is entitled to an effective date earlier than December 22, 2014, for the awards of service connection for erectile dysfunction (and associated SMC based on loss of use of a creative organ) and peripheral neuropathy of the upper extremities, both secondary to diabetes, and the award of a 20 percent rating for peripheral neuropathy of the left lower extremity. Because it appears that there may be relevant outstanding treatment records, the Board finds that it would be premature to adjudicate those claims at this time. Additionally, there is some evidence to suggest that some of the Veteran’s neurologic symptoms granted as secondary to diabetes mellitus, may be stroke residuals and entitled to consideration as part of the initial increased rating appeal for stroke residuals. See, e.g., April 2011 and June 2011 VA examination reports. Given such evidence, the Board finds that on remand a medical examination be obtained to determine the nature and onset of all the Veteran’s CVA residuals. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records from all VA facilities that have treated the Veteran dating since at least 2002. 2. Ask the Veteran to identify and complete a VA Form 21-4142 for any sources of private treatment for his stroke, TIAs, stroke residuals, peripheral neuropathy, and erectile dysfunction. Follow the procedures for obtaining the records set forth in 38 C.F.R. § 3.159 (c). If the records are unavailable, the Veteran should be notified in accordance with 38 C.F.R. § 3.159(e). 3. After all available records have been associated with the claims file, obtain an addendum opinion to determine the nature and onset of all the Veteran’s stroke residuals. If an examination is deemed necessary, one should be scheduled, and all indicated tests and studies should be conducted and all findings reported in detail. The entire claims file and this REMAND should be made available to and be reviewed by the examiner in conjunction with this request. Following review of the claims file and, if appropriate, examination of the Veteran, the examiner should respond to the following: (a) Diagnose all residuals of the Veteran’s 2007 stroke, to include, but not limited to, any neurological symptoms, vision, difficulty swallowing, voiding dysfunction, and impaired sphincter control. In providing the foregoing opinion, please address the clinical evidence from 2007 and 2008 showing complaints of upper extremity numbness and vision problems following a stroke, and a June 2011 VA examination report noting that the Veteran’s neurological problems could be related to his CVA or cervical spine disease. (b) For each stroke residual identified, please state the approximate date of onset, to the extent possible. A complete rationale for the examiner’s opinion should be provided, citing to specific evidence of record, as necessary. If the examiner cannot provide an opinion without resort to speculation, the examiner should provide an explanation as to why this is so and whether there is additional evidence that would permit the opinion to be provided. S. C. Krembs Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Fagan 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.