Citation Nr: 21023691 Decision Date: 04/21/21 Archive Date: 04/21/21 DOCKET NO. 14-24 962 DATE: April 21, 2021 REMANDED Entitlement to service connection for peripheral neuropathy of the bilateral upper extremities, to include as secondary to service-connected diabetes mellitus is remanded. Entitlement to total a disability rating due to individual unemployability (TDIU) from January 1, 2011 through February 4, 2011 is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from May 1966 to May 1969. In September 2018 and October 2020, the Board remanded the case for further development, which has been completed. Stegall v. West, 11 Vet. App. 268, 271 (1998). 1. Entitlement to service connection for neuropathy of the bilateral upper extremities, to include as secondary to service-connected diabetes mellitus At a VA examination for diabetes in November 2011 the examiner noted symptoms attributable to diabetic peripheral neuropathy for the upper extremities but found insufficient objective evidence for an official diagnosis. Again, in April 2014 at a VA examination for diabetes, the examiner noted symptoms attributable to diabetic peripheral neuropathy of the upper extremities but did not provide an official diagnosis. In July 2018 a medical opinion was obtained to determine whether the Veteran has a current diagnosis of peripheral neuropathy of the upper extremities. The examiner concluded that the Veteran does not have a current diagnosis either clinically or electro-diagnostically noting that the November 3, 2011 and July 8, 2019 electro-diagnostic (EDX) testing was negative for peripheral neuropathy. The Board finds this opinion inadequate for adjudication. The examiner’s rationale relies on negative EDX findings but fails to discuss the medical records revealing consistent complaints of pain, numbness, paresthesias, cramps and tingling sensations throughout the appeal period. In Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), the Federal Circuit held that “pain alone, without an accompanying diagnosis of a present disease, can qualify as a disability” if it “reaches the level of a functional impairment of earning capacity.” Id. at 1367-69. As such, a remand is necessary for a VA examination to determine if the Veteran has a qualifying disability pursuant to Saunders. 2. Entitlement to TDIU from January 1, 2011 through February 4, 2011 For the period at issue, the Veteran has a total combined rating of 40 percent; thus, not meeting the requirements for schedular TDIU. The Veteran’s entitlement to service connection claim on appeal may increase his combined rating total for the period at issue; thus, the Board finds that entitlement to a TDIU is inextricably intertwined and the claim for a TDIU must be remanded as well. See Harris v. Derwinski, 1 Vet. App. 180 (1991) (issues are inextricably intertwined when a decision on one issue would have a significant impact on another issue). The matters are REMANDED for the following action: 1. In remanding this case, the Board makes no credibility determination, expressed or implied, at this juncture. 2. Obtain updated VA and/or private treatment records. If such records are unavailable, the Veteran’s claim file must be clearly documented to that effect and the Veteran notified in accordance with 38 C.F.R. § 3.159(e). 3. Schedule the Veteran for a VA examination with a medical professional with appropriate expertise to determine the nature and etiology of peripheral neuropathy of the upper extremities. The examiner should review the Veteran’s claims file. Based on examination and review of the record, the examiner must address the following: (a.) Determine whether the Veteran has a current diagnosis of peripheral neuropathy of the upper extremities. If a diagnosis is not established, describe the functional impairments related to the Veteran’s upper extremity symptoms, to include pain. The examiner is advised that the Veteran’s pain may qualify as a disability if it reaches the level of a functional impairment of earning capacity. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). (b.) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran’s peripheral neuropathy or upper extremity condition is related to active service or is caused by or aggravated by military service. (c.) Is it at least as likely as not (i.e., probability of 50 percent or higher) that peripheral neuropathy or upper extremity condition is proximately due to or the result of the Veteran’s service-connected diabetes? (d.) If the answer to (a) is negative, is it at least as likely as not that the peripheral neuropathy or upper extremity condition is aggravated (i.e., permanently or temporarily worsened) by diabetes? (e.) If aggravation is found, the examiner should address the following medical issues: 1) the baseline manifestations of the disorder found prior to aggravation; and 2) the increased manifestations which, in the examiner's opinion, are proximately due to the service-connected disorder. The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a certain conclusion is so evenly divided that it is as medically sound to find in favor of such a conclusion as it is to find against it. In all opinions rendered, the examiner is advised that the Veteran is competent to report his symptoms and treatment history. If there is a medical basis to doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. A complete rationale containing clear conclusions with supporting data and a reasoned medical explanation connecting the two is required for all medical opinions. The examiner should also identify and explain the relevance or significance, as appropriate, of any history, clinical findings, medical knowledge or literature, etc., relied upon in reaching the conclusion(s). If the medical professional cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation for why an opinion cannot be rendered. In so doing, the medical professional shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). 4. Finally, readjudicate the appeal. If the service connection sought for peripheral neuropathy of the upper extremities and entitlement to TDIU remains denied, issue a supplemental statement of the case and return the case to the Board. G. A. WASIK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Prinsen, Samantha 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.