Citation Nr: 21027949 Decision Date: 05/07/21 Archive Date: 05/07/21 DOCKET NO. 16-31 087 DATE: May 7, 2021 REMANDED Entitlement to service connection for peripheral neuropathy, left upper extremity, is remanded. Entitlement to service connection for right upper extremity disability, to include peripheral neuropathy and ulnar tunnel syndrome, is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1969 to April 1973, December 1990 to May 1991, and February 2003 to May 2004. This case initially came before the Board of Veterans' Appeals (Board) on appeal from a September 2015 rating decision of a VA Regional Office (RO) which, inter alia, denied entitlement to service connection for peripheral neuropathy, left upper extremity, and peripheral neuropathy, right upper extremity. The Board has recharacterized the disability of the right upper extremity to include ulnar tunnel syndrome because the claim should not be limited to the disorder as characterized by the Veteran, but must be characterized and addressed based on the reasonable expectations of the non-expert claimant and the evidence in processing the claim. Clemons v. Shinseki, 23 Vet. App. 1, 4-5 (2009). In October 2018 and January 2020, the Board remanded the matters for further evidentiary development. 1. Left Upper Extremity / Right Upper Extremity Although the Board regrets the delay, additional development is needed to comply with the March 2018 remand instructions. Stegall v. West, 11 Vet. App. 268 (1998); D'Aries v. Peake, 22 Vet. App. 97, 105 (2008). In response to the Board's January 2020 remand directives, an addendum opinion was obtained from the May 2019 VA examiner in January 2020. The examiner opined that as noted in the EMG results, the Veteran's right upper extremity is noted to have right ulnar tunnel syndrome at the wrist. The examiner also indicated that right ulnar tunnel syndrome is not a peripheral neuropathy and thus not caused by diabetes. The examiner further opined that the Veteran reports bilateral upper extremity symptoms but does not have objective clinical findings to confirm a diagnosis other than illustrated on EMG. The examiner, however, failed to provide an opinion with clear rationale addressing whether the Veteran's left upper extremity symptoms are caused by his service-connected diabetes. The examiner also failed to provide an opinion with clear rationale addressing whether the Veteran's bilateral upper extremity symptoms are aggravated by his service-connected diabetes or are otherwise related to service. Also, in Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018), the Federal Circuit found that the term disability as used in 38 U.S.C. § 1110 refers to the functional impairment of earning capacity, not the underlying cause of said disability and held that pain alone can serve as a functional impairment and therefore qualify as a disability. In light of the above, the Board finds the examiner's opinion is inadequate and another VA medical opinion is required. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (when VA undertakes to provide an examination or obtain a medical opinion, it must ensure that the examination or opinion is adequate). The matters are REMANDED for the following action: 1. Obtain an opinion from an appropriate clinician to determine the nature and etiology of the Veteran's bilateral upper extremity symptoms, including numbness, pain, and paresthesias and/or dysesthesias. If an examination is deemed necessary, one should be conducted, to include via telehealth if warranted. The clinician should review the claims file prior to rendering the opinion. The clinician should answer the following questions: (a.) Is it at least as likely as not (at least a 50 percent probability) that any right and left upper extremity disorder, to include symptoms causing impairment, including numbness, pain, and paresthesias and/or dysesthesias, had their onset during active service or is otherwise related to military service? (b.) Is it at least as likely as not (i.e., a 50 percent or greater probability) that any right or left upper extremity disability to include symptoms causing impairment was caused by his service-connected diabetes? (c.) Is it at least as likely as not (i.e., a 50 percent or greater probability) that any right or left upper extremity disability to include symptoms causing impairment was aggravated by his service-connected diabetes? If aggravation is found, please identify the baseline level of disability prior to aggravation, to the extent possible. The clinician must provide a complete rationale for any opinion set forth. Jonathan Hager Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Walker, 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.