Citation Nr: 21031254 Decision Date: 05/21/21 Archive Date: 05/21/21 DOCKET NO. 17-45 609 DATE: May 21, 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 from April 1970 to April 1973 and from April 1975 to February 1981. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision of a Regional Office (RO) of the Department of Veterans Affairs (VA). In February 2021, the Veteran testified before a Veterans Law Judge. A transcript of this hearing is of record. 1. Entitlement to service connection for peripheral neuropathy of the right upper extremity is remanded. 2. Entitlement to service connection for peripheral neuropathy of the left upper extremity is remanded. 3. Entitlement to service connection for peripheral neuropathy of the right lower extremity is remanded. 4. Entitlement to service connection for peripheral neuropathy of the left lower extremity is remanded. The Veteran seeks service connection for peripheral neuropathy of the upper and lower extremities. He asserts, in part, that these disabilities are due to or aggravated by service-connected disabilities. Service connection may be awarded for any disability which is proximately due to or the result of, or is otherwise aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310. The Veteran was afforded a December 2014 VA examination and medical opinion. The VA examiner confirmed current diagnoses of peripheral neuropathy of the upper and lower extremities but determined that these neuropathies were not due to the Veteran's service-connected diabetes mellitus. The examiner noted that diabetic peripheral neuropathy usually manifests several years after an initial diagnosis of diabetes. In the present case, the Veteran's peripheral neuropathy symptoms preceded or were concurrent with his diabetes, which was first diagnosed in 2012, according to the examiner. The examiner also suggested the Veteran's peripheral neuropathy may be related to a prior cerebrovascular accident. After review of the record, the Board finds this December 2014 opinion inadequate on several basis. First, the examiner does not address whether the Veteran's diabetes aggravates his peripheral neuropathy. Additionally, the Veteran has been granted service connection for hypertension; however, neither the December 2014 opinion nor the remainder of the record address whether the Veteran's hypertension caused or contributed to his cerebrovascular accident, which in turn may have caused or aggravated his neurological symptoms of the upper and lower extremities. Finally, a 2015 statement was received from a private doctor suggesting the Veteran's diabetes may have manifested as early as 2008, based on blood glucose levels. A similar statement was submitted in February 2021, following the Board hearing. These statements undermine the rationale supplied by the 2014 VA examiner. For these reasons, a new VA medical opinion is required. The matters are REMANDED for the following action: 1. Forward the claims file to an appropriate examiner to determine the nature and etiology of any current peripheral neuropathy of the Veteran's upper or lower extremities. The Veteran need not be scheduled for personal examination unless the reviewer determines such examination is necessary to comply with this remand order. After reviewing the claims file, the examiner must determine if diagnoses of peripheral neuropathy of the upper and/or lower extremities are warranted. For any peripheral neuropathy identified, the examiner is asked to state whether it is at least as likely as not (probability of 50 percent or greater) that this disorder is due to or aggravated by a service-connected disability or disabilities? The examiner is also asked to state whether any current peripheral neuropathy is caused or aggravated by the Veteran's prior cerebrovascular accidents and whether this diagnosis in turn was caused or aggravated by his service-connected hypertension. The examiner is reminded the Veteran has been granted service connection for posttraumatic stress disorder (PTSD), diabetes mellitus, headaches, impingement syndrome of the right shoulder, a right knee disability, thrombosis, muscle weakness of the left upper and lower extremities, hypertension, and tinnitus. Regarding his diabetes, the Veteran contends this disability had its onset in 2008 or earlier. A complete rationale for any opinion provided is required. 2. After undertaking any additional development deemed appropriate and giving the Veteran full opportunity to supplement the record, adjudicate the Veteran's pending claims in light of any additional evidence added to the record. If any benefit sought on appeal remains denied, the Veteran and his representative should be furnished with a Supplemental Statement of the Case and be afforded the applicable opportunity to respond before the record is returned to the Board for further review. M. Donohue Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Thomas D. Jones, 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.