Citation Nr: 21032455 Decision Date: 05/27/21 Archive Date: 05/27/21 DOCKET NO. 09-46 800 DATE: May 27, 2021 REMANDED Service connection for residuals of a right ankle/foot injury. Service connection for genitourinary dysfunction, to include as secondary to diabetes mellitus. Service connection for numbness in the face (mask area), to include as secondary to diabetes mellitus. A total disability rating for compensation based on individual unemployability (TDIU). REASONS FOR REMAND The Veteran served on active duty from February 1964 to February 1967. The case is on appeal from December 2008 and February 2010 rating decisions. In April 2015, the Veteran testified at a Board hearing. The claim was last before the Board in February 2018. At that time, the Board granted service connection for left and right upper extremity peripheral neuropathy, as associated with service-connected diabetes mellitus type II, left and right lower extremity peripheral neuropathy, as associated with service-connected diabetes mellitus type II, impotence/erectile dysfunction, as associated with service-connected diabetes mellitus type II; denied service connection for hearing loss and an initial disability rating higher than 20 percent for diabetes mellitus; and, remanded the claims of service connection for residuals of a right ankle/foot injury; genitourinary dysfunction, to include as secondary to diabetes mellitus; numbness in the face (mask area), to include as secondary to diabetes mellitus, and a TDIU for further development. 1. Service connection for residuals of a right ankle/foot injury. 2. Service connection for genitourinary dysfunction, to include as secondary to diabetes mellitus. 3. Service connection for numbness in the face (mask area), to include as secondary to diabetes mellitus. The Board remanded the claims for new VA examinations and medical opinions. It appears that the examinations were cancelled and it was indicated that the Veteran did not want to pursue the claims. In March 2021, the Board sent the Veteran a letter to address whether he in fact wished to withdraw the appeal. No response was received at the time of this decision; thus, the Board will continue to have jurisdiction over the appeal. The Board will remand to attempt to reschedule the Veteran for a VA examination. Even if an examination is not conducted, a medical opinion should be obtained based on the record. 4. A TDIU. The issue of TDIU is intertwined with the pending claims and in lieu of the above awards. As such, it is also remanded. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The Veteran should also be sent a standard VA TDIU application form. In light of the remand, updated VA treatment records should be provided. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records dated from May 2017. 2. Send the Veteran a VA Form 8940 to complete as to the TDIU claim. 3. Schedule the Veteran for a VA examination (or telehealth interview, review of record, etc., if an in-person examination is not feasible) with an appropriate medical professional to determine the nature and etiology of the Veteran's right ankle/foot disorder. The entire claims file should be reviewed by the examiner. ***A medical opinion should be obtained even if a VA examination cannot be conducted. The examiner should identify all right ankle/foot disorders found on examination and in treatment records, including any right ankle arthritis. The examiner should provide an opinion, for each right ankle/foot disorder, as to whether it is at least as likely as not (50 percent or greater probability) that the disorder began during service, in the year after service, or is related to some incident of service. The examiner must discuss the Veteran's in-service injury(s) and current complaints and symptoms with the Veteran and document the Veteran's assertions in the examination report. 4. Then, schedule the Veteran for a VA examination (or telehealth interview, review of record, etc., if an in-person examination is not feasible) with urologist to determine the nature and etiology of the Veteran's genitourinary dysfunction. ***A medical opinion should be obtained even if a VA examination cannot be conducted. After clinical assessment, the examiner is requested to opine as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran's genitourinary problem is related to (caused by, or aggravated by), a service-connected disability, including the Veteran's service-connected diabetes mellitus type II and peripheral neuropathy. Aggravation is an increase in severity beyond a temporary flare-up or the natural progress of the disease. 5. Additionally, schedule the Veteran for a VA examination (or telehealth interview, review of record, etc., if an in-person examination is not feasible) with a neurologist to determine the nature and etiology of the Veteran's facial numbness. ***A medical opinion should be obtained even if a VA examination cannot be conducted. After clinical assessment, the examiner is requested to opine as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran's face numbness/tingling began during service or is related to some incident of service, or is related to (caused by, or aggravated by), a service-connected disability, including the Veteran's service-connected diabetes mellitus type II and peripheral neuropathy. Aggravation is an increase in severity beyond a temporary flare-up or the natural progress of the disease. A complete rationale for all opinions expressed should be provided. RYAN T. KESSEL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Becton, Associate 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.