Citation Nr: 21032458 Decision Date: 05/27/21 Archive Date: 05/27/21 DOCKET NO. 16-23 237 DATE: May 27, 2021 ORDER Entitlement to service connection for peripheral neuropathy of the right upper extremity is granted. Entitlement to service connection for peripheral neuropathy of the left upper extremity is granted. Entitlement to service connection for peripheral neuropathy of the right lower extremity is granted. Entitlement to service connection for peripheral neuropathy of the left lower extremity is granted. REFERRED The issue of entitlement to a total disability rating based on individual unemployability (TDIU) was referred to the agency of original jurisdiction (AOJ) for adjudication in the December 2018 Board of Veterans' Appeals (Board) decision. The issue of entitlement to a TDIU was raised during the July 2017 Board hearing. The Board is again referring the issue to the AOJ. FINDINGS OF FACT 1. The evidence is in at least relative equipoise as to whether the Veteran's peripheral neuropathy of the right upper extremity is proximately due to or the result of his service-connected diabetes mellitus. 2. The evidence is in at least relative equipoise as to whether the Veteran's peripheral neuropathy of the left upper extremity is proximately due to or the result of his service-connected diabetes mellitus. 3. The evidence is in at least relative equipoise as to whether the Veteran's peripheral neuropathy of the right lower extremity is proximately due to or the result of his service-connected diabetes mellitus. 4. The evidence is in at least relative equipoise as to whether the Veteran's peripheral neuropathy of the left lower extremity is proximately due to or the result of his service-connected diabetes mellitus. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for peripheral neuropathy of the right upper extremity have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310(a). 2. The criteria for entitlement to service connection for peripheral neuropathy of the left upper extremity have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310(a). 3. The criteria for entitlement to service connection for peripheral neuropathy of the right lower extremity have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310(a). 4. The criteria for entitlement to service connection for peripheral neuropathy of the left lower extremity have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1966 to July 1969. This appeal to the Board arose from a July 2011 rating decision issued by the Department of Veterans Affairs (VA). See August 2011 Notice of Disagreement (NOD); April 2016 Statement of the Case (SOC); May 2016 Substantive Appeal (VA Form 9). The Veteran testified before the undersigned Veterans Law Judge in a July 2017 hearing. See July 2017 Hearing transcript. In December 2018, the Board remanded the claims for further development. December 2018 Board decision. In August 2020, the Board remanded the claim again for further development. August 2020 Board decision. The Board recharacterized the Veteran's claim to encompass a claim of service connection for peripheral neuropathy of the right and left upper as well as lower extremities to more accurately capture the Veteran's asserted symptoms and the medical evidence. The Board recognizes that the December 2018 Board decision referred the claim of entitlement to service connection for bilateral lower extremity peripheral neuropathy to the AOJ for adjudication. As the AOJ has not adjudicated the claim yet and the Board has now broadened the Veteran's claims on appeal to encompass his lower extremities, the referral is moot. Service Connection Service connection may be established on a secondary basis for: (1) a disability which is proximately due to or the result of a service-connected disease or injury; or, (2) any increase in severity of a nonservice-connected disease or injury which is proximately due to or the result of a service-connected disease or injury, and not due to the natural progression of the nonservice-connected disease or injury. 38 C.F.R. § 3.310 (a)-(b); see also 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a); Allen v, Brown, 7 Vet. App. 439 (1996) (en banc); Ward v. Wilkie, 31 Vet. App. 233 (2019). Generally, to prevail on theory of secondary service connection, there must be evidence of (1) a current disability, (2) a service-connected disability, and (3) a nexus, or link, between the current disability and the service-connected disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). 1. Entitlement to service connection for peripheral neuropathy of the right upper extremity. 2. Entitlement to service connection for peripheral neuropathy of the left upper extremity. The Veteran asserts entitlement to service connection for peripheral neuropathy of his upper extremities. September 2010 VA Form 21-4138. The Veteran testified that his peripheral neuropathy may be due to his now service-connected diabetes mellitus. See July 2017 Hearing transcript. A June 2016 EMG report shows that generalized peripheral polyneuropathy is a current disability. June 2016 VA treatment evidence. The evidence also shows that the Veteran is currently entitled to service connection for diabetes mellitus. November 2016 Rating decision. VA treatment provider A D, D.O., opined that the Veteran's bilateral hand, or "glove type" neuropathy is consistent with diabetic neuropathy. September 2017 VA treatment evidence. The Veteran was noted to have been prediabetic since 2012, then started on medication for diabetes in 2016, and has had elevated A1C levels in September 2016 and April 2017. Id. Dr. A D opined that there is more than a 50 percent chance that his peripheral neuropathy is related to his diabetes and years of prediabetic symptoms. Id. Dr. A D is a medical professional qualified to opine on the cause of the Veteran's peripheral neuropathy and his VA treating physician. The Board finds the opinion to be probative and it supports that the Veteran's right and left peripheral neuropathy of the upper extremities is proximately due to or the result of his service-connected diabetes mellitus. The Board notes that Dr. A D's opinion is the only probative medical opinion as to whether the Veteran's peripheral neuropathy is proximately due to or the result of his diabetes mellitus. The Veteran's August 2016 VA neurology consultant for hand weakness opined that the cause of the Veteran's peripheral neuropathy is unclear, but appeared to be unaware of the Veteran's history of diabetes. See August 2016 VA treatment evidence. The December 2019 and September 2020 VA examiners' opinions found the Veteran's carpal tunnel syndrome was less likely than not secondary to his diabetes, but did not discuss the Veteran's generalized peripheral neuropathy diagnosis. See December 2019 VA examination medical opinion; September 2020 VA examination medical opinion. The Board finds the opinions to be not probative for those reasons. The Board, thus, finds that the more probative evidence of record supports finding that the Veteran's peripheral neuropathy of the right and left upper extremities is proximately due to or the result of his service-connected diabetes mellitus. Accordingly, entitlement to service connection for peripheral neuropathy of the right and left upper extremity is warranted. 3. Entitlement to service connection for peripheral neuropathy of the right lower extremity 4. Entitlement to service connection for peripheral neuropathy of the left lower extremity As noted above, the Veteran claimed entitlement to service connection for neuropathy of his upper extremities. September 2010 VA Form 21-4138; August 2011 NOD. However, the Veteran's medical treatment evidence at the time showed that he also had impaired sensation in his lower extremities. September 2010 VA treatment evidence. The Veteran has continued to complain of pain and numbness in his feet since. June 2012 VA treatment evidence; July 2017 Hearing transcript. The medical evidence shows that peripheral neuropathy of the left and right lower extremities is a current disability. June 2012 VA treatment evidence. The evidence also shows that the Veteran is currently service-connected for diabetes mellitus. November 2016 Rating decision. Dr. A D opined that the Veteran's bilateral lower extremity "stocking type" neuropathy is consistent with diabetic neuropathy. September 2017 VA treatment evidence. As discussed above, Dr. A D noted the Veteran has been prediabetic since 2012, then started on medication for diabetes in 2016, and had elevated A1C levels in September 2016 and April 2017. Id. Dr. A D opined that there is more than a 50 percent chance that his peripheral neuropathy is related to his diabetes and years of prediabetic symptoms. Id. Dr. A D is also the only opinion on whether the Veteran's peripheral neuropathy of the lower extremity is proximately due to or the result of his diabetes mellitus. The Board finds Dr. A D's opinion to be probative here as well. Accordingly, the Board finds that entitlement to service connection for peripheral neuropathy of the right and left extremities is warranted. R. FEINBERG Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Lin 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.