Citation Nr: 21042300 Decision Date: 07/12/21 Archive Date: 07/12/21 DOCKET NO. 17-03 863 DATE: July 12, 2021 REMANDED Entitlement to service connection for peripheral neuropathy of the bilateral upper extremity as secondary to service-connected type II diabetes mellitus is remanded. Entitlement to service connection for peripheral neuropathy of the bilateral lower extremity as secondary to service-connected type II diabetes mellitus is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1964 to August 1968. This case is before the Board of Veterans' Appeals (Board) on appeal from an August 2018 Regional Office (RO) rating decision. In that rating decision, the RO denied entitlement to service connection for type II diabetes mellitus, peripheral neuropathy of the bilateral upper extremity, and peripheral neuropathy of the bilateral lower extremity. The Veteran's notice of disagreement (NOD) was received in August 2018. In December 2018, the Board remanded the claims to the RO to issue a statement of the case. The RO issued a statement of the case (SOC) in July 2020. The Veteran's VA Form 9, substantive appeal to the Board, was received in July 2020. In November 2020, the Veteran testified at a virtual Board hearing before the undersigned Veterans Law Judge. A transcript of the testimony is associated with the claims file. In March 2021, the Board remanded the case to the RO for further development and adjudicative action. The Veteran contends that he has peripheral neuropathy of the bilateral upper and lower extremity secondary to his service-connected type II diabetes mellitus. In March 2021, the Board remanded the above issues to obtain a VA examination and medical with respect to whether the Veteran's peripheral neuropathy of the bilateral upper and lower extremities were caused by or aggravated by his type II diabetes mellitus. The Veteran underwent a VA examination in April 2021. The examiner determined that the Veteran did not have a current diagnosis of peripheral neuropathy of the bilateral upper extremity. However, the examination reflected some neurological defects in the upper right extremity to include less than normal strength, decreased light touch monofilament testing in the inner/outer forearm and hand/fingers, decreased vibration sense, and decreased cold sensation. The examiner also noted that an EMG in 2015 possibly showed peripheral neuropathy of the right upper extremity in 2015, but the EMG in 2017 was not consistent with that diagnosis. In light of the findings in the physical examination in the April 2021, as well as, the results of the 2015 EMG, the examiner did not provide an adequate explanation for why he determined that the Veteran does not have a current diagnosis (or a diagnosis during the appeal period that may have resolved) of a neurological disorder of the bilateral upper extremities. The April 2021 examiner provided a diagnosis of peripheral neuropathy of the bilateral lower extremities and provided the medical opinion that the Veteran's peripheral neuropathy of the bilateral lower extremities is not caused by or aggravated by his service-connected diabetes mellitus. The examiner's rationale appears to be based on the examiner's determination that the Veteran's type II diabetes mellitus is in remission. The Board finds that the medical opinion is inadequate as the examiner did not provide a clear explanation on why the Veteran's type II diabetes mellitus (even if now in remission, asymptomatic, or resolved) did not cause or aggravate his peripheral neuropathy of the bilateral lower extremities. The matters are REMANDED for the following action: Arrange for the Veteran to undergo a VA examination by an appropriate medical specialist who has not previously participated in this case with respect to the Veteran's service connection claim for peripheral neuropathy of the bilateral upper and lower extremities. The electronic claims file, including a copy of this REMAND, must be made available to the examiner for review, and the examiner should indicate that the claims folder was reviewed in connection with the examination. All indicated evaluations, studies, and tests deemed necessary by the examiner should be accomplished. An electromyography (EMG) and/or nerve conduction study of the bilateral upper and lower extremities must be obtained. The examiner is requested to review all pertinent records associated with the claims file and offer an opinion as to whether the Veteran's peripheral neuropathy of the bilateral upper extremity, peripheral neuropathy of the bilateral lower extremity, and/or any other neurological disorders of the upper and/or lower extremities found on examination or diagnosed at any point pertinent to the current claim (even if now asymptomatic or resolved) are at least as likely as not (i.e., a 50 percent or more probability) (a) caused by or (b) aggravated (i.e., worsened) by his service-connected type II diabetes mellitus. The examiner is reminded that an adequate opinion must address both prongs (a) and (b). If aggravation is found, the examiner must attempt to establish the baseline level of severity of the neuropathy prior to aggravation by the service-connected disability. An explanation must be given for any opinion expressed and the foundation for all conclusions should be clearly set forth. MARTIN B. PETERS Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Berry, 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.