BVA9501032 DOCKET NO. 93-05 071 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Los Angeles, California THE ISSUES 1. Entitlement to an increased rating for peripheral neuropathy of the right upper extremity, currently evaluated as 10 percent disabling. 2. Entitlement to an increased rating for peripheral neuropathy of the left upper extremity, currently evaluated as 10 percent disabling. 3. Entitlement to an increased rating for peripheral neuropathy of the right lower extremity, currently evaluated as 10 percent disabling. 4. Entitlement to an increased rating for peripheral neuropathy of the left lower extremity, currently evaluated as 10 percent disabling. 5. Entitlement to an effective date earlier than January 25, 1989, for the granting of service connection for peripheral neuropathy of the upper and lower extremities. 6. Whether the bilateral factor awarded for the veteran's peripheral neuropathy of the upper and lower extremities was calculated correctly. ATTORNEY FOR THE BOARD Patrick J. Costello, Associate Counsel INTRODUCTION The veteran had active military service from September 1941 through November 1945, and from June 1946 to November 1961. This matter came before the Board of Veterans' Appeals (hereinafter the Board) on appeal from an April 1992 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO), in Los Angeles, California. The issue of entitlement to a total rating for compensation purposes based upon individual unemployability, raised by the appellant in his notice of disagreement, has not been adjudicated by the RO. Accordingly, this "issue" is not in appellate status, and is referred to the RO for appropriate action. REMAND In February 1988, the Board granted service connection for the residuals of lung cancer secondary to exposure to asbestos. Board Decision, February 3, 1988. As a result of that decision, the RO assigned a 30 percent disability evaluation. VA Form 21- 6796, Rating Decision, March 1, 1988; Board Decision, January 9, 1989; VA Form 21-6796, Rating Decision, January 26, 1989. Following notification of that award, the veteran then applied for service connection for peripheral neuropathy of the extremities secondary to the lung cancer. VA Form 21-4138, Statement in Support of Claim, received June 27, 1989. The RO initially denied the veteran's request for service connection for peripheral neuropathy on a secondary basis. However, upon further review of the evidence, in April 1992, the RO reversed its decision and granted service connection. VA Form 21-6796, Rating Decision, April 9, 1992. Peripheral neuropathy of each extremity is currently rated 10 percent disabling. 38 C.F.R. Part 4, Diagnostic Codes 8515 and 8520 (1994). This evaluation equates to mild incomplete paralysis of each extremity. Yet, the veteran has appealed that rating claiming that each extremity is currently more disabling than rated. Peripheral neuropathy is a syndrome that affects sensory loss, muscle weakness and atrophy, decreased deep tendon reflexes, and vasomotor symptoms, singly or in any combination thereof. The Merck Manual of Diagnosis and Therapy, 16th Edition, Vol. 1, 1992. PP 1313-1316. It has been determined that the veteran's peripheral neuropathy is a result of his carcinoma of lung, and an attempt to quantify the severity of the neuropathies has been accomplished through various testing means. It does appear that on the VA examination in December 1991, the results from electromyography and nerve conduction studies were reportedly abnormal but there was no explanation as to how these abnormalities affected the veteran. In view of the findings or lack thereof on the previous VA examinations, the veteran should be afforded similar diagnostic studies to determine current symptomatology and to resolve any apparent discrepancies. Therefore, it is the opinion of the Board that additional medical documentation explaining each of the veteran's four different conditions should be obtained prior to the issuing of an appellate decision. In view of the foregoing, and in order to insure a complete and adequate record, the case is REMANDED to the RO for the following action: The veteran is to be afforded an evaluation by a specialist in neurology who has not previously examined or treated the veteran. The purpose of this examination is to ascertain the current nature and extent of the peripheral neuropathy of all four of his extremities, and of all nerves affected in those extremities, and the nature and degree of any functional impairment caused by such neuropathy. All indicated special studies, including electromyography (EMG) and nerve conduction velocity tests, should be accomplished and the examiner should set forth reasoning underlying the final diagnosis. 38 C.F.R. Part 4, Diagnostic Codes 8515 and 8520 (1994) provides the criteria applicable to rating the level of disability caused by the veteran's peripheral neuropathy. These two Diagnostic Codes distinguish the type of paralysis into two parts -- complete and incomplete paralysis. Under incomplete paralysis, the type of paralysis is further broken down into three categories: severe, moderate, and mild. With these categories in mind, the examiner should classify the veteran's four peripheral neuropathies, distinguishing among the categories and using the results of all tests' results obtained. If the examiner uses results obtained from an EMG and/or nerve conduction velocity tests, the examiner is requested to explain, in terms meaningful to a layperson, the base line results versus those obtained for the veteran. The examiner is asked to report where the base line figures come from and why any results obtained are normal or abnormal. For example, if the nerve conduction velocity test for the medial nerve of the right upper extremity is not within normal limits, the examiner should explain what is a normal arithmetic reading versus that of the obtained results. The examiner is also asked to explain how any abnormal figure classifies the veteran as having mild, moderate, or severe incomplete paralysis or complete paralysis with respect to each extremity. Also, the physician is requested to explain whether the peripheral neuropathy affects the motor and/or sensory nerves, and which nerves it affects. The examiner should explain why those results show mild, moderate, severe incomplete paralysis or complete paralysis. The examiner is further requested to explain in detail what limitation of motion and function is caused by the neuropathies. The examiner should additionally explain which nerves in both the upper and lower extremities are affected, and should comment on the etiology of the veteran's carpal tunnel syndrome, particularly as to whether it is etiologically related to the service- connected disability. The neurologist is requested to report whether the veteran suffers from pain, numbness, wrist or foot drop, and muscle weakness and/or atrophy. The claims folder and this Remand are to be made available to the examiner for review prior to the examination, and the results of the examination should be typed or otherwise recorded in a legible manner for review purposes. Following completion of the requested development, the veteran's claim should be readjudicated. If the decision remains unfavorable, the veteran and his representative should be given a supplemental statement of the case and allowed sufficient time for a response. Thereafter, the claim should be returned to the Board for further consideration. No action is required of the veteran until he is contacted by the regional office. The purpose of this REMAND is to ensure due process and to obtain additional clarifying medical evidence. BETTINA S. CALLAWAY Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. Under 38 U.S.C.A. § 7252 (West 1991), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Veterans Appeals. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (1994).