Citation Nr: 18141192 Decision Date: 10/09/18 Archive Date: 10/09/18 DOCKET NO. 15-45 790 DATE: October 9, 2018 REMANDED Service connection for peripheral neuropathy, to include as a result of herbicide exposure and/or secondary to the service-connected ischemic heart disease, is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1970 to January 1972. This matter comes before the Board of Veterans’ Appeals (Board) from a May 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Atlanta, Georgia. The Veteran’s appeal formally included a claim for service connection for post-traumatic stress disorder. This claim was granted in a March 2018 rating decision. As such, this issue is no longer part of the current appeal and is not before the Board at this time. Service connection for peripheral neuropathy, to include as a result of herbicide exposure and/or secondary to the service-connected ischemic heart disease, is remanded. The Veteran argues that he incurred peripheral neuropathy as a result of his exposure to Agent Orange, or in the alternative, that it has been caused or aggravated by his service connected ischemic heart disease. The Veteran’s in-service exposure to herbicides (Agent Orange) is presumed in light of his Vietnam service. The Board notes that peripheral neuropathy is one of the diseases associated with Agent Orange/herbicide agent exposure in service are presumed to be service connected if the disease is manifested to a compensable degree within a year of separation from service and manifested to a degree of 10 percent or more. Regardless of the presumptive provisions, direct service connection is not precluded. In other words, a regulatory established presumption is not the sole method for showing causation in establishing a claim for service connection for disability due to herbicide exposure. The Veteran has been diagnosed with peripheral sensory neuropathy. The Veteran is service-connected for ischemic heart disease. A March 2015 Agent Orange Peripheral Neuropathy Check List, signed by a rating officer and a physician, indicates that there was no evidence received showing peripheral neuropathy during time of exposure or one year after his last date of exposure. However, the Veteran has not been afforded a VA examination addressing the nature and/or etiology of his peripheral neuropathy to include any relationship to his herbicide exposure and/or his service-connected ischemic heart. A VA examination and opinion should be obtained. See McClendon v. Nicholson, 20 Vet. App. 79 (2006). Accordingly, the case is REMANDED for the following action: 1. The Veteran must be afforded a VA examination to determine the nature and etiology of the claimed peripheral neuropathy. The electronic claim file must be made available to the examiner, and the examiner must specify in the examination report that these records have been reviewed. All indicated tests or studies must be completed. The examiner must describe all findings in detail. Based on a detailed review of the evidence of record, the examiner must offer an opinion as to whether the Veteran’s peripheral neuropathy is at least as likely as not (a 50 percent or greater probability): (i) related to an injury or disease during the Veteran’s active military service; (ii) related or otherwise attributable to his presumed herbicide exposure regardless of whether the condition is a listed disease under 38 C.F.R. § 3.309(e); and/or (iii) caused or aggravated beyond its natural progression by the Veteran’s ischemic heart disease. A detailed explanation (rationale) is required for all opinions provided. (By law, the Board is not permitted to rely on any conclusion that is not supported by a thorough explanation. Providing an opinion or conclusion without a thorough explanation will delay processing of the matter and may also result in a clarification being requested). 2. If upon completion of the above action the claim remains denied, the case should be returned to the Board after compliance with appellate procedures. E. I. VELEZ Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD I. Kerner, Associate Counsel