Citation Nr: 18142832 Decision Date: 10/17/18 Archive Date: 10/16/18 DOCKET NO. 14-18 792 DATE: October 17, 2018 REMANDED Entitlement to service connection for peripheral neuropathy of the left lower extremity, to include as due to Agent Orange exposure and as secondary to service-connected diabetes mellitus is remanded. Entitlement to service connection for peripheral neuropathy of the right lower extremity, to include as due to Agent Orange exposure and as secondary to service-connected diabetes mellitus is remanded. REASONS FOR REMAND The Veteran had active service from March 1966 to May 1972. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2011 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Jackson, Mississippi. Jurisdiction was subsequently transferred to the RO in St. Petersburg, Florida. The Veteran testified before the undersigned at a Board videoconference hearing in November 2017. A transcript of the hearing has been associated with the claims file. This matter was before the Board in January 2018 at which time the Board granted the petition to reopen the previously denied claims of service connection for peripheral neuropathy of the left and right lower extremities and remanded the underlying service connection claims for additional development. As detailed below, additional remand is required. 1. Entitlement to service connection for peripheral neuropathy of the left and right lower extremities, to include as due to Agent Orange exposure and as secondary to service-connected diabetes mellitus is remanded. Pursuant to the Board’s previous remand directives, an opinion was to be obtained to determine the etiology of the Veteran’s peripheral neuropathy of the bilateral lower extremities. The clinician was to determine if the Veteran’s peripheral neuropathy is acute, subacute, or early-onset. Thereafter, he or she was to provide opinions as to whether the diagnosed disability is due to herbicide agent exposure during military service or secondary to the Veteran’s service-connected diabetes mellitus. A VA medical opinion was obtained in March 2018. However, the Board finds that it is insufficient to determine the service connection claims currently before the Board. At the outset, the clinician noted that the Veteran’s peripheral neuropathy had its onset in 2000. However, he did not determine if the Veteran’s peripheral neuropathy of the bilateral lower extremities is acute, subacute, or early-onset. Additionally, the clinician opined that the Veteran’s peripheral neuropathy of the bilateral lower extremities was not due to Agent Orange exposure during military service. In so finding, he noted that the onset of the Veteran’s peripheral neuropathy was 28 years after military service. Notwithstanding, he did not explain why the delayed onset of the Veteran’s peripheral neuropathy of the bilateral lower extremities precluded it from being etiologically related to herbicide agent exposure during military service. The clinician also concluded that the Veteran does not have diabetic neuropathy. While idiopathic neuropathy was diagnosed, the examiner did not provide an opinion as to whether the assessed disability was aggravated by the Veteran’s diabetes mellitus. As the January 2018 remand instructions have not been followed, additional remand is required. Stegall v. West, 11 Vet. App. 268 (1998). The matters are REMANDED for the following action: 1. Obtain an addendum opinion from a suitably qualified clinician regarding the nature and etiology of the Veteran’s peripheral neuropathy of the bilateral lower extremities. Access to records in the Veteran’s electronic claims file should be made available to the clinician for review in connection with his or her opinion. An additional VA examination may be provided if deemed necessary. The clinician should determine if the Veteran’s peripheral neuropathy is acute, subacute, or early-onset. Thereafter, he or she is to provide opinions to the following: (a) Is at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran’s peripheral neuropathy of the right and left lower extremities was incurred in service or is otherwise causally related to his active service or any incident therein, to include legally presumed exposure to an herbicide agent? (b) Is it at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran’s peripheral neuropathy of the right and left lower extremities was caused by his service-connected diabetes mellitus? (c) Is it at least as likely as (i.e., a 50 percent or greater probability) that the Veteran’s peripheral neuropathy of the right and left lower extremities has been aggravated (chronically worsened) by his service-connected diabetes mellitus? If aggravation is found, please identify the baseline level of disability prior to aggravation, to the extent possible, based on the medical evidence and also any lay statements as to the severity of the condition over time. A clear explanation for the VA medical opinion is required, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If the clinician cannot respond without resorting to speculation, it should be explained why a response would be speculative. In rendering the requested opinions, the examiner must discuss the Veteran’s reports regarding the onset of his neuropathy symptoms.   The examiner must also discuss the other medical opinions of record regarding the etiology of the Veteran’s peripheral neuropathy of the bilateral lower extremities, to include laboratory findings showing elevated blood sugar in February and March 2007. K. Conner Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Jones, Counsel