Citation Nr: 18148794 Decision Date: 11/08/18 Archive Date: 11/08/18 DOCKET NO. 10-42 581 DATE: November 8, 2018 ORDER Entitlement to service connection for peripheral neuropathy of the bilateral lower extremities is granted. REMANDED Entitlement to service connection for a cervical spine lesion, to include bilateral upper extremity peripheral neuropathy is remanded. FINDING OF FACT The Veteran’s peripheral neuropathy of the bilateral lower extremities had its onset in service. CONCLUSION OF LAW The criteria for entitlement to service connection for peripheral neuropathy of the bilateral lower extremities have been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty military service from October 1967 to March 1976 and from March 1977 to September 1988, including service in the Republic of Vietnam. This case was previously before the Board in August 2017, when the claim of service connection for a disability of a cervical spine segment to include paralysis of the sciatic nerve and peripheral neuropathy. The Veteran appealed the Board’s denial to the United States Court of Appeals for Veterans Claims (Court), which in May 2018 granted a Joint Motion for Remand (JMR) of the parties (VA Secretary and the Veteran), vacated the Board’s decision, and remanded the case pursuant to 38 U.S.C. § 7252(a) for readjudication consistent with the Motion. The JMR specifically took issue with the failure of the Board to address the question of entitlement to peripheral neuropathy of the bilateral lower extremities as separate from the claim for cervical spine disability. The Board has restyled the issues on appeal accordingly. Entitlement to service connection for peripheral neuropathy of the bilateral lower extremities The Veteran asserts that his peripheral neuropathy of the bilateral lower extremities had it onset in service with the leg cramps he reported prior to service separation. The Board concludes that the Veteran has a current diagnosis of bilateral peripheral neuropathy in his legs that was first manifested in service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). The Veteran’s service treatment records show that he complained of leg cramps in service in August 1984. Private treatment records include opinions that the Veteran’s current peripheral neuropathy was related to his complaints in service. At the VA examination in December 2014, the examiner attributed the Veteran’s symptoms to peripheral neuropathy and noted the onset of symptoms in service. In the addendum provided in December 2016, the examiner stated that the symptoms reported by the Veteran were those of peripheral neuropathy which likely started in service, but provided a negative opinion regarding the symptoms in the cervical spine and upper extremities. In light of the medical opinions and the evidence of symptom onset in service, the Board finds that service connection for peripheral neuropathy of the bilateral lower extremities is warranted. REASONS FOR REMAND Entitlement to service connection for a cervical spine lesion, to include bilateral upper extremity peripheral neuropathy The Veteran’s claim of service connection includes a diagnosis of cervical spine lesion and complaints of symptoms in both arms. The Veteran’s service treatment records show that he was treated for right shoulder symptoms and he is service connected for a right shoulder disability. The Veteran has stated that he began to experience numbness in his hands and arms in service and his wife submitted a statement in January 2010 that his arm symptoms began in approximately 1982, prior to his separation from service. Private medical opinions in August 2010 and March 2011 both linked the Veteran’s arm symptoms to his military service and to the cervical spine lesion. A VA examination in December 2014 and a follow-up opinion in December 2016 both stated that the Veteran’s arm symptoms were most likely peripheral neuropathy and were not related to his cervical spine lesion. The VA examination and opinions, however, did not address the private medical opinions. Neither the private nor VA opinions addressed the Veteran’s right shoulder disability and whether that has any relationship to the cervical spine lesion claim. The JMR directed that additional consideration be given to the contrast between the various opinions. The Board finds that an additional opinion to address all of the aspects of these opinions is necessary. The matter is REMANDED for the following action: Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s cervical spine lesion and/or arm symptoms, including those related to peripheral neuropathy, are at least as likely as not (probability of 50 percent or greater) related to or otherwise the result of the symptoms manifested in service, to include the right shoulder disability. The examiner should specifically address whether the Veteran’s cervical spine lesion may be related to the cause of the Veteran’s service-connected right shoulder disability. The examiner should also address the Veteran’s reports of symptoms in service and indicate whether they are consistent with those of peripheral neuropathy as currently diagnosed in the Veteran’s upper extremities. The examiner should also address the private medical opinions and the prior VA examination and opinions in all of their particulars and discuss the significance of these findings and opinions in light of the Veteran’s symptoms and the medical research and scholarship with respect to cervical spine lesions and peripheral neuropathy. The examiner should offer a statement of the reasons or rationale for all opinions that are provided. JAMES L. MARCH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Cheryl E. Handy, Counsel