Citation Nr: 18149428 Decision Date: 11/09/18 Archive Date: 11/09/18 DOCKET NO. 16-26 333 DATE: November 9, 2018 REMANDED Entitlement to service connection for peripheral neuropathy of the left upper extremity, to include as due to Agent Orange exposure, is remanded. Entitlement to service connection for peripheral neuropathy of the left lower extremity, to include as due to Agent Orange exposure, is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from September 1965 to June 1967, to include service in the Republic of Vietnam from January 1966 to June 1967. The Veteran seeks to establish service connection for peripheral neuropathy of the left upper and lower extremities. He believes that the condition can be attributed to exposure to herbicide agents in Vietnam. The available evidence reflects that the Veteran has a diagnosis of peripheral neuropathy of the bilateral upper and lower extremities. The evidence also reflects that the Veteran served on active duty in the Republic of Vietnam between January 9, 1962, and May 7, 1975. As such, he is presumed to have been exposed to herbicide agents. See 38 C.F.R. § 3.307 (a)(6)(iii). The Secretary of VA has determined that there is no positive association between exposure to herbicides and any other condition for which the Secretary has not specifically determined that a presumption of service connection is warranted. See Notice, 59 Fed. Reg. 341-46 (1994); Notice, 61 Fed. Reg. 41, 442-49 (1996); Notice, 72 Fed. Reg. 32,395-32,407 (Jun. 12, 2007); Notice, 74 Fed. Reg. 21,258-21,260 (May 7, 2009); Notice, 75 Fed. Reg. 32540 (June 8, 2010). However, a claimant is not precluded from establishing service connection for an unlisted condition by submitting evidence of direct causation. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). Early onset peripheral neuropathy is a condition entitled to presumptive service connection due to exposure to herbicides. 38 C.F.R. § 3.309 (e). However, for the presumption to apply, the condition must have become manifest to a degree of 10 percent or more within a year after the last date on which the Veteran was exposed to an herbicide agent during service. 38 C.F.R. § 3.307 (a)(6)(ii). The Veteran’s case turns on whether his peripheral neuropathy can properly be considered “early onset;” if so, whether it became manifest to a compensable degree within one year of his departure from Vietnam in June 1967; and, if not, whether his neuropathy can nevertheless be attributed to in-service exposure to herbicides. As to these matters, the Board finds that additional development is required. At the Veteran’s October 2013 VA examination, he indicated that the onset of his symptoms was in 1967, immediately following his service in the Republic of Vietnam. However, despite the Veteran’s statement and the concurrent diagnosis of peripheral neuropathy of the bilateral upper and lower extremities, the examiner indicated that he could not confirm a relationship with Agent Orange exposure, recommending that EMG and MRI studies of the Veteran’s cervical and lumbar spine be performed. The record does not reflect that these studies were performed. Under these circumstances, the Board finds that a remand for another VA examination and opinion is warranted. See McClendon v. Nicholson; 38 C.F.R. § 3.159 (c)(4). The matters are REMANDED for the following action: 1. Obtain and associate with the claims file any outstanding VA treatment records. 2. After obtaining the necessary authorization from the Veteran, obtain and associate with the claims file any identified relevant private medical records. All attempts to secure these records must be documented in the record. If any requested records are unavailable, the Veteran should be notified of such in accordance with 38 C.F.R. § 3.159 (e). 3. After the foregoing development has been completed to the extent possible, schedule the Veteran for a VA neurological examination. The examiner should review the record and elicit information from the Veteran as to when he first observed symptoms of numbness and tingling in his extremities. All indicated tests should be conducted, to include EMG and MRI studies as recommended by the October 2013 VA examiner, and the results reported. After examining the Veteran and reviewing the record, together with the results of any testing deemed necessary, the examiner should offer an opinion as to whether it is at least as likely as not (i.e., whether it is 50 percent or more probable) that the neuropathy of the Veteran’s left upper and left lower extremities can properly be considered “early onset” peripheral neuropathy; if so, whether it was manifested to a compensable degree within one year of the Veteran’s departure from Vietnam; and, if not, whether it had its onset in, or is otherwise attributable to, the Veteran’s period of active service, to include his presumed in-service exposure to herbicides. A complete medical rationale for all opinions expressed must be provided. JENNIFER HWA Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD L. Bush