Citation Nr: 18150707 Decision Date: 11/15/18 Archive Date: 11/15/18 DOCKET NO. 16-42 779 DATE: November 15, 2018 REMANDED Entitlement to service connection for peripheral neuropathy of the bilateral upper extremities is remanded. Entitlement to service connection for vascular dementia is remanded. REASONS FOR REMAND The Veteran had active service in the United States Marine Corps (USMC) from August 1967 to May 1978. The Veteran’s decorations for his active service include a Purple Heart Medal and a Combat Action Ribbon. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a March 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri. The Board finds additional development is required before the claims on appeal can be decided. 1. Peripheral Neuropathy – Bilateral Upper Extremities A review of the record shows the Veteran was afforded a VA examination for his bilateral upper extremities in July 2016. At that time, the VA examiner determined that the Veteran did not have peripheral neuropathy affecting any extremity. The examiner then noted the Veteran’s history of peripheral neuropathy. The Board finds the July 2016 VA medical opinion inadequate to adjudicate the claim. In this regard, the VA examination report is internally inconsistent and does not adequately address the Veteran’s lay statements and contentions. Thus, the Board concludes that the Veteran should be afforded another VA examination to determine the nature and etiology of any current peripheral neuropathy of the upper extremities. McLendon v. Nicholson, 20 Vet. App. 79 (2006). 2. Vascular Dementia A review of the record shows the Veteran was afforded a VA examination for his vascular dementia in July 2016. At that time, the VA examiner opined that the Veteran’s vascular dementia was not causally related to his service-connected posttraumatic stress disorder (PTSD). The Board finds the July 2016 VA medical opinion inadequate to adjudicate the claim. In this regard, the VA medical opinion does not provide an opinion as to direct service connection. Thus, the Board concludes that the Veteran should be afforded another VA examination to determine the nature and etiology of any current vascular dementia. McLendon, 20 Vet. App. 79 (2006). The matters are REMANDED for the following action: 1. Identify and obtain any pertinent, outstanding VA and private treatment records and associate them with the claims file. 2. Then, schedule the Veteran for a VA examination by an examiner with sufficient expertise to determine the nature and etiology of any currently present peripheral neuropathy of the upper extremities. The examiner should review the claims file and indicate that review in the report. Any indicated studies should be performed. Based upon the examination results and a review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any bilateral peripheral neuropathy of the upper extremities is etiologically related to service. In forming the opinion, the examiner should address the November 2013 VA treatment record indicating a current diagnosis and treatment for peripheral neuropathy. The rationale for all opinions expressed must be provided. 3. Then, schedule the Veteran for a VA examination by an examiner with sufficient expertise to determine the nature and etiology of any current vascular dementia. The examiner should review the claims file and indicate that review in the report. Any indicated studies should be performed. The examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s vascular dementia is etiologically related to service. The examiner should also provide an opinion as to whether it is at least as likely as not (50 percent of greater probability) that the Veteran’s vascular dementia was caused or chronically worsened by any service-connected disability, to specifically include PTSD. The examiner must address the June 2010 article submitted by the Veteran titled “Posttraumatic Stress Disorder Associated with Dementia Among Older Veterans.” The rationale for all opinions expressed must be provided. 4. Confirm that the VA examination reports and all medical opinions provided comport with this remand, and undertake any other development found to be warranted. 5. Then, readjudicate the issues on appeal. If the decision is adverse to the Veteran, issue a supplemental statement of the case and allow appropriate time for response. Then, return the case to the Board. Kristin Haddock Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Mariah N. Sim, Associate Counsel