Citation Nr: 18156628 Decision Date: 12/11/18 Archive Date: 12/10/18 DOCKET NO. 16-35 724 DATE: December 11, 2018 REMANDED Entitlement to service connection for peripheral neuropathy is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from October 1966 to August 1968. This matter comes before the Board from a September 2015 rating decision. 1. Entitlement to service connection for peripheral neuropathy is remanded. The Veteran claims entitlement to service connection for peripheral neuropathy because of service, to include exposure to herbicides in Vietnam. Certain diseases are presumed to be associated with herbicide exposure. See 38 C.F.R. § 3.309 (e). Peripheral neuropathy is one of several diseases/disabilities presumed to be related to exposure to herbicide agents; however, to qualify for the presumption the disease must have manifested to a compensable degree within one year of separation. Late onset peripheral neuropathy is not included in that category. VA has determined that a presumption of service connection based on exposure to herbicides used in the Republic of Vietnam is not appropriate for any condition for which the Secretary has not specifically determined a presumption of service connection is warranted. See 79 Fed. Reg. 20,308 (April 11, 2014). However, a Veteran is not precluded from establishing service connection with proof of direct causation. See Combee v. Brown, 34 F.3d 1039, 1044 (Fed. Cir. 1994). The Veteran was diagnosed with polyneuropathy affecting the upper and lower extremities in October 2014. He had service in Vietnam and is presumed to have been exposed herbicide agents, to include Agent Orange. The objective medical evidence does not establish a peripheral neuropathy diagnosis for decades after separation. In his Notice of Disagreement, the Veteran disagreed with the assertion that his neuropathy was not manifest within one year of separation. He further contends that his neuropathy is related to his exposure to Agent Orange in Vietnam. He states that his doctor told him his condition was because his exposure to Agent Orange. This is not documented in the medical records. The Veteran has not been afforded a VA examination, and no medical professional has opined as to whether the Veteran’s currently diagnosed neuropathy is related to his presumed exposure to Agent Orange. The Veteran’s contention that his has doctor has related his diagnosed peripheral neuropathy meets the “low threshold” for obtaining a VA examination for the purpose of obtaining an opinion regarding the nexus element of his claim. As such, the Veteran should be afforded a VA examination to determine the nature and etiology of the Veteran’s currently diagnosed neuropathy. McLendon v. Nicholson, 20 Vet. App. 79, 86 (2006). Additionally, if there are records missing from the claims file, such as the one from the Veteran’s doctor in Charleston, these should be requested and associated with the claims file. The matter is REMANDED for the following action: 1. Obtain and associate with the claims file updated VA and private treatment records. In so doing, the Veteran should be asked to submit the aforementioned private medical opinion relating his current neuropathy disorder to his exposure to herbicide agents such as Agent Orange. 2. Schedule the Veteran for a VA examination with a qualified physician to determine the etiology of his peripheral neuropathy. The electronic claims file and a copy of this remand must be provided to the examiner and he or she must indicate review of these items in the examination report. The examiner must provide an opinion as to whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran’s peripheral neuropathy had its onset in service or is otherwise etiologically related to his active service, to include presumed exposure to herbicide agents during service. The examiner must provide a complete rationale for all opinions expressed. If the examiner cannot provide the requested opinions without resorting to speculation, it must be so stated, and the examiner must provide the reasons why an opinion would require speculation. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD E. Rekowski, Associate Counsel