Citation Nr: 19115262 Decision Date: 03/04/19 Archive Date: 03/01/19 DOCKET NO. 16-06 528 DATE: March 4, 2019 REMANDED Entitlement to service connection for bilateral foot peripheral neuropathy due to exposure to herbicide agents, is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1968 to August 1990, to include service in the Republic of Vietnam. In August 2018, the Veteran and his spouse testified at a Travel Board hearing before the undersigned Veterans Law Judge. A copy of the hearing transcript is of record and has been reviewed. The Veteran’s claim was previously denied based on the finding that the currently diagnosed peripheral neuropathy did not have its onset during active duty service or manifested to a compensable degree within a year of discharge from service. This conclusion was supported by a February 2015 VA examiner’s opinion that upon review of the claims file, there was no evidence of early onset of peripheral neuropathy. Nevertheless, even though presumptive service connection is not warranted, the Veteran is not precluded from establishing service connection for a diagnosed disability with proof of direct causation. See Combee v. Brown, 34 F.3d 1039, 1041-42 (Fed. Cir. 1994). The Board acknowledges May 2018 treatment records authored by Dr. Stoll, who confirmed a diagnosis of moderate to severe aconal and demyelinating sensorimotor peripheral polyneuropathy with associated significant neurogenic atrophy of the bilateral intrinsic feet muscles. Dr. Stoll noted that the Veteran had a ten-year history of worsening numbness in both feet, which he (the Veteran) attributed to exposure to Agent Orange in Vietnam. It was further noted that the confirmed diagnosis was “likely due, at least in part, to the patient’s history of toxic exposure to Agent Orange during his years in military service.” Upon review, however, the Board finds that this statement is insufficient to establish a nexus. First, there is no indication that Dr. Stoll reviewed the Veteran’s claims file, and during the August 2018 hearing, the Veteran indicated that he was not sure whether the claims file was reviewed. Second, Dr. Stoll indicated that the neuropathy was “at least in part” related to exposure to Agent Orange, but did not elaborate as to what other causes or risk factors were present to contribute to the diagnosed condition. Lastly, Dr. Stoll provided no rationale to the statement. On remand, the Board will provide the Veteran with an additional opportunity to obtain further clarification from Dr. Stoll. In addition, as discussed above, VA did not obtain a medical nexus opinion on direct basis. Accordingly, a remand is necessary to obtain addendum medical opinion to help determine the likely etiology of the Veteran’s bilateral foot peripheral neuropathy. The matter is REMANDED for the following action: 1. Ensure that all outstanding VA treatment records are associated with the claims file. 2. Contact the Veteran and his attorney and invite him to submit any additional evidence from Dr. Stoll that further explains, with complete rationale, the likely etiology of the currently diagnosed bilateral foot peripheral neuropathy. 3. Then, regardless of whether additional evidence is received, obtain an addendum medical opinion from an appropriate VA examiner to help determine the likely etiology of the Veteran’s bilateral foot peripheral neuropathy. The claims file and a copy of this remand will be made available to the examiner, who will acknowledge receipt and review of these materials. The need for another examination is left to the discretion of the medical professional offering the addendum opinion. After a careful review of the claims file, the examiner is asked to respond to the following: Provide an opinion as to whether it is at least as likely as not (50 percent probability or higher) that the currently diagnosed bilateral foot peripheral neuropathy is related to the Veteran’s conceded exposure to herbicide agents during active duty service in Vietnam. In doing so, please consider Dr. Stoll’s statements. See VBMS entry titled “Medical Treatment Record- Non-Government Facility” on 08/07/2018. A complete rationale should be provided for all opinions. (Continued on the next page)   4. Thereafter, readjudicate the remanded claim. S. B. MAYS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Yaffe, Associate Counsel