Citation Nr: 20004241 Decision Date: 01/21/20 Archive Date: 01/17/20 DOCKET NO. 15-19 773 DATE: January 21, 2020 REMANDED Entitlement to service connection for peripheral neuropathy of the lower extremities is remanded. Entitlement to service connection for peripheral neuropathy of the upper extremities is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1960 to April 1965. This matter comes before the Board of Veterans’ Appeals (Board) from a November 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a hearing with the undersigned in June 2015. A transcript of that hearing has been added to the Veteran’s file. These issues were previously remanded by the Board, most recently in November 2017, and have been returned for further adjudication. In its most recent remand, the Board requested a medical opinion that took into account the Veteran’s lay statements and internet-based medical research which indicates that there may be a link between peripheral neuropathy and radiation exposure. The opinion obtained on remand suggests that lumbar radiculopathy can include symptoms that superimpose on peripheral neuropathy symptoms, but also does indicate the Veteran has peripheral neuropathy. A diagnosis of diabetes is also noted. The examiner stated that it is not known if ionizing radiation neuropathy effects can be manifested 40 years after exposure, and she was therefore unable to resolve the issue without resorting to mere speculation. It does not appear that the examiner considered all of the Veteran’s lay statements; specifically, his testimony about problems playing golf as early as 1975 due to difficulty holding still, and his report during a July 2007 VA neurology consultation that he had a history of tremor that began as a hand tremor at age 25 (1967). At the 2007 appointment the Veteran noted that the tremor was more in the left hand, but also present in the right hand, and he felt that it may also be present in the legs and trunk. In addition, it is unclear if the examiner could not offer an opinion based on limitation of knowledge in the medical community at large or of the individual examiner. See Sharp v. Shulkin, 29 Vet. App. 26, 35 (2017). Given the above, another medical opinion should be obtained. The matters are REMANDED for the following action: Send the claims file to an appropriate examiner to offer an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the current peripheral neuropathy of the upper and lower extremities onset during service or is otherwise related to an in-service injury, event, or disease, to include exposure to radiation. In offering the opinion, the examiner is asked to consider the provided internet-based medical research which indicates that there may be a link between peripheral neuropathy and radiation exposure. The examiner should also consider and discuss the Veteran’s lay statements, to include his testimony about problems playing golf as early as 1975 due to difficulty holding still and his report during a July 2007 VA neurology consultation that he had a history of tremor that began as a hand tremor at age 25 (around 1967) and progressed to different areas. The need for an examination is left to the discretion of the examiner. A rationale for all opinions offered is requested as the Board is precluded from making any medical findings. If the examiner cannot provide the requested opinion without resorting to speculation, he/she should expressly indicate this and provide a supporting rationale as to why an opinion cannot be made without resorting to speculation, to include whether such is based on limitation of knowledge in the medical community at large or of the individual examiner. Nathan Kroes Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Shuster, Attorney Advisor The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.