Citation Nr: 20004703 Decision Date: 01/21/20 Archive Date: 01/21/20 DOCKET NO. 10-18 315 DATE: January 21, 2020 REMANDED Entitlement to service connection for peripheral neuropathy involving the right ulnar nerve (claimed as due to exposure to herbicide agents, or alternatively, as secondary to diabetes mellitus type II), is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1963 through August 1967. He also had additional inactive service from August 1967 to August 1969. The Veteran testified before the undersigned Veterans Law Judge during an August 2017 Board hearing and a transcript of that hearing is of record. Most recently, the Board remanded this claim for a VA examination to ascertain the nature and etiology of the Veteran’s current right upper extremity nerve disability. The Board finds that the remand directives have been substantially complied with, as the RO completed the requested development (ie. obtained a VA examination that addresses both the current disability, as well as the secondary service connection opinion (both causation and aggravation)). Stegall v. West, 11 Vet. App. 268 (1998) (holding that a remand by the United States Court of Appeals for Veterans Claims Court (Court) or the Board confers on the veteran or other claimant, as a matter of law, the right to compliance with the remand orders). Unfortunately, the Board finds the obtained medical nexus opinion inadequate, and thus, another remand is required for a medical addendum opinion. Specifically, with regards to the aggravation opinion (secondary service connection), the August 2019 VA examiner (after confirming the presence of the peripheral neuropathy involving the right ulnar nerve) simply compared the findings at the time of the August 2019 examination to those of the September 2017 examination in explaining that “there was no progression of the claimed condition” and ultimately concluding that the Veteran’s peripheral neuropathy involving the right ulnar nerve was not at least as likely as not aggravated beyond its natural progression by the Veteran’s service-connected diabetes mellitus, type II. In doing so, the examiner failed to account for/address the full history of the Veteran’s condition (by limiting the time frame to only in between September 2017 to August 2019) in providing a negative aggravation opinion. As the examiner failed to establish concrete factual basis for finding “no progression of the claimed condition,” the Board finds that another medical addendum opinion is required. On remand, the examiner should review all relevant records and provide an adequate aggravation opinion (secondary service connection opinion). This matter is REMANDED for the following action: Return the Veteran’s claims file to the August 2019 VA examiner for an addendum medical opinion or to another examiner if that person is no longer available. The examiner should answer the following questions: Is it at least as likely as not (50 percent or greater probability) that the Veteran’s peripheral neuropathy involving the right ulnar nerve was aggravated by his service-connected diabetes mellitus, type II? In doing so, the examiner should account for the full history of the Veteran’s conditions. • Recent caselaw held that aggravation for secondary service connection does not require “permanent worsening,” but compensation is warranted for any incremental increase in disability, meaning any additional impairment of earning capacity above the degree of disability existing before the increase, in a nonservice-connected disability resulting from a service-connected disability, regardless of its permanence. A rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall explain whether additional information is needed or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). MICHELLE L. KANE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Lee 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.