Citation Nr: 20007250 Decision Date: 01/28/20 Archive Date: 01/28/20 DOCKET NO. 14-27 795 DATE: January 28, 2020 REMANDED Entitlement to service connection for cluster headaches, including as due to exposure to herbicide agents and/or contaminated water at Camp Lejeune, is remanded. Entitlement to service connection for peripheral neuropathy of the bilateral upper extremities, including as due to exposure to herbicide agents and/or contaminated water at Camp Lejeune, is remanded. Entitlement to service connection for peripheral neuropathy of the bilateral lower extremities, including as due to exposure to herbicide agents and/or contaminated water at Camp Lejeune, is remanded. Entitlement to a total disability rating based upon individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran had active duty service from March 1967 to July 1970. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from February 2012 and August 2013 rating decisions from a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ). In April 2017 and April 2018, the Board remanded these issues to the AOJ for further development. The case has since returned to the Board for further adjudication. Unfortunately, due to the reasons that follow, another remand is necessary. 1. Entitlement to service connection for cluster headaches is remanded. 2. Entitlement to service connection for peripheral neuropathy of the bilateral upper extremities is remanded. 3. Entitlement to service connection for peripheral neuropathy of the bilateral lower extremities is remanded. 4. Entitlement to a TDIU is remanded. The Board is obligated to ensure AOJ compliance with remand directives. Stegall v. West, 11 Vet. App. (1998). The April 2018 remand included five specific opinions that a VA examiner needed to provide. The July 2019 VA examiner only responded to two of the Board’s inquiries. Specifically, the examiner was asked to provide opinions regarding: 1) contaminated water at Camp Lejeune causing the Veteran’s cluster headaches; 2) contaminated water at Camp Lejeune causing the Veteran’s peripheral neuropathy of the upper and lower extremities; 3) exposure to herbicide agents causing the Veteran’s cluster headaches; 4) exposure to herbicide agents causing the Veteran’s peripheral neuropathy of the upper and lower extremities; 5) the Veteran’s service-connected coronary artery disease aggravating or proximately causing the Veteran’s peripheral neuropathy of the upper and lower extremities. The examiner only responded to inquiries one and two, as listed above. Therefore, a remand is necessary for substantial compliance with the previous remand. The TDIU claim is inextricably intertwined with the remanded claims relating to service connection. Therefore, the TDIU claim will also be remanded. The matters are REMANDED for the following action: 1. Obtain a supplemental opinion from an appropriate VA examiner to determine the etiology of the Veteran’s headaches. If the examiner determines that he or she cannot respond to the Board’s inquiry as set forth in detail below without examination of the Veteran, the Veteran should be afforded such an examination. A copy of this remand, the April 2018 remand, and the April 2017 remand must be made available to the examiner. Following a review of the entire record, to include the Veteran’s competent lay statements, including the Veteran’s report regarding the onset and progression of his current symptomatology, the examiner should address the following: (a.) The examiner must provide an opinion as to whether it is at least as likely as not (50 percent or greater) that the Veteran’s headaches are etiologically related to, incurred in, or caused by the Veteran’s military service, including his presumed exposure to herbicide agents, and his July 1968 in-service treatment for headaches. In providing an opinion, the examiner should not use the fact that headaches are not on the list of diseases presumed service-connected in veterans exposed to herbicides, or the fact that the headaches may have resolved. 2. Obtain a supplemental opinion from an appropriate VA examiner to determine the etiology of the Veteran’s peripheral neuropathy. If the examiner determines that he or she cannot respond to the Board’s inquiry as set forth in detail below without examination of the Veteran, the Veteran should be afforded such an examination. A copy of this remand, the April 2018 remand, and the April 2017 remand must be made available to the examiner. Following a review of the entire record, to include the Veteran’s competent lay statements, including the Veteran’s report regarding the onset and progression of his current symptomatology, the examiner should address the following: (a.) The examiner must provide an opinion as to whether it is at least as likely as not (50 percent or greater) that the Veteran’s peripheral neuropathy of the bilateral upper and lower extremities is etiologically related to, incurred in, or caused by the Veteran’s military service, including his symptoms of left arm numbness during service in May 1967. In providing an opinion, the examiner should not use the fact that peripheral neuropathy is not on the list of diseases presumed service-connected in veterans exposed to herbicides. (b.) The examiner must provide an opinion as to whether it is at least as likely as not (50 percent or greater) that the Veteran’s peripheral neuropathy of the upper and lower extremities is aggravated by or proximately caused by his service-connected CAD. “Aggravation” is any worsening beyond the natural progression of the disability. 3. Any opinion offered should reflect consideration of the Veteran’s lay statements, as the Veteran is competent to report symptoms and treatment. A clearly stated rationale must not be based solely on the lack of records. A complete explanation for all opinions expressed must be provided. If the examiner cannot provide a requested opinion without resorting to speculation, it must be so stated, and the examiner must provide the reasons why an opinion would require speculation. The examiner must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the examiner must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. JENNIFER HWA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Smith, Associate Counsel 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.