Citation Nr: 20009762 Decision Date: 02/06/20 Archive Date: 02/05/20 DOCKET NO. 17-24 934 DATE: February 6, 2020 REMANDED Entitlement to service connection for peripheral neuropathy of the left leg, including as due to herbicide exposure, is remanded. Entitlement to service connection for peripheral neuropathy of the right leg, including as due to herbicide exposure, is remanded. REASONS FOR REMAND The Veteran had active service from July 1966 to February 1969, including service in Vietnam. This case comes to the Board of Veterans’ Appeals (Board) on appeal from an Agency of Original Jurisdiction (AOJ) decision dated in June 2014. The Veteran testified before the undersigned Veterans Law Judge at a December 2019 hearing; a transcript of the hearing is of record. 1. Entitlement to service connection for peripheral neuropathy of the left leg is remanded. 2. Entitlement to service connection for peripheral neuropathy of the right leg is remanded. The Veteran contends that his current peripheral neuropathy of the right and left legs is due to exposure to Agent Orange during service in Vietnam. He is presumed to have been exposed to an herbicide agent during his service in the Republic of Vietnam during the Vietnam era. 38 C.F.R. § 3.307 (a)(6)(iii). A presumption of service connection exists if a veteran is diagnosed with certain enumerated diseases associated with exposure to certain herbicide agents, to include early onset peripheral neuropathy. See 38 U.S.C. § 1116 (2012); 38 C.F.R. §§ 3.307, 3.309 (2019). Early-onset peripheral neuropathy must become manifest to a degree of 10 percent or more within one year after the date of last exposure to herbicides to qualify for the presumption of service connection. 38 C.F.R. § 3.307 (a)(6)(ii). Service connection may also be established with proof of direct causation. 38 U.S.C. § 1110 (2012); 38 C.F.R. § 3.303; Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). The Veteran has asserted that he had symptoms of tingling and pain in his legs since September 1969. See his September 2014 notice of disagreement, and December 2019 Board hearing transcript, page 14. The evidence of record reflects that in February 2014, a VA physician, Dr. T., indicated that electrodiagnostic testing showed evidence of sensorimotor polyneuropathy affecting the bilateral lower extremities, most likely neurotmesis. She noted that the Veteran had a history of Agent Orange exposure. She did not provide a nexus opinion between current polyneuropathy of the bilateral lower extremities in this consultation report. Evidence indicates that there may be outstanding relevant VA treatment records. In the February 2014 consult, Dr. T. stated that the completed electrodiagnostic report was available in Vista Imaging. This report is not on file and must be obtained. At his Board hearing, the Veteran and his representative stated that they were submitting a July 2017 letter from Dr. T. that provided a nexus opinion between his peripheral neuropathy and Agent Orange exposure. This letter is not on file and must be obtained. The Veteran also testified that he continued to receive treatment for peripheral neuropathy. The most recent VA medical records on file are dated in June 2014. Any VA treatment records are within VA’s constructive possession, and are considered potentially relevant to the issues on appeal. A remand is required to allow VA to obtain them. The Veteran also testified that he has received treatment for neuropathy from private physicians, Dr. A. and Dr. S. He stated that he was submitting Dr. S.’s private medical records at the hearing, but they are not on file. The Veteran should be asked to submit these pertinent records. The Board cannot make a fully-informed decision on the issue of entitlement to service connection for peripheral neuropathy of the bilateral legs because no VA examiner has opined whether this disease is related to service, to include his presumed exposure to an herbicide agent. The matters are REMANDED for the following action: 1. Obtain relevant VA medical records of treatment or evaluation of peripheral neuropathy dated since February 2014, to include a copy of the February 2014 VA electrodiagnostic report from Vista Imaging. Obtain a copy of the July 2017 opinion from Dr. T. that was referenced by the Veteran’s representative at the Board hearing. See hearing transcript, page 14. 2. Obtain relevant private medical records of treatment or evaluation of peripheral neuropathy, to include records from Dr. A. and Dr. S. See hearing transcript, pages 16-17. 3. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any neuropathy of both lower extremities. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including his presumed exposure to an herbicide agent during service in Vietnam. The examiner should opine as to the following: (a.) Indicate whether the Veteran has peripheral neuropathy of the lower extremities and if so, indicate whether he had "early onset" peripheral neuropathy. The examiner is notified that VA amended the regulations regarding presumptive service connection for peripheral neuropathy associated with herbicide exposure. Under the amendments, peripheral neuropathy no longer needs to be transient, but it must still become manifest to a degree of 10 percent or more within one year after the date of last exposure to herbicide agents to qualify for the presumption of service connection. (b.) If "early onset" peripheral neuropathy is not diagnosed, and for any other diagnosed neuropathy of the bilateral lower extremities, opine whether it is at least as likely as not (50 percent or greater probability) that the disorder (1) began during active service, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service; or is otherwise due to service, to include herbicide exposure (without consideration of legal presumption). (Continued on the next page)   A complete rationale should be provided for all expressed opinions. S. L. Kennedy Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. L. Wasser, 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.