Citation Nr: 20022526 Decision Date: 04/01/20 Archive Date: 04/01/20 DOCKET NO. 18-28 941 DATE: April 1, 2020 REMANDED Entitlement to service connection for peripheral neuropathy of the upper right extremity, is remanded. Entitlement to service connection for peripheral neuropathy of the upper left extremity remanded Entitlement to service connection for peripheral neuropathy of the lower right extremity remanded Entitlement to service connection for peripheral neuropathy of the lower left extremity is remanded REASONS FOR REMAND The Veteran served on active duty from April 1968 to November 1969. This matter comes before the Board of Veterans’ Appeals (Board) from a rating decision by a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ). The Veteran testified before the undersigned in a Board hearing in February 2020. A transcript of the hearing is of record. 1. Service connection for bilateral peripheral neuropathy of the bilateral upper and lower extremities is remanded. The Veteran contends that his bilateral upper and lower extremity neuropathy is etiologically related to his service. Specifically, the Veteran contends his neuropathies are related to exposure to an herbicide agent. The Veteran’s DD-214 indicates that the Veteran had foreign and overseas service in Vietnam. Therefore, exposure to an herbicide is conceded. The Veteran testified in the February 2020 Board hearing that he first noticed tingling and burning in his extremities in the 1970s’ likely around 1972 or 1973. The Veteran stated he first sought treatment for his neuropathy in 1990, when his balance worsened. The Veteran’s VA treatment records indicates a diagnosis of neuropathy in December 2008. In September 2017, the Veteran’s VA treatment provider, submitted an opinion that the Veteran’s peripheral neuropathy is a least as likely as not related to his exposure to Agent Orange in service. The Veteran underwent a VA peripheral nerve condition examination in August 2017. The examiner diagnosed the Veteran with bilateral peripheral neuropathy of the upper and lower extremities. During the examination the Veteran reported that the date of the onset of his symptoms was in 1987. Service connection can be established based on herbicide exposure. 38 C.F.R. § 3.307 (a)(6). For the purposes of determining herbicide exposure, a veteran who served in qualifying locations is presumed to have been exposed to an herbicide agent. 38 C.F.R. § 3.307 (a)(6)(iii)(v). If a veteran is presumed or found to have been exposed to herbicide agents, certain disabilities will be presumed to be causally related to such exposure. 38 C.F.R. § 3.309 (e). For early onset peripheral neuropathy, the disability must have manifested to a compensable degree within one year of the last date of herbicide agent exposure. 38 C.F.R. § 3.307 (a)(6)(ii). Here, the Board notes that the Veteran’s peripheral neuropathy did not manifest itself within one year of separating from service. The earliest onset of the Veteran’s neuropathy was in 1972, three years after his service, according the Veteran’s testimony. However, the availability of presumptive service connection does not, however, preclude a grant of service connection on a direct basis. See Combee v. Brown, 34 F.3d 1039, 1043-44 (Fed. Cir. 1994); 38 C.F.R. § 3.303. As the August 2017 VA examiner did not provide an etiology opinion as to the Veteran’s peripheral neuropathy; and the Veteran’s VA provider failed to provide a rationale to her opinion, the Board finds a remand is required to obtain a medical opinion. Further, the Veteran indicated that he was treated at a VA facility in 1990. The record only contains VA treatment records from April 2008. Further, the Veteran indicated he received treatment at Kaiser Permanente. The Board notes there is evidence of treatment at Kaiser in a previous rating decision in July 1994, however, those records have not been associated with the record. Therefore, the Board finds that upon remand the AOJ must attempt to obtain the Veteran’s VA and private treatment records. The matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period prior to April 2008. 2. Ask the Veteran to complete a VA Form 21-4142 for any private treatment of the Veteran for peripheral neuropathy including through Kaiser Permanente. Make two requests for the authorized records from any identified private treatment facility, unless it is clear after the first request that a second request would be futile. 3. Obtain a medical opinion by an appropriate clinician to determine the nature and etiology of the Veteran’s bilateral peripheral neuropathy of the upper and lower extremities. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, specifically, whether it is etiologically related to exposure to an herbicide agent. If the examiner indicates that an in-person examination of the Veteran is necessary in order to respond to the Board’s remand inquiry, the Veteran should be scheduled for an appropriate examination. i. The examiner must address the Veteran’s VA treatment provider positive opinion in September 2017 and the April 2015 treatment note that indicates the Veteran’s neuropathy had no known etiology. The examiner must provide a complete medical rationale for any opinion rendered. S. L. Kennedy Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Robert Batten 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.