Citation Nr: 20041491 Decision Date: 06/18/20 Archive Date: 06/18/20 DOCKET NO. 14-34 548A DATE: June 18, 2020 REMANDED Entitlement to service connection for peripheral neuropathy of the bilateral lower extremities, to include as secondary to herbicide agents exposure and/or service-connected diabetes mellitus, Type II, is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1965 to September 1968. He had duty in the Republic of Vietnam (RVN). This case is before the Board of Veterans’ Appeals (Board) on appeal from a May 2013 Department of Veterans Affairs (VA) Regional Office (RO) rating decision that, in pertinent part, denied service connection for peripheral neuropathy of the bilateral lower extremities. In May 2018, the Board remanded this case for additional development. Entitlement to service connection for peripheral neuropathy of the bilateral lower extremities, to include as secondary to herbicide agents exposure and/or service-connected diabetes mellitus, Type II, is remanded. The Veteran contends that his peripheral neuropathy of the bilateral lower extremities is due to his presumed exposure to Agent Orange (AO) while in service. He alternatively contends that his service-connected diabetes mellitus, type II (DM) caused or aggravated his peripheral neuropathy of the bilateral lower extremities. In February 2019, and pursuant to the Board’s May 2018 remand, a VA examination and medical opinion was obtained to address the Veteran’s contention that his peripheral neuropathy of the bilateral lower extremities is due his AO exposure in service. However, an adequate VA medical opinion has not been obtained with respect to his secondary service connection claim. Specifically, the Veteran was afforded a VA examination in May 2013. The examiner’s opinion was that the Veteran’s peripheral neuropathy was less likely than not proximately due to or the result of his service-connected diabetes mellitus. The May 2013 VA examiner explained that the Veteran’s neuropathy did not follow the usual effects for diabetic peripheral neuropathy as there was no neuropathic pain, and also noted that the Veteran’s treating physician had indicated the neuropathy was longstanding and idiopathic in nature, and not from a metabolic syndrome. The examiner also noted that the Veteran’s peripheral neuropathy was diagnosed in the 1990s while diabetes mellitus was not diagnosed until approximately 2008. In March 2020, a different VA examiner similarly opined that the Veteran’s peripheral neuropathy was less likely as not secondary to his service-connected diabetes mellitus. Notably, this VA examiner had examined the Veteran initially in February 2019. At that time, he opined that the Veteran’s diabetes mellitus was as likely as not related to his AO exposure in service, and that his “polyneuropathy [was] as likely as not secondary to his [diabetes mellitus] condition.” Subsequently, the examiner was asked to clarify his statement regarding secondary service connection and in a March 2020 addendum, he changed his opinion following further review of the medical evidence. In particular, the examiner noted that the current medical evidence established that the Veteran’s peripheral neuropathy predated his diagnosis of diabetes mellitus by a “significant amount of time.” He further explained that for the Veteran’s diabetes mellitus to cause his peripheral neuropathy, the diagnosis would have had to occur “at/near time or prior to onset of polyneuropathy symptoms (which started c. 1990s) which [was] not supported by the current medical records.” Although both the May 2013 and March 2020 VA medical opinions address the question of whether the Veteran’s peripheral neuropathy of the bilateral lower extremities is caused by his service-connected diabetes mellitus, neither of the opinions adequately address whether his nonservice-connected disability is aggravated by his service-connected disability. See El Amin v. Shinseki, 26 Vet. App. 136, 140 (2013) (indicating that findings of “not due to,” “not caused by,” and “not related to” a service-connected disability are insufficient to address the question of aggravation under § 3.310(b)). Therefore, upon remand the specific question of aggravation should be addressed. The matter is REMANDED for the following action: Obtain an addendum opinion, preferably from the same VA examiner who performed the February 2019 examination and provided the March 2020 addendum. If that examiner is not available, obtain an addendum opinion from another appropriate VA examiner. The entire claims file including a copy of this remand must be made available to and be reviewed by the examiner. If an in-person examination is deemed necessary, it shall be provided. An explanation for any opinion expressed must be provided. The examiner should opine as to whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s peripheral neuropathy of the bilateral lower extremities is aggravated by his service-connected diabetes mellitus. (Continued on the next page)   The examiner is advised that aggravation in the context of a secondary service connection claim is defined as “any increase in disability.” See Allen v. Brown, 7 Vet. App. 439 (1995). A. ISHIZAWAR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Richardson, 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.