Citation Nr: 20042484 Decision Date: 06/24/20 Archive Date: 06/24/20 DOCKET NO. 13-24 192 DATE: June 24, 2020 REMANDED Entitlement to service connection for peripheral neuropathy, right upper extremity, to include as due to herbicide exposure and/or as secondary to a service-connected disability, is remanded. Entitlement to service connection for peripheral neuropathy, left lower extremity, to include as due to herbicide exposure and/or as secondary to a service-connected disability, is remanded. Entitlement to service connection for peripheral neuropathy right lower extremity, to include as due to herbicide exposure and/or as secondary to a service-connected disability, is remanded. Entitlement to service connection for peripheral neuropathy, left upper extremity, to include as due to herbicide exposure and/or as secondary to a service-connected disability, is remanded. REASONS FOR REMAND The Veteran had active duty service in the U.S. Army from January 1968 to November 1975, to include service in Vietnam. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from April 2011 and May 2011 rating decisions of the Department of Veterans Affairs (VA), Regional Office (RO), in Montgomery, Alabama. In January 2018, the Board remanded all of the above peripheral neuropathy service connection claims to obtain a VA examination. The Veteran subsequently underwent VA examinations for his peripheral neuropathy claims in March 2018 and August 2019. 1. Entitlement to service connection for peripheral neuropathy, right upper extremity, to include as due to herbicide exposure and/or as secondary to a service-connected disability, is remanded; entitlement to service connection for peripheral neuropathy, left lower extremity, to include as due to herbicide exposure and/or as secondary to a service-connected disability, is remanded; entitlement to service connection for peripheral neuropathy right lower extremity, to include as due to herbicide exposure and/or as secondary to a service-connected disability, is remanded; entitlement to service connection for peripheral neuropathy, left upper extremity, to include as due to herbicide exposure and/or as secondary to a service-connected disability, is remanded. The Veteran contends that he has peripheral neuropathy in the bilateral upper and bilateral lower extremities due to his military service. In particular, the Veteran asserts that his peripheral neuropathy is related to his presumed exposure to Agent Orange during his service in Vietnam. While the Board regrets the additional delay, a remand of these issues is necessary for additional development on the Veteran’s claims. First, the Veteran and his representative believe that additional development is necessary on the Veteran’s service connection claims to attempt to obtain additional treatment records. See May 2020 Informal Hearing Presentation. Specifically, in the Veteran’s July 2013 VA Form 9, the Veteran stated in his claim that some of his medical records had been lost. As there is no evidence showing that the VA attempted to obtain additional records after the Veteran’s assertion that his records have been lost, these issues will be remanded to attempt to obtain any available VA and private treatment records. Second, while the Veteran was afforded VA examinations for his peripheral neuropathy claims in March 2018 and August 2019, the Board finds the opinions obtained in March 2018 and August 2019 are inadequate. Specifically, the Board notes that the Veteran underwent VA examinations for his peripheral neuropathy claims in March 2018 and August 2019. The March 2018 VA examination noted a diagnosis of right-hand carpal tunnel syndrome. The August 2019 VA examination noted diagnoses of right- and left-hand carpal tunnel syndrome as well as right lower extremity peripheral neuropathy. The March 2018 VA examiner opined that the Veteran’s claimed peripheral neuropathy in the bilateral upper and lower extremities were less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. Specifically, the examiner concluded that the Veteran’s right carpal tunnel was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The examiner reasoned that carpal tunnel was found in the right upper extremities cannot be linked to service as the examiner saw records showing a diagnosis and treatment for this condition. Second, the examiner noted that there was no objective evidence of the Veteran’s claimed left lower extremity neuropathy on examination based on sensory, reflex, and muscle strength testing at the time. Therefore, the examiner concluded that the Veteran’s left carpal tunnel was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The August 2019 VA examiner opined that the Veteran’s left carpal tunnel was less likely than not (less than 50 percent probability) incurred in or caused by the claimed inservice injury, event, or illness. The examiner noted that carpal tunnel was found in the left upper extremities and cannot be linked to service as the examiner viewed no records showing a diagnosis and treatment for this condition. Third, the examiner opined that the Veteran’s right lower extremity neuropathy was less likely than not (less than 50 percent probability) incurred in or caused by the claimed inservice injury, event, or illness. The examiner reasoned that his right lower extremity neuropathy cannot be linked to service as there were no viewed records showing a diagnosis and treatment for this condition. The Board finds the March 2018 and August 2019 VA opinions inadequate for the following reasons. First, the Veteran’s DD-214 indicates that the Veteran served in Vietnam from January 1970 to December 1970. Therefore, exposure to herbicide agents is presumed. 38 C.F.R. § 3.307(1)(6)(iii). While a November 2014 VA opinion noted that there was no evidence of early onset peripheral neuropathy, the Veteran’s claim that he has neuropathy due to exposure to Agent Orange should still be addressed. The March 2018 and August 2019 VA opinions did not address the Veteran’s contention that he had peripheral neuropathy in the bilateral upper and lower extremities that are related to his exposure to herbicides. On remand, VA opinions should be obtained to address the Veteran’s contention that he has peripheral neuropathy that is directly related to his exposure to herbicides while in Vietnam. The Board notes that, in the May 2020 Informal Hearing Presentation, the Veteran and his representative contend that a determination should be made as to whether the Veteran’s claimed peripheral neuropathy is secondary to diabetes. However, as the Veteran is not currently service-connected for diabetes, the Board will not seek an opinion regarding the connection of any claimed peripheral neuropathy to a claimed diagnosis of diabetes at this time. Given the above, a remand is necessary to attempt to obtain additional treatment records as well as to obtain new VA opinions to determine the nature and etiology of any diagnosed peripheral neuropathy in the bilateral upper and lower extremities. The matters are REMANDED for the following action: 1. Give the Veteran an opportunity to identify any outstanding pertinent treatment records, VA or private, that have not already been associated with the claims file. The AOJ should then attempt to obtain those records if the appellant provides the appropriate authorization. 2. Obtain a VA opinion by an appropriate clinician to determine the nature and etiology of any peripheral neuropathy in the right upper extremity, left upper extremity, right lower extremity, and left lower extremity. a. For any diagnosed peripheral neuropathy, the examiner must opine whether it at least as likely as not (a 50 percent or greater probability) related to an in-service injury, event, or disease, including in-service herbicide agent exposure. b. The examiner must also opine whether it is at least as likely as not (a 50 percent or greater probability) (1) proximately due to any of the Veteran’s service-connected disabilities, or (2) aggravated beyond its natural progression by any of the Veteran’s service-connected disabilities, specifically prostate cancer, ischemic heart disease. c. The examiner is advised that the Veteran is competent to report his symptoms/history and that such reports must be acknowledged and considered in formulating any opinion. If his reports are discounted, the examiner should provide a reason for doing so. d. A rationale for the requested opinion shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. 3. After completing the above action, and any other development as may be indicated by any response received as a consequence of the actions taken in the paragraphs above, the claims must be readjudicated. If the claims remain denied, a supplemental statement of the case must be provided to the Veteran and his representative. After the Veteran and his representative have had an adequate opportunity to respond, the appeal must be returned to the Board for appellate review. GAYLE STROMMEN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Grossman, 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.