Citation Nr: 20043784 Decision Date: 06/29/20 Archive Date: 06/29/20 DOCKET NO. 16-19 013A DATE: June 29, 2020 REMANDED Service connection for peripheral neuropathy of the left lower extremity, claimed as tingling in both legs, is remanded. Service connection for peripheral neuropathy of the right lower extremity, claimed as tingling in both legs, is remanded. REASONS FOR REMAND The Veteran served on active duty in the Army from January 1966 to January 1968, including service in the Republic of Vietnam. These matters initially came before the Board of Veterans’ Appeals (Board) from a November 2013 rating decision. In a September 2018 Board decision, these matters were remanded to obtain updated medical records and a VA examination regarding bilateral leg tingling, including neuropathy and restless leg syndrome. These claims have since been returned to the Board for review. Although the Board regrets the delay in yet another remand, the agency of original jurisdiction (AOJ) has not substantially complied with the remand directives and further action is necessary in this regard. Stegall v. West, 11 Vet. App. 268 (1998) (holding that a remand confers on the claimant, as a matter of law, the right to compliance with the remand directive). Peripheral Neuropathy of the Bilateral Lower Extremities The Board finds that further development is necessary regarding the Veteran’s claims of service connection for peripheral neuropathy of the bilateral lower extremities, claimed as tingling in both legs. As noted above, in a September 2018 Board decision, these matters were remanded for further development. In the remand instructions, the Board directed that an examination should be performed to determine the nature and etiology of the Veteran’s bilateral leg tingling. Specifically, the Board directed the examiner to evaluate the Veteran for neuropathy and restless leg syndrome. Further, because the Veteran served in the Republic of Vietnam and is presumed to have been exposed to herbicide agents during service, the Board directed the examiner to discuss whether any diagnosed neuropathy is related to his presumed herbicide agent exposure. The Board has reviewed the examination conducted in August 2019 regarding the Veteran’s bilateral leg tingling and finds that it is inadequate. First, the examiner failed to evaluate the Veteran for restless leg syndrome, including performing diagnostic tests and soliciting a medical history and description of restless leg syndrome symptoms. Second, the examiner failed to discuss restless leg syndrome in the opinion and rationale provided regarding the Veteran’s claim of service connection for bilateral leg tingling. Lastly, in the opinion and rationale provided, the examiner failed to discuss the relationship between the Veteran’s presumed herbicide agent exposure and his diagnosed peripheral neuropathy of the bilateral lower extremities. When VA obtains an examination, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). Thus, the matter must be remanded for a new examination. Additionally, the Board notes that the AOJ failed to properly obtain updated medical records as requested in the September 2018 Board decision. In July 2019, the Veteran submitted an authorization form to release medical records but forgot to sign the form. The AOJ noted the missing signature and found the form to be insufficient; however, no reasonable attempts were made to obtain a signed form or obtain the updated medical records. Therefore, reasonable attempts should be made upon remand to obtain these updated medical records. The matters are REMANDED for the following action: 1. Obtain all treatment records from any VA facility from which the Veteran has received treatment. Make reasonable attempts to invite the Veteran to submit relevant private medical records or to submit authorizations for VA to obtain private medical records related to his reported diagnosis of restless leg syndrome. 2. Following the completion of the above, obtain an addendum opinion regarding the relationship between the Veteran’s diagnosed peripheral neuropathy of the bilateral lower extremities and his presumed herbicide agent exposure, due to service in the Republic of Vietnam. The examiner should consider the Veteran’s lay statements regarding continuing symptoms of tingling in the bilateral lower extremities, which began during service and continue to the present. 3. Schedule the Veteran for an examination regarding restless leg syndrome. The claims folder must be made available to and be reviewed by the examiner. The examiner should address the following: a. Perform any necessary diagnostic tests and solicit a medical history regarding symptoms related to restless leg syndrome. b. If restless leg syndrome is diagnosed, is it at least as likely as not (50 percent or greater probability) that the Veteran’s restless leg syndrome had its onset during service or is otherwise related to service? The examiner should consider the Veteran’s lay statements regarding continuing symptoms of tingling in the bilateral lower extremities, which began during service and continue to the present. A rationale for all opinions is to be provided. If the examiner cannot provide any of the requested opinions without resorting to speculation, he or she should provide an explanation stating why this is so. In so doing, the examiner should 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(s). JAMES L. MARCH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Page-Nelson, 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.