Citation Nr: 20063167 Decision Date: 09/25/20 Archive Date: 09/25/20 DOCKET NO. 12-15 832 DATE: September 25, 2020 REMANDED Entitlement to service connection for bilateral neuropathy of the upper extremities is remanded. Entitlement to service connection for bilateral neuropathy of the lower extremities is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1970 to February 1972. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a rating decision of January 2016 issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Phoenix, Arizona. Following the rating decision on appeal, the Veteran timely filed his notice of disagreement (NOD) in February 2016. The RO issued a statement of the case (SOC) in May 2016 and the Veteran’s timely appeal to the Board followed in June 2016. While the Veteran initially requested a hearing before the Board, the record reflects that his hearing request was subsequently withdrawn. See June 2016 VA Form 9; see also August 2017 Board Decision; cf. December 2017 VA Form 21-4138; see also January 2018 VA Form 21-4138. Accordingly, no hearing before the undersigned VLJ was scheduled. The Board denied the Veteran’s claims on these issues in July 2018. See July 2018 Board Decision at 6-8. The Veteran subsequently appealed this decision to the Court of Appeals for Veterans Claims (CAVC), which vacated and remanded the Board’s decision in June 2019. See June 2019 CAVC Decision at 3-5 (vacating for failure to consider whether a medical examination was warranted). Accordingly, the Board subsequently remanded the Veteran’s claim to the RO for a medical examination. See May 2020 Board Decision at 14-16. The record reflects that this examination was provided in July 2020. However, the Board now finds that an additional remand is warranted because the July 2020 VA examination report is inadequate to support adjudication of the Veteran’s claim. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (providing that a remand confers upon the Veteran the right to substantial compliance with remand instructions). 1. Entitlement to service connection for bilateral neuropathy of the upper and lower extremities. The Veteran asserts that he experiences bilateral neuropathy of the upper and lower extremities as a result of exposure to certain herbicide agents incurred during his active-duty service. See October 2015 VA Form 21-526EZ. The July 2020 VA examiner diagnosed the Veteran with bilateral neuropathy of the upper and lower extremities. See July 2020 VA Examination Report at 2. However, the July 2020 VA examiner opined that these conditions were less likely than not due to exposure to certain herbicide agents. See July 2020 VA Medical Opinion at 1-4. The Board notes that neuropathy can be service-connected on a presumptive basis following exposure to certain herbicide agents. See 38 C.F.R. § 3.307(a). However, qualifying for such a presumption requires that the condition manifest to a compensable degree within 1 year of the Veteran’s last date of exposure while on active duty. See 38 C.F.R. § 3.307(a)(6)(ii). The Board also notes that the Veteran has previously asserted that he began experiencing symptoms within this period. See February 2016 NOD (asserting that “I did have these same problems upon my return from Viet Nam in 1971[,] I did not seek treatment as I thought at the time it was not related”); see also June 2016 VA Form 9 (asserting that “it did start many years ago while on active duty”); cf. July 2020 VA Medical Opinion at 2 (opining that medical history “[indicates] neuropathy started about May of 2014”). Without reaching conclusions at this time as to the credibility or probative weight of the Veteran’s assertions, the Board finds that the evidence of record raises an additional possible theory of service connection that has not been adequately addressed by the July 2020 VA examiner’s opinion. In reaching her conclusion, the VA examiner noted a number of possible alternative etiologies for the Veteran’s neuropathy conditions, including alcohol abuse and degenerative changes of the spine and hands. See July 2020 VA Medical Opinion at 1-4. The record reflects that the Veteran is service-connected for alcohol abuse disorder as secondary to posttraumatic stress disorder (PTSD). See June 2020 Rating Codesheet at 1; see also May 2020 Board Decision. However, the Veteran is not service-connected for any musculoskeletal conditions. See id. The Board notes that alcohol abuse, where it has been shown to be caused or aggravated by a service-connected disability, can provide service connection for other disabilities on a secondary basis. See Allen v. Principi, 237 F.3d 1368, 1370 (Fed. Cir. 2001); see also El-Amin v. Shinseki, 26 Vet. App. 136, 141 (2013). The VA examiner’s opinion does not make clear which of these alternative etiologies is more likely than not responsible for the Veteran’s neuropathy conditions. See July 2020 VA Medical Opinion at 2 (recommending that the Veteran “[undergo] [electromyography / nerve conduction velocity] [testing] to determine if the nerve discomfort is from peripheral causes or from central radicular causes”). Where there is insufficient competent medical evidence in the record for the Board to adjudicate a claim, it must remand that claim for further development. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). “[Once] the Secretary undertakes the effort to provide an examination when developing a service-connection claim, even if not statutorily obligated to do so, he must provide an adequate one[.]” Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). These matters are therefore REMANDED for the following action: Provide the Veteran’s claims file, including a copy of this remand, to an appropriately-qualified examiner. The examiner shall review the claims file and provide an opinion as to whether it is at least as likely as not that the Veteran’s bilateral neuropathy of the upper and lower extremities is due to or aggravated by his alcohol abuse disorder. If the examiner concludes that such neuropathy conditions are more likely than not due to an alternative etiology, such as degenerative changes of the spine and hands, the examiner shall clearly explain the reasoning supporting such a conclusion. If the examiner is unable to provide such an opinion without conducting appropriate medical testing, schedule the Veteran for such testing. If the examiner is unable to provide such an opinion without personally examining the Veteran, schedule the Veteran for such an examination. M. H. HAWLEY Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Blore, 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.