Citation Nr: 21000004 Decision Date: 01/04/21 Archive Date: 01/04/21 DOCKET NO. 14-21 010 DATE: January 4, 2021 REMANDED Entitlement to service connection for neurologic symptoms, to include as due to Gulf War exposures, and/or as secondary to a service-connected disability, or other etiological cause, is remanded. REASONS FOR REMAND The Veteran served in the United States Army from September 1989 to August 1992 and had service in the Southwest Asia Theater of operations during the Persian Gulf War. This matter returns to the Board of Veterans’ Appeals (Board) from a January 2020 Board Remand of the Veteran’s appeal of a May 2012 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina, which is the agency of original jurisdiction (AOJ). 1. Entitlement to service connection for neurologic symptoms. The Veteran asserts that he suffers from neurological symptoms, such as twitching and spasms, which he asserts are due to his service, to include his Gulf War service, or the result of another service-connected disability, such as posttraumatic stress disorder (PTSD). In its January 2018 remand, the Board instructed the RO to obtain a medical opinion regarding the etiology of the Veteran’s neurological symptoms, and, based on the Veteran’s medical history, was given a list of potential causes for these symptoms for which the Board sought a medical opinion on the possible nexus for each. The examiner was asked to address each of the possible causes as they might relate to the Veteran’s neurological disorder. The causes listed were: Gulf War exposure, shingles, motorcycle/motor vehicle accidents, a fall from a tree house, cervical radiculopathy, recurrent herpetic infection (differentiated from recurrent shingles), cramp fasciculation syndrome, somatization, and/or service-connected PTSD. Thereafter, VA received an addendum report and medical opinion from February 2019, in which the VA examiner concluded that the Veteran’s neurological symptoms were due entirely to a diagnosis of carpal tunnel syndrome (CTS) and that his CTS was not caused by any of the other possible causes listed by the Board. The Board found that this report was not fully responsive to its remand instructions, and inadequate as the examiner failed to address whether all of the Veteran’s symptoms were due to the listed possible causes, as well as other reasons. Accordingly, the Board again remanded the matter for additional development to obtain a medical opinion which addressed the concerns and questions raised by the Board. The Veteran was provided a new VA examination in February 2020, from which the VA examiner prepared a written medical opinion. In this medical opinion the VA examiner did address each of the specified potential etiological causes of the Veteran’s neurological condition. Of note, the VA examiner indicated that the Veteran’s neurological condition is not likely caused by Gulf War environmental or toxic exposures, or due to residuals from previously treated shingles, herpes infection, or somatization. However, the VA examiner did indicate possible etiology links to/from injury to his cervical spine/neck and/or lower back, or radiculopathy thereto. None of these injuries are currently determined to be service connected. Therefore, the Board finds it necessary to defer its decision on this clam until the RO fully adjudicates the claims of entitlement to service connection for service connection for cervical spine/neck condition and for low and mid/thoracic back injury; as well as his claim for increased compensation based on unemployability (TDIU). The Board regrets the need for further delay and asks the RO to afford this matter expeditious treatment. See 38 U.S.C. §§ 5109B, 7112. The matter is REMANDED for the following action: 1. Following adjudication of the claims regarding the back and neck that are currently in the jurisdiction of the RO, readjudicate the Veteran’s claim for entitlement to service connection for neurologic symptoms, to include as due to Gulf War exposures and/or as secondary to a service-connected disability, such as post-traumatic stress disorder (PTSD) or either his cervical spine/neck condition or mid/thoracic back injury if such is/are determined to be service connected, as well as shingles, motorcycle/motor vehicle accidents, a fall from a tree house, cervical radiculopathy, recurrent herpetic infection (differentiated from recurrent shingles), cramp fasciculation syndrome, and/or somatization. No additional VA examination is requested. R. FEINBERG Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Bannach, 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.