Citation Nr: 21000327 Decision Date: 01/05/21 Archive Date: 01/05/21 DOCKET NO. 18-49 317 DATE: January 5, 2021 REMANDED Entitlement to service connection for neuropathy of the right upper extremity, to include as secondary to service-connected degenerative disc disease of the lumbar spine (low back condition) is remanded. Entitlement to service connection for neuropathy of the left upper extremity, to include as secondary to a service-connected low back condition is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Navy from November 1957 to December 1977. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2017 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In July 2019, the Veteran testified at a hearing before the undersigned Veterans Law Judge (VLJ); a transcript is of record. The appeal previously included claims of service connection for peripheral neuropathy of the right and left lower extremities. The RO granted the claims in a September 2020 rating decision. As this award represented a full grant of the benefits sought on appeal, the claims are no longer before the Board. See Grantham v. Brown, 114 F. 3d 1156, 1158 (Fed. Cir. 1997). The Board also notes that the evidence of record shows that the Veteran has been diagnosed with carpal tunnel syndrome as well as peripheral neuropathy of the bilateral upper extremities. See August 2020 VA fee-based opinion. As the competent evidence of record indicates that carpal tunnel syndrome is a type of upper extremity neuropathy, specifically median neuropathy, the Board will consider it as part of the Veteran’s claims. See Brokowski v. Shinseki, 23 Vet. App. 79, 84 (2009); Clemmons v. West, 206 F.3d 1401 (Fed. Cir. 2000). As such, the Board has recharacterized the Veteran’s claims as shown on the title page. This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900(c); 38 U.S.C. § 7107(a)(2). Entitlement to service connection for neuropathy of the bilateral upper extremities, to include as secondary to a service-connected low back condition is remanded. The Veteran contends that his bilateral upper extremity neuropathy is either directly related to herbicide agent exposure and/or secondary to his service-connected low back condition. While the Board regrets further delay, it finds that a remand is warranted in order to obtain new etiology opinions. The Board previously remanded the claims on appeal in November 2019 in order to afford the Veteran a VA examination and obtain etiology opinions. Such was completed in December 2019. However, the RO found that the opinions provided were inadequate and obtained new opinions in August 2020. The August 2020 examiner opined that the Veteran’s upper extremity neuropathy was less likely than not related to his active military service. However, in his rationale, the examiner only noted that the upper extremity neuropathy was unrelated to herbicide agent exposure, without any explanation as to why the two are unrelated. As such, the Board finds that the August 2020 opinion is conclusory as it pertains to the Veteran’s conceded exposure to herbicide agents and a new opinion should be obtained on remand. See Stefl v. Nicholson, 21 Vet. App. 120 (2007). The August 2020 examiner also provided a negative opinion regarding secondary service connection. The evidence of record shows that the Veteran experiences impairment of the radial nerve and median nerve bilaterally as well as impairment of the middle radicular group of the right upper extremity. See December 2019 VA fee-based examination; August 2020 VA fee-based opinion. However, as noted by the Veteran’s representative, the August 2020 examiner only addressed the Veteran’s median neuropathy (carpal tunnel syndrome) and did not address whether the Veteran’s radial nerve or middle radicular group neuropathy was secondary to his service-connected low back condition. Accordingly, the Board finds that a new opinion addressing secondary service connection also should be obtained on remand. The matters are REMANDED for the following action: 1. Obtain a VA medical opinion regarding the etiology of the Veteran’s bilateral upper extremity neuropathy from a qualified medical professional. The need for a physical examination is left to the discretion of the VA examiner. The examiner must review the entire claims file and a copy of this Remand. The examiner must opine: a) Whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s neuropathy of each upper extremity is related to his conceded exposure to herbicide agents. b) Whether it is at least as likely as not that the Veteran’s neuropathy of each upper extremity is caused or aggravated by his service-connected degenerative disc disease of the lumbar spine. The term “aggravation” means a worsening of a disability beyond its natural progression. If aggravation is found, then, to the extent possible, the examiner should establish a baseline level of severity of the neuropathy prior to aggravation by the service-connected low back condition. A complete rationale must be provided for all opinions expressed. The rationale must consider and discuss the pertinent evidence of record, to include the Veteran’s lay statements. C. CRAWFORD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Mortimer, 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.