Citation Nr: 21000329 Decision Date: 01/05/21 Archive Date: 01/05/21 DOCKET NO. 20-03 549 DATE: January 5, 2021 REMANDED Entitlement to service connection for right upper extremity peripheral neuropathy is remanded. Entitlement to service connection for left upper extremity peripheral neuropathy is remanded. Entitlement to service connection for right lower extremity peripheral neuropathy is remanded. Entitlement to service connection for left lower extremity peripheral neuropathy is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1967 to March 1970, with service in Thailand and Vietnam. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2018 rating decision by the Department of Veterans Affairs (VA). In December 2020, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. Entitlement to service connection for bilateral upper and lower extremity peripheral neuropathy. The Veteran testified that he started to have symptoms of discomfort and tingling in his hands and feet in service and continuing since that time. See December 2020 Board hearing. His treating VA physician diagnosed peripheral neuropathy in the fingers and feet. See October 2017 VA treatment records. However, a February 2018 VA examiner opined that there was no objective evidence of peripheral neuropathy and opined that the Veteran did not have a disability. The VA examiner’s opinion is inadequate because it did not discuss the Veteran’s diagnosis of record, nor did the examiner have the opportunity to consider the Veteran’s later testimony. As a result, remand for a new examination is necessary. If the Veteran is not diagnosed with peripheral neuropathy, he may still have a disability for VA purposes if he has pain with functional impairment. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir., 2018). Thus, on remand, an opinion regarding causation should still be provided even if the examiner does not diagnose peripheral neuropathy. It appears that VA treatment records since February 2018 may be incomplete. Specifically, the Veteran submitted April 2018 VA treatment records that contain electrodiagnostic findings reflecting right hand carpal tunnel syndrome that do not otherwise appear in VA treatment records obtained by the Agency of Original Jurisdiction (AOJ). See October 2018 correspondence. Thus, on remand, records from February 2018 should be obtained. The Veteran asserted that he submitted two opinions with his claim from his providers that his peripheral neuropathy is related to combat in service. See January 2020 substantive appeal (VA Form 9). The medical evidence submitted with the November 2017 claim reflects a diagnosis of peripheral neuropathy but does not provide any opinion regarding causation. The Veteran is welcome to resubmit any opinions regarding causation from his treating medical providers, if so desired. The matters are REMANDED for the following action: 1. The AOJ should obtain copies of VA treatment records from February 2018 to the present. 2. After the above development is completed, the AOJ should arrange for a VA examination of the Veteran with a different examiner than the February 2018 VA examiner to determine the nature and likely cause of any peripheral neuropathy. The examiner should review the claim file (including this remand) and note such review was conducted. Based on review of the record and examination of the Veteran, the examiner should provide an opinion with detailed rationale that responds to the following: (a.) Please opine on whether the Veteran has peripheral neuropathy in the upper and lower extremities. If no diagnosis is provided, the examiner must discuss October 2017 VA treatment records reflecting a diagnosis of peripheral neuropathy in the hands and feet and April 2018 VA treatment records reflecting carpal tunnel syndrome. (b.) Did the Veteran’s peripheral neuropathy (as an organic disease of the nervous system) manifest within one year of service? Please explain why. The examiner must discuss the Veteran’s reports of symptoms starting in service and continuing from that time and may not rely on the absence of medical evidence during or immediately after service. (c.) Is the Veteran’s peripheral neuropathy considered early onset peripheral neuropathy that manifested within one year of his exposure to herbicide agents (from approximately December 1968 to December 1969)? Please explain why. The examiner must discuss the Veteran’s reports of symptoms starting in service and continuing from that time and may not rely on the absence of medical evidence during or immediately after service. (d.) If the answers to the two above questions are negative, is it at least as likely as not (50% or greater probability) that the Veteran’s peripheral neuropathy (or pain with functional impairment if peripheral neuropathy is not diagnosed), was either incurred in or otherwise related to the Veteran’s military service, including exposure to herbicide agents? Please explain why. The examiner must discuss the Veteran’s reports of symptoms starting in service and continuing from that time. The examiner may not rely on the absence of a presumption or the absence of medical evidence during and immediately after service. Even if peripheral neuropathy is not diagnosed, the examiner must opine on the Veteran’s reported pain with functional impairment in his hands and feet. 3. If upon completion of the above action the issues remain denied, the case should be returned to the Board after compliance with appellate procedures. E. I. VELEZ Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Sandler, 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.