Citation Nr: 21000809 Decision Date: 01/06/21 Archive Date: 01/06/21 DOCKET NO. 16-24 358 DATE: January 6, 2021 REMANDED Entitlement to service connection for bilateral upper extremity peripheral neuropathy, to include as secondary to exposure to an herbicide agent is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1966 to April 1968. This matter comes before the Board of Veterans’ Appeals (Board) from a May 2014 rating decision. In a September 2018 decision, the Board remanded the appeal for further development. 1. Entitlement to service connection for bilateral upper extremity neuropathy. The Veteran contends that his bilateral upper extremity peripheral neuropathy is due to his presumed exposure to an herbicide agent in the Republic of Vietnam. In July 2020, the Veteran underwent a VA examination. The examiner diagnosed the Veteran with right upper extremity carpal tunnel syndrome. The examiner opined that the Veteran’s upper right neuropathy (diagnosed as carpal tunnel syndrome) is less likely than not incurred in or caused by an in-service injury, event, or disease including presumed exposure to an herbicide agent while in-service. The examiner explained that no service records document any injury of event to be the cause of the neuropathy. The examiner reasoned that medical records had been reviewed and the evidence is lacking to link the service and a pathophysiological connection to neuropathy. The examiner further opined that the right upper extremity neuropathy was less likely than not proximity due to or the result of the Veteran’s service-connected condition. The examiner reasoned that there is no link between the right upper extremity neuropathy and LS disc disease, since lumbar disease does not affect the upper extremity. The VA examiner further opined that the Veteran’s upper right neuropathy is less likely than not aggravated beyond its natural progression. The examiner reasoned that there is no medical link between right upper extremity neuropathy and LS disc disease, since lumbar disease does not affect the upper extremity. In regard to the claimed upper left extremity neuropathy, the July 2020 examiner found the Veteran did not have a current diagnosis of upper left extremity neuropathy. The examiner opined that the claimed left upper neuropathy is less likely than no incurred in or caused by the claimed in-service injury, event, or illness. The examiner reasoned that there is no pathology to render a diagnosis of left upper extremity neuropathy. Further, the examiner found that the claimed condition was less likely than not caused or aggravated by the Veteran’s service connected back condition. The Board finds that the July 2020 VA examiner’s opinion is not adequate for adjudication. First, as it relates to the right upper extremity neuropathy, the examiner failed to address the Veteran’s conceded in-service herbicide exposure in rendering the opinion. Second, although, the July 2020 VA examiner found the Veteran did not have a diagnosis of left upper extremity neuropathy, the Veteran was diagnosed with left upper extremity neuropathy in an April 2014 VA examination. In this case, the appellate period is from October 2012. As the Veteran was diagnosed with peripheral neuropathy of the upper left extremity during the appellate period, an adequate opinion must be obtained to determine whether the disability was etiologically related to service or a service-connected disability. Thus, a remand is required in or for VA to obtain an adequate opinion as to the Veteran’s right and left upper extremity neuropathy. The matters are REMANDED for the following action: 1. Obtain an addendum medical opinion by an appropriate clinician to determine the etiology of the Veteran’s bilateral upper extremity peripheral sensory polyneuropathy. The examiner must provide the following opinions: (a.) Whether the Veteran’s right upper extremity peripheral neuropathy is at least as likely as not related to an in-service injury, event, or disease, including presumed exposure to an herbicide agent in-service. The examiner must specifically address the Veteran’s conceded herbicide exposure. (b.) Whether the Veteran’s left upper extremity peripheral neuropathy, diagnosed in an April 2014 VA examination, is at least as likely as not related to an in-service injury, event, or disease, including presumed exposure to an herbicide agent in-service. The examiner must specifically address the Veteran’s conceded herbicide exposure. i. The Board notes that a current disability is one that is present at any time during pendency of the claim, even if the disability had resolved. (c.) Whether the Veteran’s right upper extremity peripheral neuropathy is at least as likely as not (1) proximately due to service-connected lumbosacral degenerative disc disease with strain and spondylosis, status post laminectomy, or alternatively, (2) aggravated beyond its natural progression (non-temporary increase in severity) by service-connected lumbosacral degenerative disc disease with strain and spondylosis, status post laminectomy. (d.) Whether the Veteran’s left upper extremity peripheral neuropathy is at least as likely as not (1) proximately due to service-connected lumbosacral degenerative disc disease with strain and spondylosis, status post laminectomy, or alternatively, (2) aggravated beyond its natural progression (non-temporary increase in severity) by service-connected lumbosacral degenerative disc disease with strain and spondylosis, status post laminectomy. The examiner must provide a complete medical rational for all opinions provided. D. SMART Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Robert Batten 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.