Citation Nr: 21061657 Decision Date: 10/04/21 Archive Date: 10/04/21 DOCKET NO. 17-33 074 DATE: October 4, 2021 REMANDED The claim of entitlement to service connection for right upper extremity neuropathy, including as secondary to exposure to herbicide agents, is remanded. The claim of entitlement to service connection for left upper extremity neuropathy, including as secondary to exposure to herbicide agents, is remanded. The claim of entitlement to service connection for right lower extremity neuropathy, including as secondary to exposure to herbicide agents, is remanded. The claim of entitlement to service connection for left lower extremity neuropathy, including as secondary to exposure to herbicide agents, is remanded. The claim of entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1970 to September 1971, including in the Republic of Vietnam during the Vietnam era. His claims come before the Board of Veterans' Appeals on appeal of a January 2015 Department of Veterans Affairs (VA) rating decision. In March 2019, the Board remanded these claims to the Agency of Original Jurisdiction (AOJ) for additional action. At that time, the issues on appeal included entitlement to service connection for swelling and edema of the lower extremities. In a November 2020 Decision Review Officer decision, however, VA granted this claim. Entitlement to service connection for right upper extremity neuropathy, including as secondary to exposure to herbicide agents Entitlement to service connection for left upper extremity neuropathy, including as secondary to exposure to herbicide agents Entitlement to service connection for right lower extremity neuropathy, including as secondary to exposure to herbicide agents Entitlement to service connection for left lower extremity neuropathy, including as secondary to exposure to herbicide agents The Veteran seeks service connection for neuropathy in the upper and lower extremities on either a direct basis as related to an in-service back injury (fall) and/or exposure to herbicide agents, or secondary basis as related to his service-connected prostate cancer, status post radical prostatectomy, urinary incontinence. Service treatment records confirm in-service back and ankle complaints. In addition, given the Veteran's service in Vietnam during the Vietnam era, he is presumed to have been exposed to herbicide agents during such service. Post-service treatment records include the Veteran's reports of numbness and tingling in all extremities since the injury and additional lower extremity and new upper extremity complaints following prostate cancer treatment. As well, they show current diagnoses of back, leg and hand disabilities, including neuropathy affecting all four extremities, lumbar radiculopathy and sciatica, and lymphedema of the lower extremities, all occasionally discussed conjunctively. In January 2020, the AOJ afforded the Veteran a VA examination, during which an examiner discussed the etiology of the neuropathy. The report of this examination is inadequate to proceed in deciding these claims. First, the examiner found it would be speculative to provide an opinion on any relationship between the neuropathy and the Veteran's presumed in-service exposure to herbicide exposure. She did not address the validity of any of the Veteran's other theories of entitlement. For instance, the examiner did not address whether the peripheral neuropathy is aggravated by the Veteran's service-connected lower extremity disabilities. The examiner also did not address whether, as alleged, the Veteran's service-connected residuals of prostate cancer, to include the treatment therefor, may have caused the condition to develop in both the upper and lower extremities. Second, the examiner noted that there are more common conditions that cause neuropathy, which have not been ruled out for the differentials but did not elaborate in discussing each such condition relevant in this case. Third, although the record includes diagnoses of peripheral neuropathy affecting all extremities, the examiner indicated that the Veteran's health care team had not conducted appropriate testing to confirm the presence of such condition in the Veteran's upper extremities. Additional medical information is thus needed. Entitlement to a TDIU This claim is inextricably intertwined with the claims noted above. As such, the Board must defer issuing a decision on this claim for a TDIU pending resolution of the service connection claims. Harris v. Derwinski, 1 Vet. App. 180 (1991). These matters are REMANDED for the following action: 1. Afford the Veteran a VA examination for the purpose of comprehensively addressing the etiology of his lower and upper extremity neuropathy. The examiner should review the following pertinent evidence of record: (a) all lay statements, including those dated April 2013 and September 2014, which describe an in-service injury/fall; (b) service treatment records showing back and ankle complaints; (c) VA examination reports, which include the Veteran's reported medical history; and (d) post-service treatment records reflecting diagnoses of neuropathy affecting all extremities, lumbar radiculopathy and sciatica, and lymphedema of the lower extremities, sometimes discussed conjunctively, and a January 2015 opinion of the Veteran's treatment physician finding the peripheral neuropathy "likely due" to Agent Orange. The examiner should record in detail the Veteran's description of the in-service injury he believes caused his neuropathy and his history of lower and upper extremity complaints since service and after his prostate cancer treatment. The examiner should conduct any testing necessary to respond adequately to this remand. Accepting as competent any reports of lay-observable neurological symptoms, the examiner should opine whether any lower or upper extremity neurological disability, to include neuropathy, is at least as likely as not (50 percent or greater probability) related to the Veteran's service, including his reported in-service injury and/or presumed exposure to herbicide agents. If not, discussing each extremity separately, the examiner should opine whether such disability is due to, the result of, or aggravated by, the Veteran's service-connected lymphedema of the lower extremities and/or residuals of prostate cancer. (Continued on the next page) The examiner should provide rationale for each opinion. 2. In the meantime, as these claims are being remanded for a VA examination, VA should notify the Veteran that it would be in his best interest to obtain a more comprehensive opinion from the treating physician who commented on this case in January 2015. Such opinion should include rationale and/or supporting medical documentation or literature linking the Veteran's neuropathy to in-service Agent Orange exposure. LESLEY A. REIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. N. 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.