Citation Nr: 21062741 Decision Date: 10/12/21 Archive Date: 10/12/21 DOCKET NO. 16-57 553 DATE: October 12, 2021 REMANDED Service connection for peripheral neuropathy (PN) of the left upper extremity (LUE). REASONS FOR REMAND The Board denied the appeal in November 2019. The Veteran appealed to the Veterans Claims Court. In September 2020, the Court Clerk granted a Partial Joint Motion for Remand (JMPR) which vacated the Board's decision and remanded the case for further development consistent with the JMPR. In March 2021, the Board remanded the appeal for additional development, to include obtaining a new VA examination. In June 2021, a VA examiner opined that the Veteran did not have a diagnosis of LUE PN and asserted that it was not possible that the Veteran had PN due to burn pit or any other exposure and that it was less likely than not that his condition was caused by or related to an in-service event. The examiner noted reviewing the Veteran's claims file, to include a private August 2014 examination which diagnosed LUE PN. The examiner offered that the 2014 clinician was not qualified to perform a neurological examination, took a history and administered an examination that were inconsistent with neurological disorders, and provided a diagnosis of "so many named nerves that the veteran should be written up in a medical journal." The examiner asserted that the rationale for the LUE PN diagnosis seemed to be based on the 2014 clinician's "ignorance of the weight of the medical literature" and ultimately opined that the diagnosis rendered in the 2014 assessment was offered solely for the purposes of disability compensation. The examiner suggested that the 2014 assessment was "an inferior examination with an inferior diagnostic conclusion" and advised that it should not be used for rating purposes. Under 38 C.F.R. § 3.159(a)(1), "competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions." Id.; see also generally Cox v. Nicholson, 20 Vet. App. 563 (2007). The record contains no evidence that the 2014 examiner lacked the education, training, or experience necessary to examine the Veteran and diagnose LUE PN. Rather, the record indicates that the August 2014 assessment was performed by a licensed physician. Accordingly, on its face, the clinician was competent to diagnose LUE PN; therefore, the record contains evidence of a diagnosis of LUE PN contemporaneous to the pendency of the. Nonetheless, the June 2021 examiner's dismissal of the 2014 diagnosis raises the issue of whether the diagnosis is proper and clarification is needed. Regrettably, further development is again required to determine the nature and etiology of LUE PN. The matter is REMANDED for the following actions: 1. Identify and obtain any pertinent, outstanding VA and private treatment records not currently of record and associate them with the claims file. 2. Direct the claims file to a clinician to address the following: Does the Veteran have a current diagnosis of PN of the LUE. To this end, the clinician is asked to address the June 2021 and August 2014 medical opinions. If PN of the LUE is shown, it is at least as likely as not (a 50 percent probability or more) that it is: (a) etiologically related to service, and/or (b) the product of in-service exposure to burn pits or particulate matter, to include whether burn pits or particulate matter can cause PN. The clinician is asked to address complaints of numbness and tingling in the Veteran's hands and arm in February 2006 and June 2009 post-deployment health assessments, an August 2014 VA examination, and the July 2019 hearing before the undersigned Veterans Law Judge. A rationale for all opinions must be provided. 3. If the clinician determines that an examination is necessary in order to provide the requested opinions, then one should be scheduled. L. HOWELL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Spigelman, 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.