Citation Nr: 21064343 Decision Date: 10/19/21 Archive Date: 10/19/21 DOCKET NO. 12-01 102 DATE: October 19, 2021 REMANDED Entitlement to service connection for bilateral upper extremity neuropathy and bilateral lower extremity neuropathy, including as due to herbicide agent exposure and as secondary to service-connected disabilities, is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1964 to December 1966 and from March 1967 to February 1970, including service in the Republic of Vietnam. This matter again comes before the Board of Veterans' Appeals (Board) on appeal from a March 2010 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama. The Board previously denied this matter in a March 2017 decision, which the Veteran timely appealed to the United States Court of Appeals for Veterans Claims (Court). By way of a December 2017 Order, the Court granted the parties' Joint Motion for Partial Remand (JMPR) and returned this issue to the Board. The Board again denied the Veteran's appeal in a December 2018 decision, which the Veteran timely appealed to the Court. In a February 2020 Order, the Court vacated the Board's December 2018 decision and remanded this matter again to the Board for further development. Most recently, the Board denied the Veteran's claim in November 2020, which the Veteran again timely appealed to the Court. By way of an August 2021 Order, the Court granted the parties' Joint Motion for Remand (JMR) and returned this case to the Board. 1. Bilateral Upper Extremity and Bilateral Lower Extremity Neuropathy In the August 2021 JMR, the parties agreed that the Board failed to address whether a July 2018 opinion concluding that the Veteran's bilateral upper extremity and bilateral lower extremity neuropathy was less likely than not due to his military service was adequate in light of a March 2020 statement submitted by the Veteran indicating the onset and continuity of his symptomatology. Specifically, the Veteran's March 2020 statement notes that he began experiencing numbness and tingling in his right leg in 1978 and began having pain "up and down [his] legs and numbness at [his] toes" by 1979. See March 2020 Veteran Correspondence. The Veteran is competent to report the onset and continuity of his observable symptomatology. See Barr v. Nicholson, 21 Vet. App. 303 (2007); Layno v. Brown, 6 Vet. App. 465 (1994). As the physician who authored the July 2018 opinion was not able to consider the Veteran's subsequently submitted competent lay statements regarding the onset and continuity of his symptomatology, the Board finds that this opinion is inadequate to determine the nature and etiology of his condition. Thus, on remand, the Board requests an addendum opinion regarding the cause of the Veteran's bilateral upper extremity and bilateral lower extremity neuropathy as it relates to his military service, including due to exposure to herbicide agents. Finally, the Board notes that, in the Veteran's November 2008 claim for service connection for bilateral upper extremity and bilateral lower extremity neuropathy, he asserts that his condition is causally linked to his service-connected disabilities. Because no opinion regarding this theory of entitlement is of record, the Board requests on remand an opinion as to whether the Veteran's bilateral upper extremity and/or bilateral lower extremity neuropathy is secondary to any of his service-connected disabilities. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). The matter is REMANDED for the following action: Forward the claims file to an appropriate clinician who has not previously provided an opinion in this case to determine the nature and etiology of the Veteran's bilateral upper extremity neuropathy and bilateral lower extremity neuropathy. If the clinician determines that an examination (or telehealth interview, etc., if an in-person examination is not feasible) would be beneficial, one is to be provided. (a) The clinician should opine as to whether it is at least as likely as not (probability of about 50 percent) that the Veteran's bilateral upper extremity neuropathy and/or bilateral lower extremity neuropathy manifested during, or is the result of, his active duty service, including as due to exposure to herbicide agents. (b) The clinician should opine as to whether it is at least as likely as not (probability of about 50 percent) that the Veteran's bilateral upper extremity neuropathy and/or bilateral lower extremity neuropathy was/were either (i) caused and/or (ii) aggravated by his service-connected disabilities. NOTE: With respect to the questions concerning aggravation, the clinician is advised that aggravation under 38 C.F.R. § 3.310(b) does not require "permanent worsening" of the nonservice-connected disability. If aggravation is found, the clinician should attempt to identify the baseline level of severity of disability prior to such aggravation. In formulating his or her opinions, the clinician should consider an address the competent medical and lay evidence of record, including, but not limited to: (i) The Veteran's service treatment records; (ii) The Veteran's service personnel records; (iii) The Veteran's post-service medical records; and (iv) The Veteran's competent lay statements regarding his first-hand in-service experiences and the onset and continuity of his symptomatology, including his statement submitted in March 2020 along with other lay statements affiliated with the claims file. If the clinician determines that the Veteran's bilateral upper extremity peripheral neuropathy and/or bilateral lower extremity peripheral neuropathy is/are less likely than not due to his active duty service and/or less likely than not caused and/or aggravated by his service-connected disabilities, the clinician should determine what other factor(s) caused the disorders. In other words, the clinician should ascertain the most likely etiology of the Veteran's bilateral upper extremity neuropathy and bilateral lower extremity neuropathy. The clinician must provide a comprehensive report that includes a complete rationale for all opinions and conclusions reached. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Hoffman 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.