Citation Nr: 21065487 Decision Date: 10/26/21 Archive Date: 10/26/21 DOCKET NO. 16-61 932 DATE: October 26, 2021 REMANDED Entitlement to service connection for right upper extremity peripheral neuropathy is remanded. Entitlement to service connection for bilateral lower extremity peripheral neuropathy is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1964 to August 1977. He served in Vietnam between March 1969 to March 1970. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2013 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO), which denied the Veteran service connection for right upper extremity and bilateral lower extremity peripheral neuropathy. A Board hearing was held in August 2019. A transcript is of record. In April 2021, the Veteran was notified that the Veterans Law Judge (VLJ) who conducted the hearing is no longer available. In the same notice, the Veteran was afforded the opportunity to request another hearing before a different VLJ within 30 days. As the Veteran has not indicated that he wanted a new hearing and 30 days has elapsed, the Board will proceed with the appeal. In December 2019, December 2020, and July 2021, the Board remanded the Veteran's claims to the Agency of Original Jurisdiction (AOJ) for further action consistent with the Board's remand directives. Specifically, the Board remanded for opinions addressing the contentions of record. The claims are back before the Board for further appellate proceedings. Regrettably, the Board finds that further evidentiary development is necessary and remands the case to ensure compliance with the Board's prior remand instructions. See Stegall v. West, 11 Vet. App. 268, 271 (1998). In the Board's most recent remand, a clinician was asked to opine as to whether the Veteran's peripheral neuropathy, in all extremities, was etiologically related to his service, to include presumptive exposure to herbicide agents. While the clinician offered opinions as to other contentions of record, no opinion was intimated as to the Veteran's presumptive exposure to herbicide agents. See August 2021 VA examination report. Thus, remand is required for substantial compliance with the Board's prior remand directives. The Board notes that the opinions that were offered are inadequate for any adjudicative purpose. For example, the clinician opined that the Veteran's right upper extremity peripheral neuropathy lacks any documentation of symptoms during the Veteran's cardiac event in service. Id. However, as more fully described below, service treatment records indicate complaints of right-sided numbness during his cardiac event. See STRs. The clinician also noted that his peripheral neuropathy was diagnosed in 2011 as "hereditary sensory neuropathy." See August 2021 VA examination report. However, review of the treatment entry shows that the Veteran was diagnosed as "predominantly sensory neuropathy" with "no family history of neuropathy." See April 2013 VA treatment records. Regardless, the Board finds the August 2021 VA examination report to be inadequate. The Veteran and record raise the following theories of entitlement for service connection for his right upper and bilateral lower extremities peripheral neuropathy: (1) it had its onset in service, see Board Hearing Tr. at 11 and February 1979 VA examination report; (2) it is caused by his service-connected coronary artery disease, see October 2011 VA Form 21-4138 and February 1979 VA examination report; and (3) it was caused by his presumptive exposure to herbicide agents. On remand, opinions are required as to these contentions. The matters are REMANDED for the following action: 1. Obtain any outstanding VA and/or private treatment records relevant to treatment the Veteran received for his peripheral neuropathy that are not already of record. All obtained records should be associated with the evidentiary record. If any identified records are not obtainable (or none exist), the Veteran and his representative should be notified, and the record clearly documented. 2. After the above development is completed, obtain an opinion from an appropriately qualified clinician to determine the nature and etiology of the Veteran's right upper extremity and bilateral lower extremity peripheral neuropathy. The evidentiary record, including a copy of this remand, must be made available and reviewed by the clinician. The opinion should include a notation that this record review took place. It is up to the discretion of the reviewing clinician as to whether a new examination is necessary to provide an adequate opinion. After the record review, and examination if deemed necessary, the reviewing clinician is asked to respond to the following inquiries: A. Is it at least as likely as not that the Veteran's right upper extremity and/or bilateral lower extremity peripheral neuropathy had its onset within one year of March 1970? The clinician should consider the neurological consult in service treatment records requesting a neurologist rule out organicity after a doctor noted "some organic difficulties" related to his neurologic exam. See May and June 1976 treatment entries. The clinician should also consider the February 1979 VA examination report noting radiating pain in the bilateral upper extremities in service. B. Is it at least as likely as not that the Veteran's right upper extremity and/or bilateral lower extremity peripheral neuropathy were incurred in, or are otherwise related to, his time on active service, to include his exposure to herbicide agents and documented myocarditis therein? The clinician should consider the February 1979 VA examination report noting radiating pain in the bilateral upper extremities related to myocarditis. The clinician should also consider the Veteran's reports of tingling in his hands and feet in service. See Board Hearing Transcript at 11. The clinician must discuss the relationship, if any, between the Veteran's peripheral neuropathy and his exposure to herbicide agents in service. C. Is it at least as likely as not that the Veteran's right upper extremity and/or bilateral lower extremity peripheral neuropathy were (a.) caused or (b.) aggravated by his service-connected CAD? The clinician should consider the February 1979 VA examination report noting acute chest pain attacks with radiation to the bilateral upper extremities. The clinician should also consider the Veteran's report of loss of circulation in his feet and fingers noted in the October 2011 VA Form 21-4138. In rendering this opinion, the reviewing clinician is advised that the Veteran is competent to report his symptoms and history. Such reports must be acknowledged and considered in formulating any opinion. If the reviewing clinician rejects the Veteran's reports, he or she must provide an explanation for such rejection. The reviewing clinician is not to improperly discount the Veteran's lay statements or mistakenly rely on an absence of medical evidence in the record to support his or her conclusions. The complete rationale for all opinions should be set forth and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an opinion cannot be provided without resorting to mere speculation, the reviewing clinician must provide a complete explanation for why an opinion cannot be rendered. In so doing, the reviewing clinician must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. (Continued on the next page) 3. After the above has been completed to the extent possible, readjudicate the claims. If any benefit sought remains denied, provide the Veteran and his representative with a supplemental statement of the case (SSOC), and return the case to the Board. DONNIE R. HACHEY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Strickland 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.