Citation Nr: 21065736 Decision Date: 10/27/21 Archive Date: 10/27/21 DOCKET NO. 17-48 451 DATE: October 27, 2021 REMANDED Entitlement to service connection for peripheral neuropathy of the bilateral upper extremities is remanded. INTRODUCTION The Veteran served in the United States Army from June 1972 to May 1975. When this case was before the Board in October 2019, the above-noted issue was remanded for additional development. The case has now been returned to the Board for further appellate review. REASONS FOR REMAND While additional delay is unfortunate, the Board finds further development is required before the Veteran's claim is decided. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Further, a remand by the Board confers upon the claimant, as a matter of law, the right to compliance with the remand instructions, and imposes upon VA a concomitant duty to ensure compliance with the terms of the remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998). By way of an October 2019 decision, the Board found a new VA examination was necessary to determine the diagnosis and etiology of the Veteran's neurological symptoms in his bilateral upper extremities. In particular, the Board noted the October 2015 VA examination indicated no clear diagnosis had been rendered for the Veteran's neurological symptoms, and as such the examiner declined to identify a diagnosis beyond reporting the Veteran's subjective symptoms. Further, the October 2015 examiner stated that since there was not clear diagnosis related to the Veteran's neurological symptoms, an opinion regarding the etiology of such could not be made without resorting to mere speculation. In December 2019, the Veteran underwent a VA peripheral nerves conditions examination. The examiner found the Veteran's neurological symptoms of the bilateral upper extremities were less likely than not incurred in service. To support this conclusion, the examiner noted the Veteran does not have a current diagnosis for his symptoms and there is no evidence of a chronic disability. However, the Board notes the examiner failed to acknowledge or discuss the medical records referenced in the October 2019 remand as instructed. Additionally, the examiner failed to discuss whether the Veteran's current neurological manifestations, regardless of diagnosis, were related to the neurological manifestations he experienced and received treatment for during his active service. Additionally, the Board notes an opinion based upon an inaccurate factual premise has no probative value. Reonal v. Brown, 5 Vet. App. 458, 461 (1993). Of note, the examiner stated, "records were silent from 1975 to 2015" for the Veteran's neurological symptoms. However, the Veteran was also evaluated in 2005 for weakness in his legs and arms. Based on the foregoing, the Board finds substantial compliance with the October 2019 Board remand instructions has not been achieved. As such, a new examination and medical opinion must be obtained. Accordingly, this case is REMANDED for the following actions: Afford the Veteran a VA examination by a Neurologist with sufficient expertise to determine the diagnosis and etiology of the Veteran's neurological symptoms in his bilateral upper extremities. All pertinent evidence of record should be made available to and reviewed by the examiner. Any indicated studies should be performed. Following a review of the relevant records and lay statements, the examiner is asked to address the following questions: a. What, if any, diagnosis does the Veteran have related to his bilateral upper extremities? In answering the question, the examiner should address the following medical records and state why the Veteran cannot be diagnosed with peripheral neuropathy (if the Veteran is not so diagnosed): document labeled "STR-Medical," received March 19, 2015, pages 59, 64, and 65 of 98; document labeled "Medical Treatment Record-Government Facility," received February 1, 1982, pages 1 and 10 of 19; document labeled "Medical Treatment Record-Government Facility," received May 16, 2006, pages 1-3 of 11; document labeled "C&P Exam," received December 22, 2014; and document labeled "C&P Exam," received October 8, 2015. b. If the Veteran does not have a peripheral neuropathy diagnosis (that would otherwise be service-connected due to herbicide exposure): 1. Is it at least as likely as not that the symptoms the Veteran currently experiences are the same as the symptoms the Veteran experienced during his active-duty service and these symptoms are linked to his active duty service? 2. Is it at least as likely as not that the symptoms the Veteran currently experiences are a result of herbicidal agent exposure, even if the Veteran does not have a diagnosis of peripheral neuropathy? In addressing the above, the examiner is reminded that the Veteran is considered to be competent and credible in reporting symptoms that he experienced first-hand. The examiner must provide a complete rationale for all proffered opinions. If the examiner is unable to provide any required opinion, he or she should explain why. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation as to why this is so. If the inability to provide a more definitive opinion is the result of a need for additional information, the examiner should identify the additional information that is needed. T. REYNOLDS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Nestander, Jessica S. 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.