Citation Nr: 21067206 Decision Date: 11/03/21 Archive Date: 11/03/21 DOCKET NO. 20-22 092 DATE: November 3, 2021 REMANDED Service connection for a left upper extremity neurological disability, including as due to herbicide exposure, is remanded. Service connection for a left lower extremity neurological disability, including as due to herbicide exposure, is remanded. Service connection for a right upper extremity neurological disability, including as due to herbicide exposure, is remanded. Service connection for a right lower extremity neurological disability, including as due to herbicide exposure, is remanded. REASONS FOR REMAND The appellant is the daughter of a Veteran who served on active duty from November 1970 to May 1972 and died in July 2021. In September 2021, the Agency of Original Jurisdiction (AOJ) granted her request for substitution in these claims. These matters are before the Board of Veterans' Appeals (Board) on appeal from an October 2006 rating decision appealed in a timely August 2007 notice of disagreement (NOD) and perfected by a timely May 2020 substantive appeal in response to March 2020 statement of the case (SOC). The Board notes that the SOC in this case indicates it is on appeal from a later May 2018 rating decision. However, a review of the record shows the Veteran was first denied service connection for numbness and tingling of the hands and feet in October 2006 and filed an August 2007 NOD with the entire rating decision at that time. Moreover, VA received an October 2007 statement asking for help finding representation to help him "in appealing [his] service-connected disability claim for benefits," specifically including "numbness in my hands and feet." Therefore, the Board finds the evidence reasonably shows the Veteran properly initiated an appeal in that matter, which involves almost identical pathology to that now at issue. No SOC was ever issued addressing that NOD until the March 2020 SOC leading to the instant appeal. Thus, the Board finds this appeal extends from the original October 2006 denial for service connection of numbness in the hands and feet. 1. Service connection for a left upper extremity neurological disability, including as due to herbicide exposure, is remanded. 2. Service connection for a left lower extremity neurological disability, including as due to herbicide exposure, is remanded. 3. Service connection for a right upper extremity neurological disability, including as due to herbicide exposure, is remanded. 4. Service connection for a right lower extremity neurological disability, including as due to herbicide exposure, is remanded. The only relevant VA examination report of record is from April 2018 and does not include any medical opinions. Notably, the record shows that (1) herbicide agent exposure is presumed based on qualifying in-country service during the Vietnam War; (2) STRs document complaints of painful, swollen legs, feet, and ankles at separation related to a cellulitis infection; and (3) the Veteran and his family members have submitted competent lay statements indicating that observable symptoms of neurological conditions (e.g., pain, numbness, or tingling of the hands, legs, and feet with resultant functional impairment such as trouble standing and grasping objects) were present upon returning home from Vietnam and worsened over the years. Consequently, the Board finds a remand appropriate to obtain a medical nexus opinion considering all relevant evidence. The matters are REMANDED for the following action: 1. Forward the Veteran's records to a neurologist or other appropriate physician to obtain an opinion clarifying the nature and likely cause of any neurological symptoms affecting the extremities. Based on a review of the record, the examiner must respond to the following: (a.) Please identify documented diagnoses or disabilities in the record consistent with the Veteran's complaints of left and right upper and lower extremity symptoms. All diagnostic findings (or lack thereof) must be reconciled with conflicting evidence in the record. If any previously documented diagnoses are no longer or otherwise not felt to apply, the examiner must explain why, citing to the pertinent diagnostic criteria. (b.) For each disability identified, please opine as to whether it is AT LEAST AS LIKELY AS NOT (A 50 PERCENT PROBABILITY OR GREATER) that such disability is related to the Veteran's military service, to include (BUT NOT LIMITED TO) presumed herbicide exposure or a documented cellulitis infection (with secondary lower extremity pain and swelling) therein. The examiner MUST CONSIDER AND DISCUSS ALL RELEVANT LAY REPORTS, keeping in mind that the Veteran is FULLY COMPETENT to describe the onset, course, and progression of lay-observable symptoms (such as pain, weakness, tingling, numbness, etc.). Relevant statements in this case include (but are not limited to) self-reports that he "began experiencing tingling in [the] feet, lower legs, and hands in 1972 after returning home from Vietnam" but did not seek treatment at the time because he was unaware it could be a sign of serious illness AND reports from his sister indicating he returned from Vietnam with leg and foot pain that caused functional loss (e.g., "trouble walking around or standing for more than a few minutes"), still bothered him years later, and had worsened in the intervening years. Other relevant records include service treatment records (STRs) which document complaints of painful, swollen legs, feet, and ankles at separation related to a cellulitis infection. The examiner should presume that the Veteran was exposed in service to herbicide agents, specifically, 2,4-D; 2,4,5-T and its contaminant TCDD; cacodylic acid; and picloram. (Continued on the next page) All opinions must include a detailed rationale. Providing an opinion or conclusion without enough explanation will delay processing of the claim and require further clarification. David Gratz Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Yuan, 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.