Citation Nr: 21067524 Decision Date: 11/04/21 Archive Date: 11/04/21 DOCKET NO. 08-37 163A DATE: November 4, 2021 REMANDED Entitlement to service connection for peripheral neuropathy of the lower extremities is remanded. Entitlement to service connection for upper extremity peripheral neuropathy is remanded. Entitlement to service connection of myelitis is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1968 through June 1970. This matter comes before the Board of Veterans' Appeals (BVA or Board) on appeal from a May 2007 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In April 2016, September 2017, November 2018, and December 2020, the Board remanded these matters to the Agency of Original Jurisdiction (AOJ) for additional development. The appeal has since returned to the Board. 1. Entitlement to service connection for peripheral neuropathy of the lower extremities is remanded. 2. Entitlement to service connection for upper extremity peripheral neuropathy is remanded. The Veteran contends that his peripheral neuropathy of his upper and lower extremities is related to his service, to include as secondary to his service-connected disabilities. Service treatment records document the Veteran's complaints regarding problems with his legs, feet, and ankles in September 1968. He had extensive workup, but no cause was found. In September 1968, the Veteran transcribed a letter to a family member detailing that his legs "are killing [him]" and reported that he was going to sick call almost every day. The Veteran has also submitted statements alleging that he has had swelling and pain in his legs, hands, and feet since service. He has also specifically alleged that he experienced pain and aching in his legs while serving in Vietnam. Lastly, he asserted that he had numbness in his hands and feet since discharged from service. Despite notations of legs, hands, and feet symptoms in-service, no VA has addressed whether these symptoms are related to an undiagnosed presentation of peripheral neuropathy in service, or whether the symptoms ultimately led to the Veteran's current peripheral neuropathy. Additionally, no VA examiner has considered the Veteran's assertion that he had swelling and pain in his legs in the Army, and that he had hand and feet numbness since discharged from service. The Veteran has also asserted several theories for service connection for peripheral neuropathy that have not been considered by a VA examiner. First, the Veteran asserted in his August 2016 VA examination that he had a lot of strains in service. In correspondence, he represented that he had complained about his legs during basic training and advanced training. He sought care for these complaints at sick call and was only given Aspirin. Despite these statements, no VA examiner has considered whether his peripheral neuropathy was a result of injuries or strains during basic training or infantry training. He has also alleged that he believes that the pain in his hands and feet were caused by adverse environmental factors in service, especially those experienced in Vietnam. However, no examiner has considered whether the environmental factors, including those experienced in Vietnam, caused his peripheral neuropathy of his upper and lower extremities. Furthermore, the Veteran has alleged that his peripheral neuropathy of his upper and lower extremities was caused by the medication, Lithium, that is used to treat his post-traumatic disorder (PTSD). In October 2002, the Veteran's private physician opined that the Veteran's numbness was secondary to hyperventilation due to stress. However, no examiner has specifically addressed, in sufficient detail, whether the Veteran's medications for, or symptoms of, PTSD caused or aggravated his peripheral neuropathy. Based on the aforementioned, further development is necessary. 3. Entitlement to service connection of the myelitis is remanded. The Veteran contends that his myelitis is related to service, to include as secondary to his service-connected disabilities. The Veteran has asserted that he had clumsiness of the legs for a while with the inability to keep up with family members and with the physical requirements in service. Additionally, he experienced aching and pain in legs since service. Despite these statements, no examiner has considered whether these symptoms were possibly related to an undiagnosed myelitis disability in service. Further, the Veteran has alleged that his myelitis was caused or aggravated by medications used to treat his diarrhea in service. He submitted an article in support of this theory that suggests the medications, such as Lodoquinol and Clioquinol used to treat his diarrhea, is associated with a toxic reaction of myeo-opic neuropathy. However, no VA examiner has addressed whether the Veteran's myelitis was caused or aggravated by his treatments in service. As such, further development is necessary. The matters are REMANDED for the following action: 1. Obtain an addendum opinion as to the nature and etiology of the Veteran's peripheral neuropathy of the upper and lower extremities. For each extremity, the clinician is asked to opine whether it is at least as likely as not (i.e., probability of 50 percent or greater) that the Veteran's peripheral neuropathy is related to his active duty service, to include his exposure to Agent Orange? In formulating an opinion, the examiner should consider the Veteran's and discuss the Veteran's lay statements of record, to include, that his aching, pain, swelling, and numbness of his upper and lower extremities began in-service, or since discharge. The examiner should also consider and discuss medical evidence documenting leg and feet symptoms in service. Further, the examiner should specifically discuss the Veteran's assertion that his peripheral neuropathy is related to adverse environmental exposures, to include his service in Vietnam. See VBMS, document labeled, STR, receipt date 6/26/1970, page 44, 46, 74 of 76; VA 21-4138 Statement In Support of Claim, receipt date 4/28/2021; Medical Treatment Record-Non-Governmental Facility, receipt date 11/13/1998, page 1 of 3; C&P Exam, receipt date 8/4/2016, page 1 of 11; Correspondence, receipt date 2/18/1992; Correspondence, receipt date 6/8/2017, page 3 of 13; VA 21-4138 Statement In Support of Claim, receipt date 6/24/1991; VA 21-4138 Statement In Support of Claim, receipt date 6/24/1991, 1 page. 2. The examiner is also asked to opine whether the Veteran's peripheral neuropathy of his upper and lower extremities is at least as likely as not caused or aggravated beyond its natural progression by his service-connected PTSD, to include his use of medications, and the effects of the associated symptoms. Note that aggravation means any incremental increase in disability in non-service-connected disabilities (i.e., any additional impairment of earning capacity) resulting from service-connected conditions. 3. Obtain an addendum opinion as to the nature and etiology of the Veteran's myelitis. The clinician is asked to opine whether it is at least as likely as not (i.e., probability of 50 percent or greater) that the Veteran's myelitis is related to his active-duty service? In formulating an opinion, the examiner should consider the Veteran's consider and discuss the Veteran's lay statements of record, to include, that his aching, pain, swelling, and numbness of his upper and lower extremities began in-service or since discharge and medical evidence documenting leg and feet symptoms in service. The examiner should also consider the Veteran's statements, and the submitted article in support, that the treatment of his bouts of diarrhea in service caused his myelitis. See VBMS, document labeled, C&P Exam, receipt date 12/16/2016, page 8 of 10; Correspondence, receipt date 2/18/1992; Correspondence, receipt date 6/8/2017, page 3 of 13; and Correspondence, receipt date 12/9/2015, page 58 of 73. 4. The examiner is also asked to opine whether the Veteran's myelitis is at least as likely as not caused or aggravated beyond its natural progression by his service-connected irritable bowel syndrome (IBS), to include his use of medications for treatment of IBS. Note that aggravation means any incremental increase in disability in non-service-connected disabilities (i.e., any additional impairment of earning capacity) resulting from service-connected conditions. The examiner is asked to provide the underlying reasons for all opinions expressed, and is reminded that the term "as likely as not" does not mean "within the realm of medical possibility," but rather that the evidence of record is so evenly divided that, in the examiner's expert opinion, it is as medically sound to find in favor of the proposition as against it. Cynthia M. Bruce Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N.B. Mmeje, 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.