Citation Nr: 21068143 Decision Date: 11/09/21 Archive Date: 11/09/21 DOCKET NO. 19-28 544 DATE: November 9, 2021 REMANDED Entitlement to service connection for Parkinson's disease is remanded. Entitlement to service connection for neuropathy of bilateral upper extremities, to include as secondary to herbicide exposure, is remanded. Entitlement to service connection for neuropathy of bilateral lower extremities, to include as secondary to herbicide exposure, is remanded. Entitlement to service connection for an unspecified neurocognitive disorder, to include as secondary to herbicide exposure, is remanded. REASONS FOR REMAND The Veteran had active service from June 1969 to May 1971. These matters come before the Board of Veterans' Appeals (Board) on appeal from a December 2018 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). All matters are remanded. The Veteran contends that he is entitled to service connection for Parkinson's disease, dementia, and neuropathy as secondary to his in-service herbicide agent exposure. See August 2018 VA Form 21-526EZ. First, at a December 2018 VA Parkinson's disease examination, the examiner found that the Veteran did not have a Parkinson's disease diagnosis. However, in an April 2019 correspondence, A.D. indicated that he has witnessed the Veteran exhibit symptoms of Parkinson's disease. Further, in an April 2019 correspondence, Dr. E.B. opined that it was at least as likely as not that the Veteran has Parkinson's disease that is related to in-service herbicide exposure. As it is unclear as to whether the Veteran carries a diagnosis of Parkinson's disease, the Board finds that a remand is necessary to obtain an addendum medical opinion. Second, on the August 2018 VA Form 21-526EZ, the Veteran reported that he suffered from neuropathy with symptoms of chronic weakness and pain in his hands and feet. At a December 2018 VA peripheral nerves condition examination, the examiner noted that the Veteran did not have a peripheral neuropathy condition. Under the medical history section, the examiner noted that the Veteran denied claiming a peripheral nerves condition. The December 2018 VA examiner did not address the symptoms the Veteran identified in his August 2018 claim. Further, in an April 2019 correspondence, Dr. E.B. opined that exposure to herbicides was a contributing factor to the development of neuropathy. Based on the foregoing, the Board finds that a remand is necessary to obtain an addendum medical opinion which addresses all relevant favorable evidence of record. Third, in a September 2020 correspondence, the Veteran's representative indicated that the Veteran was unable to obtain records from Dr. E.B. following the doctor's stroke and subsequent office closure. There are records from Dr. E.B. associated with the Veteran's electronic claims folder. It is unclear as to whether there are outstanding records. On remand, the RO should clarify if there are any outstanding relevant private treatment records. If so, efforts should be made to obtain them. The matters are REMANDED for the following action: 1. Contact the Veteran and request that he provide or authorize the release of records from Dr. E.B. as well as any other records, not already of record, that are relevant to the claim. All attempts to secure the above-referenced evidence must be documented in the claims file. If, after making reasonable efforts to obtain any outstanding non-Federal records the AOJ is unable to secure same or if after continued efforts to obtain Federal records the AOJ concludes that it is reasonably certain they do not exist or further efforts to obtain them would be futile, the Veteran should be notified in accordance with 38 C.F.R. § 3.159 (e). The Veteran must then be given an opportunity to respond. 2. Then, obtain an addendum opinion from the December 2018 VA examiner (or a suitable substitute) regarding the etiology of the Veteran's claims. The Veteran's electronic claims folder, including a copy of this remand should be provided to the clinician. If the clinician believes another examination is required, schedule one. The clinician is requested to provide an opinion as to the following: (a) Whether it is at least as likely as not (50 percent probability or greater) that the Veteran has a diagnosis of Parkinson's disease. (b) If not, opine whether the Veteran suffers from Parkinsonism symptoms. (c) If the Veteran suffers from Parkinsonism symptoms, opine whether it is at least as likely as not (50 percent probability or greater) that they are related to in-service herbicide exposure. The examiner is requested to address the following: (i) the Veteran's conceded in-service herbicide exposure and (ii) Dr. E.B.'s April 2019 opinion that states the Veteran exhibits symptoms of tremors, instability, and rigidity which were indicative of Parkinson's disease and no other known risk-factors which would cause the Veteran to develop Parkinson's disease. (d) Whether it is at least as likely as not (50 percent probability or greater) that the Veteran suffers from neuropathy of the upper or lower extremities that was incurred in or is otherwise related to in-service herbicide exposure. The examiner is requested to address the following: (i) August 2018 VA Form 21-526EZ where the Veteran reported that he suffered from neuropathy with symptoms of chronic weakness and pain in his hands and feet and (ii) April 2019 correspondence where Dr. E.B. opined that exposure to herbicides was a contributing factor to the development of neuropathy. (e) Whether it is at least as likely as not (50 percent probability or greater) that the Veteran suffers from dementia that was incurred or is otherwise related to in-service herbicide exposure. (f) Whether it is at least as likely as not (50 percent probability or greater) that the Veteran suffers from a neurological disorder (exhibited by symptoms of frequent memory loss) that was incurred or is otherwise related to in-service herbicide exposure. A complete rationale, with citation to appropriate medical principles, is requested. 3. Thereafter, readjudicate the issues on appeal as noted above. If the determination remains unfavorable to the Veteran, he and his attorney should be furnished a supplemental statement of the case (SSOC) which addresses all evidence associated with the claims file since the last statement of the case. The Veteran and his attorney should be afforded the applicable time period to respond. Michael A. Pappas Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Baskerville 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.