Citation Nr: 21068324 Decision Date: 11/10/21 Archive Date: 11/10/21 DOCKET NO. 16-08 917 DATE: November 10, 2021 REMANDED Entitlement to service connection for a neurological disorder of the right upper extremity (RUE), to include as secondary to exposure to herbicide agents or a service-connected disability, is remanded. Entitlement to service connection for a neurological disorder of the left upper extremity (LUE), to include as secondary to exposure to herbicide agents or a service-connected disability, is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1967 to November 1969. This case originally came before the Board of Veterans' Appeals (Board) on appeal from a June 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran did not request a Board hearing. See March 2016 VA Form 9. These claims were previously before the Board in November 2017, May 2018, June 2020, January 2021, and April 2021, at which time they were remanded for additional development. Unfortunately, the Board must again remand the claims in order to obtain an adequate medical opinion, as discussed below. Issues 1-2: Entitlement to service connection for neurological disorders of the RUE and LUE is remanded. A remand is required to obtain another VA medical opinion. The Veteran has current diagnoses of bilateral carpal tunnel syndrome (CTS) and bilateral ulnar sensory neuropathy. See 8/24/15 VA treatment record; May 2019 VA examination report. The claims have been previously remanded numerous times to obtain an adequate and complete opinion. The Board notes that the August 2021 VA examiner appears to provide opinions regarding direct service connection and secondary service connection, including causation and aggravation. However, the November 2015, January 2018, May 2019, August 2020, January 2021, and August 2021 VA opinions focused on the CTS diagnosis while ignoring the bilateral ulnar sensory neuropathy diagnosis. None of the VA examiners addressed whether the Veteran's diagnosis of bilateral ulnar sensory neuropathy was caused by, aggravated by, or otherwise related to service or whether it is caused by or aggravated by a service-connected disability. Therefore, another remand is required in order to more completely evaluate the nature and etiology of all neurological disorders of the BUE, to include bilateral ulnar sensory neuropathy. The matters are REMANDED for the following action: 1. Obtain additional medical opinions from the August 2021 VA examiner or another qualified VA examiner to address the nature and etiology of the Veteran's claimed neurological disorder of the RUE and LUE, to include CTS and ulnar sensory neuropathy. The entire claims file, including a copy of this remand, must be made available to the examiner, who should note review of the record in the examination report. Any indicated tests or studies should be performed, and all material relevant evidence should be discussed. The Veteran should be scheduled for another examination if deemed necessary. This case has been remanded MULTIPLE TIMES to obtain adequate opinions. After reviewing the claims file in its entirety, the examiner is asked to address the following with complete rationale: a) Provide an opinion as to whether the Veteran's neurological disorder of the RUE and/or LUE, to include CTS and ulnar sensory neuropathy, is at least as likely as not (50 percent or greater probability) incurred in, caused by, aggravated by, or otherwise related to service, TO INCLUDE conceded exposure to herbicide agents. b) Provide an opinion as to whether the Veteran's neurological disorder of the RUE and/or LUE, to include CTS and ulnar sensory neuropathy, was at least as likely as not (50 percent or greater probability) caused by or otherwise related to diabetes mellitus type II (DM II) or any other service-connected disabilities. c) Provide an opinion as to whether the Veteran's neurological disorder of the RUE and/or LUE, to include CTS and ulnar sensory neuropathy, was at least as likely as not (50 percent or greater probability) aggravated by DM II or any other service-connected disabilities. d) Provide an opinion as to whether the Veteran's obesity was an intermediate step between his current neurological disorder of the BUE, to include CTS and ulnar sensory neuropathy, and any service-connected disability. In doing so, the examiner must opine whether it is at least as likely as not (50 percent or greater probability) that any service-connected disability caused the Veteran to become obese or gain weight AND/OR aggravated any obesity and/or weight gain. If so, the examiner must opine whether the obesity was a substantial factor in causing the Veteran's neurological disorder of the BUE, to include CTS and ulnar sensory neuropathy, AND whether the Veteran's neurological disorder would not have occurred or worsened BUT FOR the weight gain or obesity caused or aggravated by his service-connected disability. A complete rationale should be provided. (Continued on the next page) 2. Then, review the newly obtained opinions to ensure that all remand directives have been answered by the examiner. If the questions posed are not answered or sufficiently answered, return the case to the examiner for corrective action. 3. Thereafter, readjudicate the remanded claims on appeal. S. B. MAYS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Lee, 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.