Citation Nr: 21069536 Decision Date: 11/18/21 Archive Date: 11/18/21 DOCKET NO. 17-04 076 DATE: November 18, 2021 REMANDED Entitlement to service connection for peripheral neuropathy of the right lower extremity is remanded. Entitlement to service connection for peripheral neuropathy of the left lower extremity is remanded. Entitlement to service connection for peripheral neuropathy of the right upper extremity is remanded. Entitlement to service connection for peripheral neuropathy of the left upper extremity is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1967 to December 1970. This matter comes to the Board of Veterans' Appeals (Board) from a January 2016 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Paul, Minnesota. In September 2019, the Board remanded these claims for additional development. 1. Entitlement to service connection for peripheral neuropathy of the right lower extremity is remanded. 2. Entitlement to service connection for peripheral neuropathy of the left lower extremity is remanded. 3. Entitlement to service connection for peripheral neuropathy of the right upper extremity is remanded. 4. Entitlement to service connection for peripheral neuropathy of the left upper extremity is remanded. While the Board sincerely regrets further delay in this matter, additional development is required before the Veteran's claims may be adjudicated on the merits. In a December 2019 VA opinion, the examiner opined that it was less likely than not that the Veteran's peripheral neuropathy of the bilateral upper and lower extremities was related to service. The examiner reasoned that there was no evidence for diagnosis of a chronic condition of peripheral neuropathy of the bilateral upper and lower extremities during service years or within one year after separation from service. There was evidence of a current chronic diagnosis with a diagnosis in 2019, with no etiology confirmed. A nexus had not been established. However, the Veteran reported initially experiencing numbness and tingling dating back to 1968. Initially, the Board finds this opinion inadequate because a lack of contemporaneous evidence following separation from service is not a bar to service connection. The Veteran's representative pointed to medical literature that suggested difficulties in diagnosing peripheral neuropathy, including exposure to Agent Blue, which could delay the onset of progressive chronic sensorimotor axonal polyneuropathy. Therefore, on remand, an additional VA opinion is needed to provide an adequate opinion for direct service connection, noting that a lack of contemporaneous records is not an absolute bar to service connection. The examiner should consider the medical literature provided by the Veteran's representative. 5. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. The Veteran's claim of entitlement to TDIU is inextricably intertwined with the claims remanded for further development. Accordingly, they must be considered together, and thus a decision by the Board on the Veteran's claim of entitlement to TDIU would at this point be premature. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (two issues are "inextricably intertwined" when they are so closely tied together that a final Board decision cannot be rendered unless both are adjudicated). The matters are REMANDED for the following action: Obtain a VA opinion from an appropriate examiner to determine the etiology of the Veteran's peripheral neuropathy of the bilateral upper and lower extremities. The claims file and a copy of this remand must be made available for review. Following a review of the pertinent evidence, the examiner must determine the following: Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's peripheral neuropathy of the bilateral upper and lower extremities is related to service, to include exposure to herbicides. The examiner should note that a lack of contemporaneous records from service is not a bar to service connection. The examiner is advised that the Veteran is competent to report injuries and symptoms, and his reports must be considered and discussed in formulating the requested opinions. If his reports are discounted, the examiner should provide an explanation for doing so. The Veteran's statements may not be discounted solely on the basis of the lack of confirmation in the medical records. A complete rationale for all opinions rendered must be provided. If the examiner cannot provide an opinion without resorting to speculation, he or she should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made. Michael J. Skaltsounis Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. R. Montalvo, 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.