Citation Nr: 21071100
Decision Date: 11/29/21	Archive Date: 11/29/21

DOCKET NO. 17-44 735
DATE: November 29, 2021

REMANDED

Entitlement to service connection for bilateral peripheral neuropathy of the lower extremities, to include as secondary to exposure to herbicides, is remanded.

REASONS FOR REMAND

The Veteran served on active duty from June 1968 to January 1971, to include service in the Republic of Vietnam. He testified before the undersigned in August 2021; a transcript of the hearing is associated with the record. 

During the hearing, the Veteran testified that he doesn't recall when he first noticed symptoms but it was "well before 1996." He said he was treated by a private neurologist who thought his symptoms could be related to herbicide exposure, but that physician is retired and the Veteran does not know where he is.  

The claim must be remanded to obtain an adequate medical opinion. 

The Veteran was diagnosed with peripheral neuropathy in July 2016. See September 2016 VA examination. A November 2016 VA neurology treatment note indicated that the Veteran's peripheral neuropathy was likely due to Agent Orange exposure, but did not include a rationale.  In a November 2016 addendum opinion, the VA examiner considered that note and provided a negative nexus opinion. That opinion is inadequate because it was based only on a finding that the neuropathy did not have an onset within one year of the exposure. The examiner did not offer an opinion on whether the diagnosed neuropathy is directly related to service. 

Service connection on a presumptive basis does not preclude consideration of service connection on a direct basis. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). 

The matters are REMANDED for the following action:

1. Ask the Veteran to identify any providers who treated him for neuropathy complaints since service. Take all appropriate action to obtain records from identified providers. Take all appropriate action to obtain identified records. 

2. After completion of the foregoing, obtain a medical opinion from an appropriate clinician on the likely etiology of the diagnosed peripheral neuropathy claim. If the examiner determines that an opinion cannot be provided without an examination, one should be scheduled. Copies of all pertinent records must be made available to the examiner for review. 

The examiner is asked to answer the following questions:

Is it at least as likely as not (50 percent probability) that any currently diagnosed peripheral neuropathy of the lower extremities was incurred in or is otherwise related to service, to include Agent Orange exposure?

In answering this question, the examiner should not use as a basis for the opinion the fact that peripheral neuropathy is not on the list of diseases presumed service connected in Veterans exposed to herbicide agents. 

The examiner must provide reasons for each opinion given. If the examiner is unable to provide an opinion without resort to speculation, he or she should explain why this is so and what, if any, additional evidence would be necessary before an opinion could be rendered. 

 

M.E. Larkin

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	T. Jarman, 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.