Citation Nr: 21071120 Decision Date: 11/29/21 Archive Date: 11/29/21 DOCKET NO. 17-57 477 DATE: November 29, 2021 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 lower extremity is remanded. Entitlement to service connection for peripheral neuropathy of the left upper extremity is remanded. Entitlement to service connection for peripheral neuropathy of the right upper extremity is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1977 to July 1983. This matter comes before the Board of Veterans' Appeals (Board) from a July 2015 rating decision. In January 2020, the Veteran testified at a Board videoconference hearing; a transcript of the hearing is associated with the electronic claims file. The Veteran was sent a letter in August 2021 notifying him that the Veterans Law Judge who presided over the hearing was no longer employed at the Board and providing him with the option of requesting another hearing. No response was received within 30 days from the date of the letter; as stated in the letter, the Board will assume the Veteran does not want another hearing and will proceed accordingly. In February 2021 and April 2020, the Board remanded the appeal to the agency of original jurisdiction (AOJ) for additional development. While the Board regrets the additional delay, remand is again required to ensure a fully informed decision is reached out of fairness to the Veteran. In the February 2021 remand directives, the Board instructed the AOJ to obtain the following: a) All records from the Bronx, New York VA Medical Center since establishing care around 1984 or 1985 b) All records from the New Jersey VA Healthcare System since establishing care, apparently sometime in the 1980s c) All private treatment records from Neurology Associates of South Carolina d) Any other private or VA treatment records the Veteran identifies that are pertinent to his claims If additional treatment records were obtained, the AOJ was instructed to obtain a VA neurologist opinion on whether it is at least as likely as not that the Veteran's peripheral neuropathy of the bilateral upper and lower extremities, which may be a hereditary motor and sensory neuropathy (HMSN) such as Charcot-Marie-Tooth disease, began during military service, manifested to a compensable degree within one year of separation from service, or is otherwise related to disease or injury during active service. The examiner was specifically directed to consider the Veteran's complaint of weakness and numbness in his bilateral upper extremities in February 1979 after sustaining a cervical spine strain one month earlier in a motor vehicle accident; his treatment of ingrown toenails on both feet in October 1979; and other complaints during service regarding muscle pain with walking, squatting, and using stairs and knee pain after several apparent knee injuries within a two-week period in November 1981. A subsequent development letter was mailed to the Veteran and his representative on February 24, 2021 advising him to provide additional information on any outstanding treatment records relevant to his claim and providing him with a VA Form 21-4142a. No response was received. Records from the Bronx VA Medical Center (VAMC) were requested on March 30, 2021 with a follow-up email on June 2, 2021. June 14, 2021 correspondence from Bronx VAMC states that no records were found. Records from the New Jersey VAMC were received from December 9, 1993 through December 17, 1998; however, October 2021 correspondence states that medical records from January 1, 1986 through December 8, 1993 were unable to be located. No private treatment records were obtained. The Board finds that sufficient attempts were made to obtain the outstanding private and VA treatment records previously identified by the record. While the Neurology Associates of South Carolina records were not obtained, the Veteran did not respond to VA's request for information regarding outstanding private treatment records, which was needed for VA to locate the exact treatment facility and send a records request. Therefore, the Board finds that the directives pertaining to obtaining the outstanding treatment records have been substantially complied with. See Stegall v. West, 11 Vet. App. 268 (1998). While an examination request for a neurologist was submitted, the examination vendor cancelled the request because a neurologist could not be provided to perform the examination. The Board finds that an additional VA opinion is necessary. The only medical opinion of record is the June 2020 opinion and addendum in which the examiner provided a negative opinion, finding that a review of the records did not show chronic complaint or treatment during service or within a year of separation, nor was there continuity of symptoms from active service to the present. The examiner addressed a January 1979 service treatment record (STR) in which the Veteran complained of bilateral upper extremity numbness and attributed this complaint to an acute cervical strain which resolved. As directed in the February 2021 remand, an examiner should address the other potentially relevant evidence of record, to include in-service complaints and treatment for ingrown toenails, lower extremity muscle pain, and knee injuries. Additionally, the Veteran has explained in his hearing and in correspondence that while serving in the infantry, he sustained multiple mosquito, tick, and chigger bites that could have contributed to the condition. He also recalled developing an infection that manifested in painful sores and blisters on his legs, which is reflected in the STRs. These contentions must be considered by a VA medical examiner on remand. The matters are REMANDED for the following action: Obtain a VA examination and opinion for the Veteran's peripheral neuropathy. To the extent possible, the examination should be scheduled with a specialist, such as a neurologist. However, the examination should not be cancelled if such a specialist is unavailable. The examiner should review all relevant evidence of record and opine whether it is at least as likely as not (approximately 50 percent or greater probability) that the Veteran's peripheral neuropathy of the bilateral upper and lower extremities (and any other diagnoses pertaining to the neuropathy, such as carpal tunnel syndrome and/or a hereditary motor and sensory neuropathy (HMSN) such as Charcot-Marie-Tooth disease) began during military service, manifested to a compensable degree within one year of separation from service, or is otherwise related to disease or injury during military service. It is emphasized that the Veteran is competent to report his symptoms and onset, experiences, and history, to include a lack of positive family history for neuropathy, and such reports must be specifically acknowledged and considered in formulating any opinions. If the examiner rejects the Veteran's reports of symptomatology, he or she must provide a reason for doing so. The examiner must also consider and address the significance, if any, of complaints or treatment for other potentially relevant conditions or injuries in service, to include mosquito, tick, and chigger bites sustained in service; the in-service leg infection; treatment for ingrown toenails in October 1979; the complaint of weakness and numbness in the Veteran's bilateral upper extremities in February 1979 after sustaining a cervical spine strain in a motor vehicle accident; other complaints during service regarding muscle pain with walking, squatting, and using stairs; and complaints of knee pain after several apparent knee injuries within a two-week period in November 1981. L. M. BARNARD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Carroll, 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.