Citation Nr: A21019050 Decision Date: 11/30/21 Archive Date: 11/30/21 DOCKET NO. 210917-185800 DATE: November 30, 2021 REMANDED Service connection for bilateral lower extremity neuropathy is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from October 1963 to October 1967 as a jet engine mechanic, including service at Takhli Air Base in Thailand from February to October 1966. The rating decision on appeal was issued in September 2020 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies. In October 2020, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of the September 2020 decision. In February 2021, the agency of original jurisdiction (AOJ) issued the HLR decision on appeal, which considered the evidence of record at the time of the prior September 2020 decision. In the September 2021 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the AOJ September 2020 decision on appeal. 38 C.F.R. § 20.301. Service connection for bilateral lower extremity neuropathy is remanded. The Board cannot make a fully informed decision on the issue of service connection for bilateral lower extremity neuropathy because no VA examiner has reflected consideration of the Veteran's lay statements and addressed the Veteran's allegations of symptoms from discharge to the present. The March 2020 VA examination was inadequate. Once VA undertakes to provide an examination, it must provide an adequate one. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The VA examiner opined that it was "less likely than not the veteran incurred b/l neuropathy as a result of leg cramps during service." The VA examiner found that the Veteran's service treatment records (STR) "show on separation cramps in legs and recurrent back pain for past year, no treatment sought, no coup., no seq." The VA examiner found that the STRs does not show any complaints of leg cramps during presumptive period. The VA examiner explained that "leg cramps can be due to multiple condition to include diabetes and dehydration." The opinion does not consider all the relevant evidence of record, including lay statements. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Dalton v. Nicholson, 21 Vet. App. 23 (2007). The Veteran has reported leg symptoms, tingling and numbness, beginning during service in 1966 and after service during college in 1967. The Veteran indicated he reported these symptoms to the doctor performing his separation physical examination and the doctor recorded it as leg cramps and told the Veteran that if it was due to Agent Orange, then the symptoms would worsen over time. The March 2020 VA examination did not reflect consideration of this lay evidence, including the Veteran's allegations of symptoms from discharge to the present. In fact, the medical history section of the examination report is completely blank. The VA medical opinion does mention the Veteran's report in-service leg cramps, but explained, "Leg cramps can be due to multiple condition to include diabetes and dehydration." However, neither the VA examination report nor the VA medical opinion ever addressed whether the Veteran has had diabetes or dehydration either during service or currently. The Board finds that remand is necessary to correct this pre-decisional duty to assist error. 38 C.F.R. § 3.159(c)(4). A new VA examination and medical opinion addressing all relevant lay evidence, including the Veteran's allegations of symptoms from discharge to the present, are warranted. The matter is REMANDED for the following action: In remanding these matters, however, the Board makes no finding, implicit or otherwise, as to the credibility of the Veteran's assertions. Neither the Veteran's credibility nor any lack thereof should be presumed in this remand order. Schedule the Veteran for a VA examination for peripheral neuropathy. The examiner must review the claims file, including Veteran's August 2019 submissions to the claims file and a copy of this remand order. The examiner is asked to provide a response to the following: (a.) Is the peripheral neuropathy at least as likely as not related to service? (b.) Is it at least as likely as not that the peripheral neuropathy (1) began during active service, (2) manifested within a year after the Veteran's service in Thailand in 1966, or (3) was noted during service with continuing symptoms since service? Provide a rationale to support the opinions. In providing the requested opinion, consider the Veteran's description of in-service injury and symptoms as well as post-service symptoms and address the Veteran's allegations of symptoms from discharge to the present. Laypersons are competent to attest to matters of first-hand knowledge, including observable symptoms and conversations with medical providers. As noted above, the Veteran has reported tingling and numbness since 1966. Stated another way, do the Veteran's reports about symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? G. A. WASIK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board James Hekel 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.