Citation Nr: 21072129 Decision Date: 12/02/21 Archive Date: 12/02/21 DOCKET NO. 16-61 241 DATE: December 2, 2021 REMANDED Entitlement to service connection for peripheral neuropathy, left lower extremity peroneal nerve, is remanded. Entitlement to service connection for peripheral neuropathy, left lower extremity tibial nerve, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from March 1970 to May 1974, and from May 1975 to August 1976. This case comes before the Board of Veterans' Appeals (Board) on appeal from a December 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. In December 2018, the Board remanded the Veteran's claims for additional development. In February 2020, the Board issued a decision denying the Veteran's service connection claims for peripheral neuropathy of the left lower extremity peroneal and tibial nerves. The Veteran appealed the Board's denial decision to the United States Court of Appeals for Veterans Claims (CAVC), resulting in the December 2020 Joint Motion for Remand (JMR), which vacated the February 2020 Board decision, and remanded the issues for readjudication consistent with the JMR. Regrettably, the Board finds that a remand is necessary prior to readjudication of the claims. The December 2020 JMR found that the Board erred by failing to address the reasonably raised theory of secondary service connection, more specifically, whether the Veteran's peripheral neuropathy of his left lower extremity of the peroneal and tibial nerves were proximately caused or aggravated by his service-connected coronary artery disease. The JMR found that due to the September 2019 and October 2019 VA examiners opining that vascular and blood problems were a common problem and one of the numerous causes of peripheral neuropathy, to which the Veteran is currently service-connected for coronary artery disease, the Board was required to consider this raised secondary contention. See CAVC Decision, December 2020. As a result, in July 2021, the Veteran was afforded a new VA examination and medical opinion to determine the etiology of his claimed conditions on a secondary basis. Upon review, the examiner opined that the Veteran's claimed conditions are less likely than not proximately due to or the result of his service-connected heart condition, as the Veteran's neuropathy did not begin until five years after his myocardial infarction. The examiner noted there was no medical literature to support the claim. See C&P Exam, July 2021. In August 2021, the Veteran was afforded an addendum VA medical opinion to address the aggravation prong of the secondary service connection claim. Upon review, the examiner opined that the Veteran's claimed conditions are not aggravated beyond its natural progression by his heart conditions, as there is no medical literature to support that a heart condition would cause increase neuropathy in lower extremities. See C&P Exam, August 2021. Nevertheless, the Board finds these opinions to be inadequate, as the examiners failed to consider and/or discuss the submitted October 2021 medical literature regarding risk factors for peripheral neuropathy, and the September 2019 and October 2019 VA examiners' opinions noting that vascular problems are a common problem and one of the numerous causes of peripheral neuropathy. Additionally, the August 2021 examiner failed to provide a rationale based on aggravation. Therefore, the Board finds that the Veteran should be given additional addendum VA medical opinions that adequately addresses the Veteran's claims on a secondary basis, prior to readjudication of the claims. The matters are REMANDED for the following action: 1. Request the Veteran to identify all medical providers (VA and private) from whom he has received treatment for his peripheral neuropathy, left lower extremity of the peroneal and tibial nerves, and obtain any outstanding records and associate them with the Veteran's claims file. 2. After associating all newly acquired records with the claims file, send the claims file back to the July 2021/August 2021 VA examiner, to provide addendum VA medical opinions to determine the nature and etiology of the Veteran's conditions. If the July 2021/August 2021 VA examiner is not available, please forward the claims file to another appropriate clinician. The entire claims file, including a copy of this remand, must be made available to the examiner, and note review of the record in the examination report. Any indicated tests or studies should be performed, and all relevant evidence should be discussed. All pertinent medical complaints, symptoms, and clinical findings must be reported in detail. If the examiner finds that a new VA examination must be scheduled prior to providing the opinion, schedule such an examination. Following complete review of the record, the examiner must address the following: (a) Opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran's peripheral neuropathy, left lower extremity of the peroneal nerve was caused or aggravated (beyond its natural progression) by his service-connected coronary artery disease. Please note: the examiner must address both causation and aggravation in the requested opinion. The examiner must also address the October 2021 submitted medical literature. (b) Opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran's peripheral neuropathy, left lower extremity of the tibial nerve was caused or aggravated (beyond its natural progression) by his service-connected coronary artery disease. Please note: the examiner must address both causation and aggravation in the requested opinion. The examiner must also address the October 2021 submitted medical literature. (c) Any opinion should include a detailed rationale. The examiner should consider the entire claims file, and discuss the Veteran's lay statements regarding the nature, onset, and chronicity of symptoms. The examiner is advised that the Veteran is competent to report symptoms, and that his reports must be considered in formulating the requested opinion. (d) If the examiner is unable to offer the requested opinion, it is essential that the examiner offer a rational for the conclusion that an opinion could not be provided without resorting to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 3. The RO must review the medical opinions obtain and ensure the responses comply with the above remand directive. If any opinion is deficient, undertake corrective action prior to returning the case to the Board. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Carter, 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.