Citation Nr: 21072956 Decision Date: 12/07/21 Archive Date: 12/07/21 DOCKET NO. 17-26 537 DATE: December 7, 2021 REMANDED Entitlement to service connection for a neurological disability of the right and left upper extremities is remanded. Entitlement to service connection for a neurological disability of the right and left lower extremities is remanded. REASONS FOR REMAND The Veteran served on active duty with the United States Navy from April 1965 to July 1968. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a hearing in October 2019. This case was previously before the Board in March 2020, when it was remanded for development. The case has been returned to the Board for further appellate review. 1. Entitlement to service connection for a neurological disability of the right and left upper extremities is remanded. 2. Entitlement to service connection for a neurological disability of the right and left lower extremities is remanded. The Veteran was afforded a VA examination in September 2020. The VA examiner diagnosed peripheral neuropathy of the right and left upper extremities, and opined that there was no objective evidence for a diagnosis of any neurological disability of the lower extremities. As for the upper extremities, the examiner opined that the peripheral neuropathy is less likely than not incurred in or caused by service, as there was insufficient evidence in the service treatment records to act as a nexus. The examiner further opined that the upper extremity peripheral neuropathy is more likely than not due to independent factors, but did not name any such factors or explain why they were a more likely cause than the Veteran's active duty service. Finally, the examiner opined that the upper extremity neuropathy had clear and specific etiology and therefore are less likely than not related to any exposures in service, noting that no significant exposures were documented in the service treatment records. This examination is inadequate for the purposes of deciding the Veteran's service connection claim for neurological disabilities of the right and left upper and lower extremities. The examiner appears to have impermissibly dismissed the Veteran's reports of neurological problems in all four extremities solely because these complaints were not documented in medical treatment records, regarding both the history of symptoms in the upper extremities and the reports of current symptoms in the lower extremities. See Dalton v. Nicholson, 21 Vet. App. 23, 39-40 (2007); see also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) (that reports of symptomatology are not supported by contemporaneous clinical evidence does not render them inherently not credible). Further, the examiner did not address the relationship, if any, of herbicide exposure to the Veteran's reported history of symptoms as early as 1969, within one year of separation from service and when the Veteran was only approximately 22 years old. For these reasons, the examination is inadequate and a remand is necessary to obtain a new opinion addressing all relevant evidence of record. The matters are REMANDED for the following action: Forward the claims file to an appropriate clinician to determine whether any current neurological disabilities affecting the Veteran's upper and lower bilateral extremities are related to his military service. If the examiner determines that an additional in-person examination is required, one should be scheduled. Please note, if the examiner deems it reasonable, an alternate format such as telehealth interview is acceptable. Following review of the claims file and, if indicated, examination of the Veteran, the examiner should identify all neurological disabilities of the extremities currently found, both at the time of the examination and within the pendency of this appeal, since approximately July 2015. The examiner should be advised the Veteran has consistently and credibly reported that he began experiencing numbness intermittently in his extremities within the year following separation from service, when he was approximately 22 years old, and has experienced these symptoms since that time. In providing the following requested opinions, the examiner must address these lay reports of symptomatology and must provide a reason if the examiner rejects these reports. The examiner may not reject these reports of symptoms solely on the basis that they are not recorded in contemporaneous treatment records. First, the examiner should opine whether any current neurological disability affecting the upper and/or lower extremities meets the criteria for a diagnosis of early onset peripheral neuropathy. Next, for each neurological disability identified other than early onset peripheral neuropathy, the examiner should opine whether it is at least as likely as not (50 percent or greater probability) that the disability began in or is otherwise caused by the Veteran's active service, to include conceded exposure to herbicides. All findings must be reported in detail and all opinions must be accompanied by a clear rationale. If any of the above issues cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided. M. HYLAND Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Josey, 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.