Citation Nr: 21073131 Decision Date: 12/07/21 Archive Date: 12/07/21 DOCKET NO. 12-08 708 DATE: December 7, 2021 REMANDED Entitlement to a rating in excess of 10 percent for right ilioinguinal and genitofemoral nerve neuralgia, status post inguinal hernia laparoscopic operative repair, is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1974 to December 1977. In March 2013 a Board hearing was held before a Veterans Law Judge (VLJ)who has since retired. By September 2017 letter the Veteran was advised of his right to a hearing before a VLJ who would decide the matter; he responded, and declined a new hearing. This claim was most recently before the Board on appeal in March 2021 when it was remanded for additional development. There has not been substantial compliance with the Board's prior remand directives and the claim must be remanded again. Stegall v. West, 11 Vet. App. 268 (1998). Thereafter, in a September 2021 rating decision, the Veteran was granted service connection for right genitofemoral nerve neuralgia from October 22, 2009, and it was evaluated along with his right ilioinguinal neuralgia. Therefore, the claim has been recharacterized above. 1. Entitlement to a rating in excess of 10 percent for right ilioinguinal and genitofemoral nerve neuralgia, status post inguinal hernia laparoscopic operative repair, is remanded. In March 2021 the Board remanded the claim for another VA medical examination and opinion. The Board noted, in part, that the prior examiner did not state the severity of the condition of each nerve affected by incomplete paralysis, neuritis, or neuralgia, nor the historical degree of impairment since 2009 due to that nerve. The Veteran was afforded a VA medical examination and medical opinions were obtained in August 2021. The examiner found that current examination findings indicate diagnosis of right ilioinguinal and genitofemoral neuralgia. The examiner noted that symptoms of both neuropathies overlap to a point that it is too difficult to distinguish a difference between the two nerves without EMG studies. The examiner reported that as EMG of genitofemoral nerve have not been done and all clinical evidence suggests neuropathy of the genitofemoral nerve, it is more likely than not that the claimant has both ilioinguinal and genitofemoral neuralgias. The right ilioinguinal neuralgia is mild with incomplete paralysis of the ilioinguinal nerve. The right genitofemoral neuralgia is mild with incomplete paralysis of the genitofemoral nerve. Exam indicates that the impact of the condition is strictly sensory and does not impact function. In another opinion dated in August 2021, the examiner noted that it is more likely than not that the Veteran's ilioinguinal and genitofemoral neuralgias are a result of injury incurred from hernia surgery. The Board finds that the examination and opinions are not adequate. As the Veteran is in receipt of service-connected benefits for both nerves, evaluated together, there is not sufficient information to evaluate the disabilities due to the statement that an EMG study is necessary to distinguish between the two nerves and an EMG study was reported to not have been conducted. Therefore, the claim must be remanded for the Veteran to be afforded an adequate medical examination. See 38 C.F.R. § 3.159. Review of the claims file shows that the Veteran was treated by a non-VA orthopedic surgeon in 2012 and by Jacksonville Orthopedic Institute in June 2015. The claims file does not show treatment records from any private providers dated since April 2010. On remand, the Veteran must be asked to identify all relevant private providers and, after obtaining any necessary authorization, attempts must be made to obtain and associate with the claims file all identified private treatment records. Id. Finally, the Veteran receives consistent care from VA. The most recent VA treatment record associated with the claims file is dated in June 2021. On remand, attempts must be made to obtain and associate with the claims file updated VA treatment records regarding the Veteran. Id. The matters are REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for all private providers, including the orthopedic surgeon from 2012 and Jacksonville Orthopedic Institute dated in June 2015. Make two requests for the authorized records from all private providers, including the orthopedic surgeon from 2012 and Jacksonville Orthopedic Institute, unless it is clear after the first request that a second request would be futile. 2. Obtain the Veteran's complete VA treatment records for the period from June 2021 to the present. 3. Thereafter, schedule the Veteran for an examination (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) by an appropriate clinician to determine the current severity of his service-connected diabetes mellitus and lower extremity neuropathies. All necessary testing must be accomplished, to include an EMG, or it must be explained why the testing is not feasible or unnecessary. The examiner should provide a full description of the disabilities and report all signs and symptoms necessary for evaluating the Veteran's disabilities under the rating criteria, using the appropriate DBQ. The examiner must: a) Identify all nerves affected by complete or incomplete paralysis, neuritis, or neuralgia, including ilioinguinal and genitofemoral nerves. b) For each nerve affected by incomplete paralysis, neuritis, or neuralgia, including ilioinguinal and genitofemoral nerves, state the severity of that condition and explain the medical basis for the classification. The examiner must distinguish the symptoms between the ilioinguinal and genitofemoral nerves as possible or explain why it is not possible. Also explain what limitation of motion and other function, if any, is caused by the paralysis of each affected nerve. c) For each nerve found to be affected by complete or incomplete paralysis, neuritis, or neuralgia related to the Veteran's bilateral inguinal hernias, postoperative repair, including ilioinguinal and genitofemoral nerves, what is the historical degree of impairment since 2009 due to the nerves? The examination report must include a complete rationale with clear conclusions and supporting data for any opinion provided. If the provider cannot provide the requested opinion without resort to speculation, it must be so stated, and the examiner must provide the reasons why an opinion would require speculation. The provider should state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e., no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e., additional facts are required, or the examiner lacks the knowledge or training needed). L. BARSTOW Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Robert J. Burriesci, 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.