Citation Nr: 21075153 Decision Date: 12/17/21 Archive Date: 12/17/21 DOCKET NO. 17-00 674 DATE: December 17, 2021 REMANDED Entitlement to service connection for right lower neuropathy, to include as due to herbicide exposure is remanded. Entitlement to service connection for left lower neuropathy, to include as due to herbicide exposure is remanded. Entitlement to service connection for right upper neuropathy, to include as due to herbicide exposure is remanded. Entitlement to service connection for left upper neuropathy, to include as due to herbicide exposure is remanded. REASONS FOR REMAND The Veteran service on active duty in the Army from May 1968 to May 1970. This case comes before the Board of Veterans' Appeals (Board) on appeal from a May 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Cleveland, Ohio. In August 2019, the Board remanded the Veteran's claims for additional development. The Board notes that there was substantial compliance with its August 2019 remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998); D'Aries v. Peake, 22 Vet. App. 97, 105 (2008). Regrettably, the Board finds that another remand is necessary prior to readjudication of the claims. The Veteran contends that his bilateral upper and lower extremity neuropathy is directly related to his active duty service, to include as due to herbicide exposure. As an initial matter, the Board notes that the VA has conceded to the Veteran's herbicide exposure due to his service in Vietnam during the applicable period. See SSOC, June 2020; see also VA Memo, August 2021. However, consideration of the Veteran's claims under a presumptive basis as due to exposure to herbicide exposure is not warranted, as the record reflects the Veteran's neuropathy was first diagnosed, at the earliest, in March 2005, which is not within a year after the last date of which the Veteran was exposed to the herbicide agent during active duty. See 38 C.F.R. § 3.307(a)(6)(ii). Nevertheless, consideration on a direct basis is still warranted. In January 2020, the Veteran was afforded a VA examination and medical opinion to assess the current nature and etiology of his claimed conditions. Upon examination, the examiner diagnosed the Veteran with inclusion body myositis, however, provided an unfavorable opinion as to this condition being etiologically related to the Veteran's active service, to include his exposure to herbicides. Nevertheless, the Board finds this medical opinion to be inadequate, as the examiner improperly relied on the lack of medical evidence in-service corroborating complaints, treatment, or a diagnosis of neuropathy. Additionally, the examiner partially based the rationale on inaccurate medical information by stating the Veteran's medical records report muscle weakness beginning in 2011. A review of the medical evidence reveals several notations of the Veteran's muscle weakness beginning in 2005, with the Veteran specifically reporting that he started noticing his muscle weakness in 2005 when he was dropping things and sometimes falling, which later accelerated to severe weakness in the arms and legs in early 2006. Therefore, based on the above, the Board finds that an addendum VA medical opinion is needed that adequately addresses the Veteran's claims on a direct basis, with consideration/discussion of the Veteran's accurate medical history. Accordingly, a remand is necessary to address the matter discussed above. 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 bilateral upper and lower extremity neuropathy 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 January 2020 VA examiner, to provide addendum VA medical opinions to determine the nature and etiology of the Veteran's bilateral upper and lower extremity neuropathy. If the January 2020 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 for the Veteran's bilateral upper and lower extremity neuropathy 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 bilateral upper and lower extremity neuropathy had its onset during any period of active duty, or is otherwise etiologically related to his active duty service, to include his conceded exposure to herbicides. (b) 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. (c) 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. Zi-Heng Zhu Acting 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.