Citation Nr: 21076852 Decision Date: 12/28/21 Archive Date: 12/28/21 DOCKET NO. 14-11 876 DATE: December 28, 2021 REMANDED Entitlement to service connection for left lower extremity peripheral neuropathy to include as secondary to service-connected coronary artery disease and/or due to herbicide exposure is remanded. Entitlement to service connection for right lower extremity peripheral neuropathy to include as secondary to service-connected coronary artery disease and/or due to herbicide exposure is remanded. Entitlement to service connection for bilateral upper extremity peripheral neuropathy (initially claimed as familiar tremor and claimed as a seizure disorder) to include as secondary to service-connected coronary artery disease and/or due to herbicide exposure is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1966 to February 1969. In March 2017, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. This case has been before the Board multiple times. In a September 2020 decision, the Board denied entitlement to service connection for bilateral lower extremity peripheral neuropathy and remanded the issues of service connection for bilateral upper extremity peripheral neuropathy, hypertension, and erectile dysfunction for additional development. The Veteran appealed the denial regarding service connection for bilateral lower extremity peripheral neuropathy to the United States Court of Appeals for Veterans Claims (Court). In an April 2021 order, the Court granted a Joint Motion for Partial Remand (JMPR), vacating only that portion of the September 2020 decision that denied entitlement to service connection for bilateral lower extremity peripheral neuropathy. In an August 2021 decision, the Board granted the issues of service connection for hypertension and erectile dysfunction and remanded the issues of service connection for bilateral upper and lower extremity peripheral neuropathies. Unfortunately, there has not been substantial compliance with the Board's remand directives and another remand is required. Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to service connection for left lower extremity peripheral neuropathy to include as secondary to service-connected coronary artery disease and/or due to herbicide exposure is remanded. Entitlement to service connection for right lower extremity peripheral neuropathy to include as secondary to service-connected coronary artery disease and/or due to herbicide exposure is remanded. Entitlement to service connection for bilateral upper extremity peripheral neuropathy (initially claimed as familiar tremor and claimed as a seizure disorder) to include as secondary to service-connected coronary artery disease and/or due to herbicide exposure is remanded. The claim must be remanded because the October 2021 VA opinion obtained on remand is inadequate. The examiner provided a negative opinion on direct service connection but the rationale was limited to the criteria for presumptive service connection. The examiner did not address whether the diagnosed neuropathies are directly related to the Veteran's conceded exposure to herbicides. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). The October 2021 opinion is also inadequate as to the aggravation prong of secondary service connection. The examiner considered the wrong standard for determining aggravation. The examiner used "beyond natural progression," rather than the correct "any increase" in disability. 38C.F.R. §3.310 (b); Allen v. Brown, 7 Vet. App. 439 (1995). The rationale for the possible effect of medications for the service-connected heart disease was cursory. The basis for the negative opinion was that peripheral neuropathy is not listed as a side-effect of the relevant medications. However, the examiner did not explain why the fact that a specific side effect is not listed means that the claimed side effect is precluded. As such, an addendum opinion must be obtained on remand. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate VA provider to determine the nature and etiology of the Veteran's bilateral upper and lower extremity peripheral neuropathies. Copies of all pertinent records, including this remand, must be made available to the examiner for review. Based on the review of the record (and examination if needed), the examiner should answer the following: (a.) Is it at least as likely as not that the Veteran's diagnosed bilateral upper extremity and bilateral lower extremity neuropathies are related to an in-service injury, event, or disease, to include his conceded exposure to herbicides? The fact that the neuropathies were not diagnosed within one year of service cannot be the basis of a negative opinion. (b.) Is it at least as likely as not that the Veteran's bilateral upper extremity and bilateral lower extremity peripheral neuropathy is (i) caused by or (ii) aggravated by (defined as any increase in disability) his service-connected coronary artery disease, to include the medication used to treat coronary artery disease? Why or why not? The examiner must explain the rationale for all opinions in detail, citing to supporting clinical data and/or medical literature, as appropriate. If an opinion cannot be provided, the examiner should indicate why. 2. Confirm that the VA medical opinions provided comport with this remand, specifically that the standard for the secondary aggravation opinion is any increase in disability, not the standard of beyond the natural progression as noted on the examination form itself. If not, get an addendum. M.E. Larkin Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. E. Bresler 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.