Citation Nr: 21077177 Decision Date: 12/28/21 Archive Date: 12/28/21 DOCKET NO. 11-14 719 DATE: December 28, 2021 REMANDED Entitlement to service connection for sensory neuropathy of the right upper extremity, to include as secondary to service-connected lumbar disc disease is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1978 to March 1989. In an April 2017decision, the Board denied the claim. The Veteran subsequently appealed that decision to the United States Court of Appeals for Veterans Claims (Court). In September 2018, the Court issued a Memorandum Decision vacating the Board's decision and remanding the Veteran's appeal to the Board. This claim was most recently before the Board in June 2019. Entitlement to service connection for sensory neuropathy of the right upper extremity, to include as secondary to service-connected lumbar disc disease is remanded. The claim must be remanded again because the September 2021 VA opinion obtained on remand is inadequate. Stegall v. West, 11 Vet. App. 268 (1998). The September 2021 examiner considered only objective evidence of radiculopathy and not the Veteran's subjective complaints he experienced with his sensory neuropathy of his right arm. Additionally, the examiner also appeared to focus the opinion on the Veteran's current complaints, stating that his symptoms were relieved after an ulnar release. despite the appeal period beginning in February 2009. Since the September 2021 VA examination was inadequate, a new examination is warranted. The opinion on remand should also consider the Veteran's report that a private physician told him that his right upper extremity symptoms may be caused by the laminectomy he underwent for his service-connected back disability, as a result of spinal adjustments the body naturally makes after the area stabilized after the procedure becomes immobile. The matters are REMANDED for the following action: 1. Forward the copies of all pertinent records to an appropriate VA examiner to obtain a medical opinion for the Veteran's right upper extremity sensory neuropathy claim. If the examiner determines that an opinion cannot be provided without an examination, one should be scheduled. After reviewing the record, the examiner is asked to answer the following questions: (a) Is it at least as likely as not (50 percent probability) that any currently diagnosed right upper extremity sensory neuropathy was incurred in or is otherwise related to service? In answering this question, the examiner should review and discuss the Veteran's service treatment records from (i) November 1980 documenting that the Veteran complained of right forearm and shoulder pain after lifting a heavy object, and; (ii) October 1988 complaints of right-hand throbbing. (b) If (a) is answered no, is it at least as likely as not (probability of at least 50 percent) that any currently diagnosed right upper extremity sensory neuropathy is proximately due to (caused by) the Veteran's service-connected lumbar spine disability? (c) If (b) is answered no, is it at least as likely as not (probability of at least 50 percent) that any currently diagnosed right upper extremity sensory neuropathy has been aggravated by the Veteran's service OR service-connected lumbar spine disability? Aggravation here is defined as any increase in disability. For sections (b) and (c), the examiner is asked to review and discuss (i) the Veteran's right sided weakness and numbness following the February 2008 surgery for his lumbar spine disability (records received February 4, 2010 and also January 19, 2010); (ii) right sided ulnar nerve decompression surgery in February 2009 (record received October 19, 2009), and; (iii) the Veteran's report that a physician told him the right upper extremity symptoms may be caused by the laminectomy he underwent for his back disability, as a result of spinal adjustments the body naturally makes after the area stabilized after the procedure becomes immobile. A complete rationale must be provided for all opinions, citing to supporting factual data and medical literature, as appropriate. If the examiner cannot provide an opinion without resort to speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training) and note what, if any, additional evidence would permit such an opinion to be made. 2. Confirm that the VA medical opinion provided comports 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 M. G. Perkins, 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.