Citation Nr: 21007638 Decision Date: 02/10/21 Archive Date: 02/10/21 DOCKET NO. 15-35 079 DATE: February 10, 2021 REMANDED Service connection for a left lower extremity neurologic condition is remanded. Service connection for a right lower extremity neurologic condition is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1965 to May 1985. In February 2017, the Veteran provided testimony before the undersigned Veterans Law Judge (VLJ). A complete transcript is of record. This appeal was previously before the Board in September 2018 and in April 2020. The September 2018 Board decision found that presumptive service connection for neurologic impairment was not warranted because it did not manifest within the presumptive period for Agent Orange exposure. The issue was remanded for a VA examination that addressed whether the neurologic impairment was secondary to the Veteran’s service-connected insomnia or the service-connected low back disability. The Veteran was afforded a VA examination in October 2019 and the examiner provided nexus opinions regarding direct service connection and secondary service connection regarding his service-connected lumbar spine disability. The April 2020 Board decision found that there was substantial compliance with the September 2018 Board remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). However, a supplemental statement of the case (SSOC) was not issued, which required a remand. See Manlincon v. West, 12 Vet. App. 238, 240-41 (1999). The regional office (RO) issued a SSOC on August 19, 2020 regarding the service connection claim for a bilateral neurologic condition. As such, the Board finds that there has been substantial compliance with the April 2020 Board remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). VA received the Veteran’s Appellate Brief on January 11, 2021. The representative pointed out that the Veteran was diagnosed with lumbar spine arthritis, which was confirmed by the October 2019 VA examiner. The representative also pointed out that the VA treatment records show that the Veteran has an active diagnosis for radiculopathy. However, as explained by the October 2019 VA examiner, a clinical evaluation of the Veteran did not reveal radiculopathy of the lower extremities; rather he was diagnosed with idiopathic peripheral neuropathy of both lower extremities. The Board notes that the VA examiner is a board-certified neurologist. After an in-person examination and a review of the Veteran’s claims file, the examiner provided negative nexus opinions regarding both direct and secondary service connection. The representative asserts that service connection is warranted because the Veteran is being treated for radiculopathy and the Veteran has been found to have arthritis of the lumbar spine. However, the October 2019 VA examiner acknowledged that the Veteran had arthritis in the lumbar spine, but specifically reported that the Veteran did not have radiculopathy, and any neurologic condition was less likely than not related to his lumbar spine. As such, the Board affords the Veteran’s representative opinion that service connection is warranted on a secondary basis, little probative weight because they are not competent to provide such an opinion; whereas the VA examiner’s opinion is afforded great probative weight because they are competent to provide a medical opinion and provided a sufficient rationale to support their conclusion. However, the representative did raise the issue of whether the Veteran is entitled to service connection on a secondary basis, as due to his service-connected hypertension. The representative also cited to a medical journal article entitled, Hypertension-induced peripheral neuropathy and the combined effects of hypertension and diabetes on nerve structure and function in rats. See https://pubmed.ncbi.nlm.nih.gov/22791295/#:~:text=Rats%20with%20combined%20insulinopenia%2C%20hyperglycemia,the%20etiology%20of%20diabetic%20neuropathy. The Veteran was granted service connection for hypertension in the September 2018 Board decision. However, the October 2019 VA examiner did not provide a medical nexus opinion regarding whether the neurologic condition was secondary to hypertension. As such, a medical opinion is needed to address the theory of secondary service connection between the Veteran’s service-connected hypertension and his bilateral lower extremity neurologic condition. The matters are REMANDED for the following action: 1. Obtain a medical opinion to assess the etiology of the neurologic condition in the Veteran’s lower extremities. If a physical examination is necessary to answer the Board’s questions, one should be scheduled. The examiner should provide the following opinions: (a) Is it at least as likely as not (50 percent or greater) that the neurologic condition of the lower extremities was caused by his service-connected hypertension? Why or why not? (b) Is it at least as likely as not (50 percent or greater) that the neurologic condition of the lower extremities was aggravated (made worse) by his service-connected hypertension? Why or why not? If aggravation is found, the examiner should identify a baseline level of severity of the neurologic impairment by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the neurologic impairment. If such cannot be done, it should be explained why. In rendering these opinions, the examiner should address the medical literature cited to by the Veteran’s representative; Hypertension-induced peripheral neuropathy and the combined effects of hypertension and diabetes on nerve structure and function in rats. The medical journal article can be found at: https://pubmed.ncbi.nlm.nih.gov/22791295/#:~:text=Rats%20with%20combined%20insulinopenia%2C%20hyperglycemia,the%20etiology%20of%20diabetic%20neuropathy. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Fu, Associate 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.