Citation Nr: 21010083 Decision Date: 02/24/21 Archive Date: 02/24/21 DOCKET NO. 18-30 179 DATE: February 24, 2021 ORDER Entitlement to service connection for bilateral lower extremity (BLE) peripheral neuropathy is granted. REMANDED Entitlement to service connection for BLE arthritis is remanded. FINDING OF FACT The Veteran’s BLE peripheral neuropathy is aggravated beyond its natural progression by his service-connected low back disability. CONCLUSION OF LAW The criteria to establish service connection for BLE peripheral neuropathy have been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January 1956 to December 1957. A Board hearing was held in January 2020. A transcript is of record. In March 2020, the Board remanded the Veteran’s claims of entitlement to service connection for bilateral hearing loss, vertigo, and a BLE disability to the Agency of Original Jurisdiction (AOJ) for further action consistent with the Board’s remand directives. Since, the AOJ granted service connection for bilateral hearing loss and vertigo. See December 2020 Rating Decision. As such, these issues have been granted in full and are no longer before the Board. However, the AOJ confirmed the prior denial of service connection for a BLE disability. See December 2020 Supplemental Statement of the Case (SSOC). Therefore, the issue of entitlement to service connection for a BLE disability is back before the Board for further appellate proceedings. Service Connection A Veteran is entitled to VA disability compensation if there is a disability resulting from personal injury suffered or disease contracted in the line of duty in active service, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty in active service. 38 U.S.C. § 1110. Generally, to establish a right to compensation for a present disability, a Veteran must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the so-called “nexus” requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that a disease was incurred in service. 38 C.F.R. § 3.303(d). Under section 3.310(a) of VA regulations, service connection may be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show: (1) a current disability; (2) a service-connected disability; and (3) a nexus between the current disability and the service-connected disability. See Wallin v. West, 11 Vet. App. 509, 512 (1988). As to the third Wallin element, the current disability may be either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). BLE Neuropathy The Veteran has a BLE disability, diagnosed as BLE peripheral neuropathy. See December 2020 VA examination report. He is also service connected for a lower back disability. See August 2020 Rating Decision. Accordingly, the first and second Wallin elements are met. A VA examiner opined that the Veteran’s BLE peripheral neuropathy was at least as likely as not aggravated beyond its natural progression by his service-connected low back disability. See December 2020 VA examination report. He reasoned that the Veteran already has pain, burning, and tingling in his BLE, and bulging discs can pinch nerves and cause worsening symptoms. Id. Thus, the December 2020 VA examiner’s opinion provided a link between the Veteran’s service-connected back disability and his BLE peripheral neuropathy. Accordingly, service connection for a BLE disability, diagnosed as BLE peripheral neuropathy, is granted.   REASONS FOR REMAND BLE Arthritis In March 2020, the Board remanded this case for an opinion to address the nature and etiology of the Veteran’s claimed BLE disability, to include arthritis. The record reflects that the Veteran does have a history of arthritis of the knee. See November 2005 VA treatment notes; see also September 2007 VA treatment notes. The December 2020 VA examination report only addressed the Veteran’s BLE neuropathy, not his arthritis claim. As discussed in the March 2020 Board remand, the Veteran contends that he has BLE arthritis that is secondary to his service-connected back disability. As the examiner did not properly follow the Board’s directives regarding an opinion for BLE arthritis, the Board finds that there has not been substantial compliance with the prior directives and remand is necessary in order to obtain a new opinion regarding the nature and etiology of the Veteran’s claimed BLE arthritis disability. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The matters are REMANDED for the following action: 1. Obtain any outstanding VA and/or private treatment records relevant to treatment the Veteran received for his BLE arthritis, to include arthritis of the knees, that are not already of record. All obtained records should be associated with the evidentiary record. If any identified records are not obtainable (or none exist), the Veteran and his representative should be notified, and the record clearly documented. 2. After the above development is completed, schedule the Veteran for an examination to determine the nature and etiology of any lower extremity arthritis disability. The evidentiary record, including a copy of this remand, must be made available to and reviewed by the examiner. The examination should include a notation that this record review took place. After the record review and examination of the Veteran, the examiner should identify all lower extremity disabilities present other than peripheral neuropathy, including any BLE arthritis diagnosis, including the knees. For each identified disability, the examiner is asked to respond to the following inquiry: (a.) Is it at least as likely as not that any diagnosed BLE arthritis, to include but not limited to BLE knee arthritis, was incurred in, or otherwise related, to the Veteran’s time on active service? (b.) Is it at least as likely as not that that any diagnosed BLE arthritis, to include but not limited to BLE knee arthritis was proximately caused OR aggravated by the Veteran’s service-connected back disability? The complete rationale for all opinions should be set forth and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an opinion cannot be provided without resorting to mere speculation, the examiner must provide a complete explanation for why an opinion cannot be rendered. In so doing, the examiner must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. 3. After the above has been completed to the extent possible, readjudicate the claims. If any benefit sought remains denied, provide the Veteran and his representative with a supplemental statement of the case (SSOC), and return the case to the Board. DONNIE R. HACHEY Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Katie Poe, 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.