Citation Nr: 21011885 Decision Date: 03/02/21 Archive Date: 03/02/21 DOCKET NO. 13-14 981 DATE: March 2, 2021 REMANDED Service connection for a neurological disorder. REASONS FOR REMAND The Veteran served on active duty from June 1972 to May 1976, including a period of inactive duty for training (INACDUTRA). He served in the Army National Guard from September 1979 to August 1988. The case is on appeal from a May 2011 rating decision. In May 2014, the Veteran testified at a Board hearing. The claim was last before the Board in March 2019. At that time, the Board remanded the claims of service connection for a low back disorder, a left knee disorder, a right knee disorder, a neurological disorder and a psychiatric disorder, for further development. When the case was in remand status, in a July 2020 rating decision, the RO granted service connection for lumbosacral strain, major depressive disorder, right knee arthritis and left knee arthritis. As the benefits sought for these four claims were granted in full, they are no longer before the Board. Service connection for a neurological disorder. The Veteran has contended that he has a neurological disorder (separate from now service-connected major depressive disorder (MDD)) due to service, including due to exposure to hazardous substances at Camp Lejeune. Additionally, he now contends that his diagnosed neurological disorder is secondary to, including aggravated, by his now service-connected disabilities, including MDD, lumbosacral strain, and bilateral knee arthritis. Evidence of record demonstrates that, in April 1977, the Veteran began experiencing problems with the lumbar spine, possibly demonstrating early sclerosis. He also had a nerve conduction study to rule out carpal tunnel syndrome (CTS) in October 2008. However, he began experiencing bilateral CTS at least as early as May 2010. Private medical records provide evidence of mononeuropathy of the median nerve consistent with moderate CTS in October 2011. Pursuant to the Board’s remand, the Veteran was afforded a January 2020 VA examination during which he reported a neurological condition with multisystem problems, including numbness and tingling in his extremities, speech changes, memory problems, and issues with balance and coordination. While there is no evidence of memory or speech problems in his records, during the January 2020 examination, the examiner noted he would sometimes forget a word and exhibit reduction in strength and in his light sensory exams with reduced sensation to his feet and lower legs, indicating he is developing diabetic neuropathy. An opinion has not yet been rendered addressing secondary service connection of the Veteran’s neurological disorder as a result of his service-connected disabilities, to include MDD, lumbosacral strain, and bilateral knee arthritis, which were not service connected at the time of that examination. Further, the January 2020 medical opinion provided that the Veteran’s neurological condition was “likely to have become aggravated due to his diabetes mellitus that he is service connected for.” As the Veteran is not service connected for diabetes mellitus, clarification is needed regarding this medical opinion. As such, the Board finds remand is warranted to provide the Veteran with an examination that properly considers the secondary service connection theories. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). In light of the remand, updated VA treatment records should be obtained. The matters are REMANDED for the following action: 1. Obtain any additional VA treatment records dated since December 2019. 2. Thereafter, schedule the Veteran for a VA examination (or telehealth interview, review of record, etc., if an in-person examination is not feasible) with an appropriate medical professional to determine the nature and etiology of the Veteran’s neurological condition. The entire claims file should be reviewed by the examiner. The examiner should first identify any current neurological condition that is separate and distinct from his MDD. The examiner should opine as to whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s neurological condition had its onset during, or is otherwise related to, service, to include exposure to Camp Lejeune contaminated water. The examiner should also opine as to whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s neurological condition was caused or aggravated by his service-connected disabilities, including MDD, lumbosacral strain, and bilateral knee arthritis. In doing so, the examiner should also clarify the January 2020 medical opinion as to the nexus between the Veteran’s neurological condition and diabetes mellitus. Aggravation is an increase in severity beyond the natural progress of the disease. A complete rationale should be provided for all opinions expressed. RYAN T. KESSEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Becton, 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.