Citation Nr: 21012865 Decision Date: 03/05/21 Archive Date: 03/05/21 DOCKET NO. 16-34 677 DATE: March 5, 2021 REMANDED Entitlement to service connection for neuropathy of the bilateral upper extremities is remanded. REASONS FOR REMAND The Veteran served on active duty with the United States Army from October 1967 to October 1970. In December 2018, the Veteran testified before the undersigned at a Board Central Office hearing. A transcript of that hearing is of record. The Veteran’s appeal was previously before the Board in September 2020 but was returned to the Agency of Original Jurisdiction (AOJ) for further development. Specifically, the AOJ was directed to obtain an addendum medical opinion regarding whether the Veteran’s neuropathy of the bilateral upper extremities was caused or aggravated beyond its natural progression by a service-connected disability. As discussed in detail below, the November 2019 VA addendum opinion is inadequate and cannot be used for evaluating the Veteran’s claim for service connection. There has not been substantial compliance with the remand instructions. See Stegall v. West, 11 Vet. App. 268, 271 (1998). 1. Entitlement to service connection for neuropathy of the bilateral upper extremities While the Board regrets additional delay, another remand is required to obtain an adequate medical opinion regarding whether the Veteran’s current neuropathy of the bilateral upper extremities was caused or aggravated beyond its natural progression by a service-connected disability. The Veteran’s appeal was previously before the Board and remanded for an addendum medical opinion in September 2020. The required opinion was obtained and associated with the claims file in November 2020. The November 2020 opinion was completed following a review of the Veteran’s claims file. The November 2020 opinion states that the Veteran’s neuropathy of the bilateral upper extremities was less likely than not proximately due to a service-connected disability. The examiner stated “unable to confirm a current chronic diagnosis of bilateral upper extremity neuropathy with current available records. Therefore, no nexus or plausible secondary relationship is established.” This rationale is directly refuted by a December 2019 Peripheral Nerves Conditions examination that diagnosed the Veteran with neuropathy of the bilateral upper extremities. At the December 2019 examination, the examiner noted that the Veteran experienced moderate, incomplete paralysis of the radial, median, and ulnar nerves. The Veteran has been diagnosed with a current disability during the appeal period. Therefore the November 2020 opinion is based on an inaccurate factual premise and is inadequate. Reonal v. Brown, 5 Vet. App. 458, 461 (1993). An additional VA addendum opinion regarding whether the Veteran’s current neuropathy of the bilateral upper extremities was caused or aggravated by a service-connected disability is required to comprehensively evaluate his claim for service connection. The matters are REMANDED for the following action: 1. Return the Veteran’s claims file to a different VA clinician so a supplemental opinion may be provided. The entire claims file and a copy of this remand must be made available to the examiner for review. A new examination is only required if deemed necessary by the examiner. The examiner must provide an opinion as to whether it is at least as likely as not (50 percent or greater probability): a. The Veteran’s current neuropathy of the bilateral upper extremities was caused by a service-connected disability. b. The Veteran’s current neuropathy of the bilateral upper extremities was aggravated by a service-connected disability. The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion (Continued on the next page)   2. After all completed development, the AOJ should then readjudicate the claim. If the benefits sought on appeal are not granted, the Veteran and his representative should be provided a Supplemental Statement of the Case and afforded the requisite opportunity to respond before the case is returned to the Board. D. Martz Ames Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Riordan, 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.