Citation Nr: 21014243 Decision Date: 03/11/21 Archive Date: 03/11/21 DOCKET NO. 15-04 935 DATE: March 11, 2021 REMANDED Service connection for neuropathy of the right and left upper extremities is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from January 1990 to July 1990. Historically, this appeal was denied by the Board in September 2019. Upon receipt of a Joint Motion for Partial Remand (JMPR), the Court of Appeals for Veterans Claims (Court) vacated this determination and remanded the matter for further development in August 2020. This appeal has since been returned to the Board for further review. Notably, the September 2019 Board decision also remanded claims seeking higher ratings for bilateral ankle disabilities and a total disability rating based on individual employability (TDIU). Development for these appeals is ongoing, such that they will be addressed in a subsequent Board decision, should such action be required. See, e.g., January 2021 correspondence (indicating that the requested VA examinations were on hold due to the Veteran’s concerns regarding COVID-19). Turning to the instant matter, remand of the claim is warranted. As noted by the parties in their JMPR, a June 2014 VA nexus opinion is inadequate for several reasons, to include the examiner’s failure to fully address a secondary theory of entitlement or provide a supporting rationale. Further, the VA opinion was provided prior to VA’s receipt of certain relevant medical records. Briefly, the Board acknowledges that a January 2020 VA examination was associated with the claims file following the Court’s vacatur. However, this examination does not cure the deficiencies reported by the parties in their JMPR, as a nexus opinion was not provided at that time. The matter is REMANDED for the following action: Obtain an addendum opinion addressing the questions below.  If the reviewing examiner determines that the opinion requested may not be offered without first examining the Veteran, then consider whether a telehealth interview may be appropriate.  Schedule an in-person examination only if deemed necessary to answer the questions below.     The claims file and a copy of this remand must be made available for review, and the examination report must reflect that review of the claims file occurred. In particular, the examiner must address the following: (1) Does the Veteran demonstrate a current nerve disability (including neuropathy) of the right and left upper extremities? (2) If so, is it at least as likely as not (50 percent probability or more) that the disabilities began during a period of active duty service, were caused by service, or are otherwise related to service? (3) Further, is it at least as likely as not (50 percent probability or more) that the disorder(s) were caused or aggravated by the Veteran’s service-connected back disabilities or the treatment thereof?  In providing the above opinions, the examiner must address: private treatment records from the Yale Community-Based Outpatient Clinic and received by VA in November 2015; and a January 2020 VA examination indicating that the Veteran’s symptoms began in the 1990s. In formulating the opinions, the examiners are advised that the term “at least as likely as not” does not mean “within the realm of possibility.”  Rather, it means that the weight of the medical evidence for and against the claim is so evenly divided that it is as medically sound to find in favor of the claim as it is to find against it.    Further, “aggravation” is defined as“[a]ny increase in severity . . . which is not due to the natural process of the non-service connected disease.” See JMPR. [CONTINUED ON NEXT PAGE] A complete rationale must be provided for all opinions or conclusions expressed.  It should be noted that the Veteran is competent to attest to observable symptomatology.  If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. Evan M. Deichert Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Kovarovic, 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.