Citation Nr: 21014331 Decision Date: 03/11/21 Archive Date: 03/11/21 DOCKET NO. 15-32 230 DATE: March 11, 2021 REMANDED Entitlement to service connection for a respiratory disorder, including sarcoidosis, to include as due to exposure to herbicides, is remanded. Entitlement to service connection for peripheral neuropathy of the lower extremities, to include as due to exposure to herbicides, is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1969 to February 1971. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Boston, Massachusetts. The Veteran testified at a hearing before the undersigned Veterans Law Judge (VLJ) in October 2018. A transcript is of record. This matter was previously remanded by the Board in April 2019 for further development. 1. Entitlement to service connection for a respiratory disorder, including sarcoidosis, to include as due to exposure to herbicides, is remanded. 2. Entitlement to service connection for peripheral neuropathy of the lower extremities, to include as due to exposure to herbicides, is remanded. Additional development is necessary with regard to the Veteran's claims. Although the Board sincerely regrets the delay, it is necessary to ensure that there is a complete record upon which to decide his claims so that he is afforded every possible consideration. The Veteran contends that he developed a respiratory disorder, in particular sarcoidosis, as a result of being exposed to herbicides during active service. See October 2018 Hearing Transcript. He is conceded to have been exposed to herbicides during his active service in Vietnam. The Veteran was afforded a VA examination for respiratory conditions in November 2019, wherein the examiner concluded that the Veteran’s sarcoidosis was not incurred in service, partly relying on the fact that the illness is not considered a presumptive disease related to herbicide exposure by the VA. However, while sarcoidosis is not among the diseases listed as presumptively due to herbicide exposure under 38 C.F.R. § 3.309(e), this does not obviate the need to determine whether a direct relationship exists. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). Accordingly, a new medical opinion is warranted. The Veteran also contends that he developed peripheral neuropathy of the lower extremities as a result of being exposed to herbicides during active service. See October 2018 Hearing Transcript. He was afforded a VA examination for peripheral nerve conditions in November 2019, wherein the examiner concluded that the Veteran’s peripheral neuropathy of the lower extremities was not incurred in service, as “his symptoms began about 19-20 years after he was exposed to herbicides” and “he could have had other environmental exposure or other illness during the 19-20 years after his herbicide exposure in Vietnam.” As the basis for the examiner’s opinion is speculative, i.e., that the Veteran “could have had” other environmental exposure or other illness after service that caused his peripheral neuropathy, the opinion is inadequate. Therefore, the case must be remanded for an additional medical opinion. The matters are REMANDED for the following action: 1. Obtain the Veteran’s updated VA treatment records. 2. Obtain an addendum medical opinion from an appropriate examiner to determine whether the Veteran’s sarcoidosis is related to service, to include conceded Agent Orange exposure. The entire claims file, to include a copy of this REMAND, must be reviewed by the examiner in conjunction with the examination. The examiner should confirm in the examination report that he or she has reviewed the folder in conjunction with the examination. The examiner is requested to address whether it is at least as likely as not (50 percent probability or greater) that the Veteran's sarcoidosis, had its onset during service or is related to any incident of service, to include his conceded exposure to herbicides. If the examiner concludes that the Veteran's sarcoidosis is not etiologically related to his in-service exposure to Agent Orange, that conclusion may not be based solely on the fact that sarcoidosis is not considered a presumptive disease related to herbicide exposure by the VA. In other words, the examiner should determine in this specific case, whether the Veteran's sarcoidosis is related to his Agent Orange exposure, regardless of the fact that it is not considered a presumptive disease related to herbicide exposure by the VA. The examiner must take into account the Veteran's personal circumstances and how the recognized risk factor(s) apply in his particular case. Other factors may affect the analysis, such as whether the examiner finds studies persuasive, whether there are other risk factors that might be the cause of the Veteran's sarcoidosis, whether his sarcoidosis manifested itself in an unusual manner, etc. The examiner must provide a complete rationale for all opinions provided. If the examiner is unable to provide any opinion as requested, the examiner should fully explain the reason why such opinion could not be rendered. 3. Obtain an addendum medical opinion from an appropriate examiner to determine whether the Veteran’s peripheral neuropathy of the lower extremities is related to service, to include conceded Agent Orange exposure. The entire claims file, to include a copy of this REMAND, must be reviewed by the examiner in conjunction with the examination. The examiner should confirm in the examination report that he or she has reviewed the folder in conjunction with the examination. The examiner is requested to address whether it is at least as likely as not (50 percent probability or greater) that the Veteran's peripheral neuropathy of the lower extremities had its onset during service or is related to any incident of service, to include his conceded exposure to herbicides. If the examiner determines that the Veteran's peripheral neuropathy of the lower extremities is less likely than not due to his in-service exposure to herbicides, he or she should specifically discuss what other factors caused the disorder(s). (Continued on the next page)   The examiner must provide a complete rationale for all opinions provided. If the examiner is unable to provide any opinion as requested, the examiner should fully explain the reason why such opinion could not be rendered. P.M. DILORENZO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Mohammad 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.