Citation Nr: 21014437 Decision Date: 03/12/21 Archive Date: 03/12/21 DOCKET NO. 16-13 060 DATE: March 12, 2021 REMANDED Entitlement to service connection for left lower extremity, peripheral neuropathy, to include as due to herbicide exposure or as secondary to the service-connected ischemic heart disease (IHD) or left knee disability is remanded. Entitlement to service connection for right lower extremity, peripheral neuropathy, to include as due to herbicide exposure or as secondary to the service-connected ischemic heart disease (IHD) or left knee disability is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1969 to March 1971. These matters come before the Board of Veterans’ Appeals (Board) from an April 2013 rating decision of the Department of Veterans Affairs (VA), Regional Office (RO). The Board remanded the claim for further development in March 2019. 1. Entitlement to service connection for left lower extremity, peripheral neuropathy, to include as due to herbicide exposure or as secondary to the service-connected ischemic heart disease (IHD) or left knee disability is remanded. 2. Entitlement to service connection for right lower extremity, peripheral neuropathy, to include as due to herbicide exposure or as secondary to the service-connected ischemic heart disease (IHD) or left knee disability is remanded. In the March 2019 VA medical opinion, the examiner opined that the Veteran’s bilateral peripheral neuropathy is less likely than not incurred in or caused by the claimed in-service injury, event or illness; is less likely as not due to the Veteran’s service-connected coronary artery disease (CAD); or aggravated by the Veteran's service-connected ischemic heart disease. The examiner reasoned “his chronic condition in service was his left knee condition status post left medial meniscectomy. This does not cause a polyneuropathy. The Veteran developed a bilateral S1 radiculopathy with left lower extremity atrophy in 2007. An S1 radiculopathy is not caused by cardiac problems. This is due to a lumbar spine problem. It is very unlikely that the statin prescribed for his CAD in April 2007 caused left lower extremity atrophy. Statins cause muscle pain but acutely do not cause atrophy. This radiculopathy did not have its onset in service or within one year of exposure of AO.” However, the examiner did not address reports of an October 1970 service treatment note of “still has atrophy no effusion”; an April 1971 VA rating decision noting “quadriceps atrophy”; and March 1972 and September 1973 VA examinations noting “atrophy of left lower extremity.” Also, the examiner did not address the decreased leg measurements noted in the September 1973 and November 2007 VA examinations, and the July 2011 VA treatment note. Also, the examiner did not address the May 2012 impression of “the needle exam abnormalities are most likely due to the peroneal neuropathy and less likely due to an L5 radiculopathy due to the lack of involvement of proximal muscles which receive L5 input.” Finally, the examiner did not address the June 2007 private treatment record noting the Veteran’s report of symptoms in “lower left leg after heart attack in March 2007,” and the March 2012 private treatment record noting the physician’s report of “left leg atrophy while on Zocor. This medication was stopped, and his muscular problems have subsequently stabilized.” Therefore, the Board finds a remand is necessary to obtain an addendum opinion. The matters are REMANDED for the following action: Obtain an addendum opinion regarding the Veteran's bilateral peripheral neuropathy by an appropriate clinician to determine the nature and etiology of peripheral neuropathy of the lower extremities. The electronic claims file, to include this Board remand, must be reviewed by the examiner, and a note that it was reviewed should be included in the report. The examiner should answer the following questions: (a) Is it at least as likely as not (50 percent or greater probability) that the Veteran's peripheral neuropathy is etiologically related to his military service, to include in-service herbicide exposure? *The examiner should address: (1) the reports of atrophy in an October 1970 service treatment record; quadriceps atrophy in an April 1971 rating decision; atrophy of the left lower extremity in March 1972 and September 1973 VA examination reports, (2) the decreased leg measurements noted in the September 1973 VA examination report, November 2007 VA examination report, and July 2011 VA treatment record. (b) Is it at least as likely as not (50 percent probability or greater) that the Veteran's peripheral neuropathy was CAUSED or AGGRAVATED by his service-connected IHD or left knee disability? *The examiner should address: (1) the June 2007 treatment record noting the “Veteran noticed symptoms in lower left leg after heart attack in March 2007,” (2) the May 2012 treatment record noting “the needle exam abnormalities are most likely due to the peroneal neuropathy and less likely due to an L5 radiculopathy due to the lack of involvement of proximal muscles which receive L5 input.” (3) the March 2012 treatment record noting the physician’s report of “left leg atrophy while on Zocor. This medication was stopped, and his muscular problems have subsequently stabilized.” All opinions should be supported by a clear rationale, and a discussion of the facts and medical principles involved would be of considerable assistance. TANYA SMITH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Edwin B. Esmenda, 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.