Citation Nr: 21015089 Decision Date: 03/16/21 Archive Date: 03/16/21 DOCKET NO. 16-15 807 DATE: March 16, 2021 REMANDED Entitlement to service connection for numbness of the bilateral upper extremities, to include Raynaud's syndrome, to include as due to herbicide agent exposure, is remanded. REASONS FOR REMAND The Veteran served honorably on active duty from April 1969 to December 1972, to include service in the Republic of Vietnam. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2015 rating decision of a Regional Office (RO) of the Department of Veterans Affairs (VA). By way of history, the Board denied the Veteran’s claim for service connection for numbness of the bilateral upper extremities in a September 2019 decision. The Veteran subsequently appealed the Board’s September 2019 denial to the United States Court of Appeals for Veterans Claims (Court). In October 2020, the Veteran and VA filed a Joint Motion for Partial Remand (JMPR), in which both parties requested that the Court vacate and remand the Board’s September 2019 denial of the Veteran’s service connection claim. The Court granted the JMPR in October 2020. The claim has now been returned to the Board. Entitlement to service connection for numbness of the bilateral upper extremities, to include Raynaud's syndrome, to include as due to herbicide agent exposure is remanded. The Veteran contends that he has a current bilateral upper extremity disability of numbness due to his military service, to include as due to exposure to herbicide agents during his tour in Vietnam. The October 2020 JMPR found that the Board erred when it failed to address whether service connection is warranted for Raynaud’s syndrome, to include as secondary to the Veteran’s service-connected ischemic heart disease. Specifically, the JMPR found that a VA treatment record indicated that the Veteran’s hands and fingers were blue in color, cold to the touch, and slightly numb on occasion. See e.g., April 9, 2015 VA addendum treatment note. The JMPR also noted that following this visit to the VA, the Veteran’s VA treatment provider diagnosed him with Raynaud’s syndrome (also listed as Raynaud’s phenomenon in the VA treatment records), and indicated that it was “likely due to metoprolol” which the Veteran is prescribed for his service-connected coronary artery disease. The JMPR found that numbness of the fingers is a known side effect for this type of medication, as well as a symptom of Raynaud’s syndrome. Further, the JMPR found that while the Board acknowledged in the September 2019 decision that the Veteran had a history of Raynaud’s phenomenon, the Board failed to discuss whether the Veteran was entitled to service connection for Raynaud’s syndrome, to include as secondary to his service-connected ischemic heart disease. As such, a VA examination and medical opinion should be obtained that clarifies the nature of the Veteran’s numbness of the bilateral upper extremities, and determines the etiology of such disability, to include whether it is due to his in-service exposure to herbicide agents, or related to another service-connected disability. Additionally, there are likely outstanding VA treatment records, as indicated by the JMPR, and as the most recent VA medical records in the claims file are dated March 2020. Therefore, all outstanding VA treatment records should be obtained on remand. The matter is REMANDED for the following action: 1. Request all outstanding VA treatment records from March 2020 to the present. 2. Then, schedule the Veteran for a VA examination for his claimed numbness of the bilateral upper extremities, to include Raynaud’s syndrome. Following a review of the claims file, the examiner is requested to provide an opinion as to the following: (a.) Whether it is at least as likely as not that the Veteran’s numbness of the bilateral upper extremities, including Raynaud’s syndrome, is caused by or related to his active military service, to include as a result of his exposure to herbicide agents therein. (b.) Whether it is at least as likely as not that the Veteran’s numbness of the bilateral upper extremities, including Raynaud’s syndrome, is (i) caused by or (ii) aggravated by his service-connected ischemic heart disease. Specific attention is invited to the VA treatment record discussing the Veteran’s Raynaud syndrome phenomenon as a side effect of a medication he currently takes for his service-connected ischemic heart disease. See VBMS, document labeled CAPRI, receipt date 7/10/2015, pages 28-29 of 369. Note that aggravation means any incremental increase in disability in non-service-connected disabilities (i.e., any additional impairment of earning capacity) resulting from service-connected conditions. The examiner is asked to provide the underlying reasons for all opinions expressed, and is reminded that the term "as likely as not" does not mean "within the realm of medical possibility," but rather that the evidence of record is so evenly divided that, in the examiner's expert opinion, it is as medically sound to find in favor of the proposition as against it. It should be noted that the Veteran is competent to attest to factual matters of which he has first-hand knowledge, including 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. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Because it is important “that each disability be viewed in relation to its history [,]” (38 C.F.R. § 4.1), copies of all pertinent records in the Veteran’s claims file, or in the alternative, the claims file, must be made available to the examiner for review. 3. HE AOJ MUST REVIEW THE CLAIMS FILE AND ENSURE THAT THE FOREGOING DEVELOPMENT ACTION HAS BEEN COMPLETED IN FULL. IF ANY DEVELOPMENT IS INCOMPLETE, APPROPRIATE CORRECTIVE ACTION MUST BE IMPLEMENTED. IF ANY REPORT DOES NOT INCLUDE ADEQUATE RESPONSES TO THE SPECIFIC OPINIONS REQUESTED, IT MUST BE RETURNED TO THE PROVIDING EXAMINER FOR CORRECTIVE ACTION. T. Berry Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. M. Lowman, 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.