Citation Nr: 21015465 Decision Date: 03/17/21 Archive Date: 03/17/21 DOCKET NO. 14-43 458 DATE: March 17, 2021 REMANDED Entitlement to service connection for peripheral neuropathy, left lower extremity, to include as secondary to service-connected central nervous system (CNS) disorder manifested by nystagmus or due to exposure to herbicide agents is remanded. Entitlement to service connection for peripheral neuropathy, right lower extremity to include as secondary to service-connected CNS disorder manifested by nystagmus or due to exposure to herbicide agents is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from June 1966 to July 1970. At a September 2015 videoconference hearing, the Veteran testified before the undersigned Veterans Law Judge. A transcript of the proceeding has been associated with the claims file. These matters were previously before the Board in February 2017 and August 2019. In August 2019 the Board issued a decision which denied the claims. The Veteran appealed to the Court of Appeals for Veterans Claims (Court). The parties to the appeal entered a Joint Motion for Remand (JMR) and in September 2020, the Court issued an Order granting the motion. The August 2019 Board decision was vacated and remanded for action in accordance with the JMR. The JMR found the Board erred when it did not ensure that VA complied with its duty to assist under the requirement of 38 U.S.C. §§ 5103A and 38 C.F.R. § 3.159(c) to provide an adequate medical opinion regarding whether the Veteran’s bilateral peripheral neuropathy was aggravated by his service-connected CNS disability. The JMR notes that in May 2017 the Veteran received a VA peripheral nerves examination where the examiner opined that the Veteran’s peripheral neuropathy was not aggravated by his CNS disorder because it is a separate condition from peripheral neuropathy. In this examination, the examiner stated, “I cannot find any objective evidence to support that they are related and that one is affecting the other.” The JMR found that the May 2017 examiner did not explain why the CNS disability could not affect the Veteran’s peripheral neuropathy, other than simply stating that the disabilities are separate conditions. The JMR further notes the parties agree that the May 2017 VA opinion is inadequate, and remand is warranted to obtain an adequate VA opinion that provides sufficient rationale regarding whether the Veteran’s bilateral lower extremity peripheral neuropathy was aggravated by his service-connected CNS disability. See El-Amin v. Shinseki, 26 Vet. App. 136, 141 (2013) (an adequate medical opinion must “expressly opine []” whether a service-connected condition aggravated the non-service-connected condition at issue). The Board notes in February 2021, the Veteran’s private physician submitted a private opinion stating, “Patient has both central nerve disorder causing tremor and nystagmus as well as peripheral neuropathy demonstrated by abnormal nerve conduction studies. The central nerve disorder can exacerbate the peripheral disorder, that is, make it worse.” The Board notes this physician did not state the central nerve disorder actually exacerbated the peripheral disorder, only that it could. Likewise, he did not provide a rationale for this opinion. In these circumstances, the matters are remanded in order to obtain an opinion that provides sufficient rationale regarding whether the Veteran’s bilateral lower extremity peripheral neuropathy was aggravated by his service-connected CNS disability as instructed by the JMR. The matters are REMANDED for the following action: 1. Provide the claims file to an appropriate clinician for review, and an opinion that addresses whether it is at least as likely as not the Veteran’s bilateral lower extremity peripheral neuropathy has been aggravated (i.e., permanently worsened beyond natural progression) by his service-connected CNS disorder. If aggravation is found, the examiner should quantify the degree of such aggravation, if possible. As required by the terms of the JMR, the reviewer is asked to explain the reasons behind any opinions expressed and conclusions reached. If it is necessary to examine the Veteran to obtain the requested opinion, that should be arranged. 2. After completing the requested actions and any additional development deemed warranted, readjudicate the claim in light of all pertinent evidence and legal authority. MICHAEL E. KILCOYNE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Johnson, 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.