Citation Nr: 21016097 Decision Date: 03/19/21 Archive Date: 03/19/21 DOCKET NO. 20-18 877 DATE: March 19, 2021 REMANDED Entitlement to service connection for peripheral polyneuropathy of the right lower extremity is remanded. Entitlement to service connection for peripheral polyneuropathy of the left lower extremity is remanded. Entitlement to service connection for a loss of balance condition is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1966 to February 1986. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a July 2018 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In January 2021, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge; a transcript of the hearing has been associated with the record. In May 2020, the Veteran’s representative appears to indicate that the Veteran is seeking increased ratings for his service-connected radiculopathy of the right and left lower extremities. The representative states “[i]t simply has gotten worse.” Given the representative’s statement, this matter is referred to the RO for any clarification or action deemed appropriate. Entitlement to service connection for peripheral polyneuropathy of the right lower extremity. Entitlement to service connection for peripheral polyneuropathy of the left lower extremity. The Veteran contends that he is entitled to service connection for peripheral polyneuropathy of the bilateral lower extremities on a direct basis or as secondary to his service-connected intervertebral disc syndrome (IVDS). In June 2018, the Veteran was afforded a VA examination and was diagnosed with bilateral peripheral polyneuropathy. The examiner provided a negative nexus opinion and noted that the Veteran has a significant lumbar spine condition, as well as peripheral polyneuropathy causing significant denervation of muscles below the knee. He noted that this is a complicated peripheral nerve condition with symptoms both related to his lumbar spine pathology and a peripheral polyneuropathy. However, the examiner found that the medical evidence does not point to the lumbar pathology as the cause of the peripheral polyneuropathy. Once the VA undertakes providing a veteran with an examination, it has a duty to ensure it is adequate. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). In secondary service connection claims, a medical opinion is inadequate if it does not address both causation and aggravation of the nonservice-connected condition. El-Amin v. Shinseki, 26 Vet. App. 136, 138 (2013). Although the June 2018 VA examiner addressed secondary service connection, he did not adequately consider the relationship, or lack thereof, regarding aggravation between the Veteran’s service-connected lumbar spine disability (IVDS) and his bilateral peripheral polyneuropathy. Additionally, as the VA examiner only addressed secondary service connection, a remand is necessary to obtain an addendum opinion to fully address service connection on a direct basis as a result of his back injury and numerous hours of flying an aircraft in service.  Entitlement to service connection for a loss of balance condition. The June 2018 VA examiner determined that the Veteran’s balance loss is likely secondary to his peripheral polyneuropathy. The examiner noted that the Veteran’s moderate to severe peripheral polyneuropathy is causing significant denervation of the muscles below the knees, as well as axonal loss on the nerve conduction studies, that is likely causing the Veteran’s decreased balance and leg weakness. As development on the service connection claims being remanded could impact the loss of balance condition claim, the claims are inextricably intertwined. Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). Accordingly, the claim for service connection for a loss of balance condition must also be remanded. Finally, as the Veteran receives ongoing treatment for his polyneuropathy, specifically private treatment from Dr. C.A.S., outstanding treatment records should be obtained on remand. The matters are REMANDED for the following action: 1. Obtain and associate with the claims file all outstanding VA and private treatment records. 2. After completion of the above development, obtain a medical opinion from a neurologist or other appropriate medical professional regarding the nature and etiology of the Veteran’s peripheral polyneuropathy of the bilateral lower extremities. After reviewing the entire claims file, to include a copy of this remand, the examiner should opine as to: (a) Whether the Veteran’s peripheral polyneuropathy of the bilateral lower extremities at least as likely as not (i.e., 50 percent or greater probability) had its onset in or is otherwise related to the Veteran’s active service, to include his in-service back injury and/or numerous hours flying aircrafts. (b) Whether it is at least as likely as not (i.e., 50 percent or greater probability) that the Veteran’s peripheral polyneuropathy of the bilateral lower extremities is caused by his service-connected disabilities, to include IVDS. (c) Whether it is at least as likely as not (i.e., 50 percent or greater probability) that the Veteran’s peripheral polyneuropathy of the bilateral lower extremities was aggravated by his service-connected disabilities, to include IVDS. A complete rationale must be provided for all opinions expressed. The rationale must consider and discuss the pertinent evidence of record, to include the Veteran’s lay statements. C. CRAWFORD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. B. Smith, 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.