Citation Nr: 21023865 Decision Date: 04/21/21 Archive Date: 04/21/21 DOCKET NO. 16-00 964 DATE: April 21, 2021 REMANDED Entitlement to service connection for bilateral lower extremity peripheral neuropathy (BLEPN), on a substitution basis, is remanded. REASONS FOR REMAND The Veteran served in the Navy from September 1961 to January 1966 and from April 1966 to January 1970. He died in March 2020. His widow is the appellant and has been substituted as the claimant. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2015 rating decision of the Department of Veterans’ Affairs (VA) Regional Office (RO). In December 2018, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge (VLJ). A transcript of the hearing is associated with the record. In May 2019, the Board remanded the Veteran’s claim for further development. Specifically, the Veteran had contended that his BLEPN was secondary to diabetes mellitus. As the Board found it necessary to remand the Veteran’s claims for service connection for coronary artery disease (CAD) and diabetes mellitus type II, and the Board found his claim for service connection for BLEPN was inextricably intertwined with his claim for diabetes mellitus type II, the Veteran’s claim was remanded in tandem. The Veteran’s exposure to herbicides in Vietnam was conceded in an August 2020 VA Memo. In August 2020 the RO granted the Veteran’s pending claims for, among others, service connection for CAD and diabetes mellitus type II. Thus, entitlement to service connection for BLEPN is the remaining issue before the Board. The Board notes that the March 2021 appellate brief from the Veteran’s representative waived the Veteran’s right to have all new evidence reviewed by the Agency of Original Jurisdiction (AOJ). Entitlement to service connection for BLEPN, on a substitution basis, is remanded. The appellant contends the Veteran’s BLEPN was secondary to diabetes mellitus type II, for which he is service connected. Additionally, in October 2007 the Veteran submitted a statement linking his BLEPN to medication he had been prescribed for CAD, a condition for which he is also service connected. During private physical exams in February 2007 and December 2008, examinations of the Veteran’s bilateral lower extremities were normal, and no paresthesia was noted. The records noted dysesthesia; however, they did not specify the location. See December 2008 Medical Treatment Record - Non-Government Facility, pages 13, 19. In October 2007 the Veteran submitted a statement in which he related that he occasionally experienced what felt like neuropathy in his fingers and toes since around four years prior, or 2003. He further related that, since beginning new medication for CAD earlier in October 2007, he experienced numbness in his upper legs. Previously he had been taking Actos, Digitek, Tricor, Simvastatin, Vitamin B complex, Vitamin E, and baby aspirin. Beginning in October 2007 he was prescribed Lisinol and Bisoprolol. See October 2007 Medical Treatment Record – Non-Government Facility. During a private cardiology visit in March 2008, the Veteran reported suffering from cold feet. See March 2009 Medical Treatment Record - Non-Government Facility (1), page 5. The Veteran underwent a VA examination for diabetes in March 2008. The examiner noted the Veteran’s right and left lower extremities had normal temperature, color, dorsalis pedis pulse, and posterior tibial pulse. No ulcers were found in either lower extremity. Babinski tests on both lower extremities revealed negative results. However, both lower extremities showed trophic changes; namely, dystrophic nails. See March 2008 VA Examination, pages 4-6. Finally, during his December 2018 hearing before the undersigned VLJ, the Veteran testified to taking medication for peripheral neuropathy. See December 2018 Hearing Transcript, page 9. Based on the foregoing, Board finds that a VA medical opinion should be obtained with respect to his claim for entitlement to service connection for BLEPN. Under McLendon, VA is obligated to provide an examination when the record contains (1) competent evidence of a current disability (or persistent or recurrent symptoms of a disability), (2) evidence establishing that an event, injury, or disease occurred in service, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service, but (4) there is insufficient competent medical evidence on file to decide the claim. 38 U.S.C. § 5103A(d); McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). The Board notes that the record does not contain a medical opinion regarding the Veteran’s claimed condition. Accordingly, as the evidence of record shows the Veteran stated he took medication for peripheral neuropathy, and he reported symptoms of coldness in his feet and numbness in his legs; as he has been granted service connection for diabetes mellitus type II and CAD; as his exposure to herbicide agents in Vietnam has been conceded; and as the Veteran’s reported symptoms may be associated with the Veteran’s service, a remand is necessary to obtain a VA medical opinion on whether the Veteran suffered from BLEPN and whether such condition was related to his military service. See McLendon, 20 Vet. App. at 81. The Board finally observes that the March 2021 appellate brief referred to an attachment, evidence that toxic exposure may cause delayed peripheral neuropathy, that was not found in the Veteran’s file. On remand, this attachment should be located and associated with the record. The matter is REMANDED for the following action: 1. Contact the appellant’s representative to provide the attachment referenced in the March 2021 appellate brief and associate it with the claims file. 2. Obtain a VA medical opinion from an appropriately qualified clinician as to the nature and etiology of the Veteran’s bilateral lower extremity peripheral neuropathy (BLEPN). The entire claims file must be made available to and reviewed by the examiner, including a copy of this REMAND order. If the clinician determines the Veteran had a BLEPN condition, the clinician is asked to provide an opinion whether it is at least as likely as not (50 percent probability or more) that the Veteran’s condition is etiologically related to an in-service event, injury, or disease, to include conceded herbicide-agent exposure. Please explain why or why not. Alternatively, the clinician is asked to provide an opinion whether it is at least as likely as not (50 percent probability or more) that the Veteran’s condition is (a) caused by or (b) aggravated by the Veteran’s service-connected CAD and/or diabetes mellitus. Please explain why or why not. A clear rationale for the opinion(s) and a discussion of the facts and medical principles involved should be provided as it will be of considerable assistance to the Board. If the requested opinion(s) cannot be provided without resorting to speculation, the examiner should so state and explain why an opinion cannot be provided without resorting to speculation. In so doing, the medical professional shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to the particular question(s). S. HENEKS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Slomka, 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.