Citation Nr: 21023904 Decision Date: 04/21/21 Archive Date: 04/21/21 DOCKET NO. 16-18 821 DATE: April 21, 2021 REMANDED Entitlement to service connection for peripheral neuropathy (PN) of the bilateral lower extremities is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from January 1971 to January 1974. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously before the Board in November 2019. In the November 2019 decision, the Board directed the RO to obtain outstanding private and VA treatment records as well as afford the Veteran a VA neurological examination to determine the etiology of any diagnosed PN of the bilateral lower extremities. The RO was to obtain a medical nexus opinion as to whether it was as likely as not that the Veteran’s PN of the bilateral lower extremities was related to his active duty service, including exposure to herbicide agents. Further, the examiner was requested to address the 2009 and 2010 private evaluations and the 2015 and 2017 VA examination reports. The Veteran contends his current PN of the bilateral lower extremities is the result of his exposure to herbicide agents while serving in Vietnam. The Veteran’s August 2015 military personnel records show that the Veteran had boots on the ground in Vietnam from November 21, 1971 to November 16, 1972. Specifically, 38 C.F.R. § 3.307 provides that a veteran who served in Vietnam from January 9, 1962, to May 7, 1975, is presumed to have been exposed to a tactical herbicide agent, to include Agent Orange, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during his service. See 38 C.F.R. § 3.307(a)(6)(iii). Accordingly, herbicide agent exposure is conceded. In November 2019, the RO asked the Veteran to identify any health care providers who treated him for his PN of the bilateral lower extremities. The evidence of record indicates the Veteran did not respond to the RO’s request. In February 2020, the RO obtained VA treatment records and associated them with the claims file. Subsequently in February 2020, the Veteran was afforded a VA examination. The examiner’s negative nexus opinion was limited to service connection on a direct basis and did not address the 2009 and 2010 private evaluations nor the 2015 and 2017 VA examination reports. The examiner did not opine whether it was as likely as not that the Veteran’s PN of the bilateral lower extremities were causally related to herbicide agent exposure while on active duty. Accordingly, the RO did not substantially comply with the November 2019 Board directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding veterans are entitled to compliance with Board remand instructions). Accordingly, the claim is remanded to the RO to obtain an adequate nexus opinion. While the Board regrets the delay, a remand is required before the Board can adjudicate the Veteran’s claim. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA neurological examination by an appropriate medical professional, other than the February 2020 examiner, to determine the current nature and etiology of any diagnosed PN of the bilateral lower extremities. 2. The entire claims file, to include the November 2019 Remand and this Remand, must be reviewed by the examiner. The examination report should reflect that such review was accomplished. 3. Based on the examination and a review of the claims file, the examiner must provide an opinion as to whether it is at least as likely as not (50 percent or more probability) that the Veteran’s PN of the bilateral lower extremities is related to his active duty service, including exposure to herbicide agents during active duty service. The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of conclusion as it is to find against it. The examiner must specifically note that service connection can be established on a direct basis for diseases, such as PN even if it has not been shown to warrant a regulatory presumption of service connection due to herbicide agent exposure. 4. In formulating the above opinions, the examiner must address the Veteran’s allegations as well as the 2009 and 2010 private evaluations and the 2015 and 2017 VA examination reports. 5. A complete rationale must be provided for any and all opinions offered. If any requested opinion cannot be provided without resorting to mere speculation, the examiner must fully explain why this is the case and identify what, if any, additional evidence or information might allow for a more definitive opinion. Additionally, the examiner must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. 6. After completing the foregoing and any other development necessary, readjudicate the Veteran’s claims. 7. If any benefit sought on appeal remains denied, a Supplemental Statement of the Case (SSOC) should be furnished to the Veteran and his representative, and he and his representative should be afforded a reasonable opportunity to respond. Cynthia M. Bruce Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Agarwal, 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.