Citation Nr: 21023937 Decision Date: 04/21/21 Archive Date: 04/21/21 DOCKET NO. 13-11 407 DATE: April 21, 2021 ORDER From December 16, 2007, to the present, entitlement to a 40 percent evaluation, at least, for service-connected residuals of chemotherapy-induced peripheral neuropathy of all right (major) radicular groups is granted, subject to the applicable regulations concerning the payment of monetary benefits. From December 16, 2007, to the present, entitlement to a 30 percent evaluation, at least, for service-connected residuals of chemotherapy-induced peripheral neuropathy of all left (minor) radicular groups is granted, subject to the applicable regulations concerning the payment of monetary benefits. From December 16, 2007, to the present, entitlement to a 20 percent evaluation, at least, for service-connected residuals of chemotherapy-induced peripheral neuropathy of the right sciatic nerve is granted, subject to the applicable regulations concerning the payment of monetary benefits. From December 16, 2007, to the present, entitlement to a 20 percent evaluation, at least, for service-connected residuals of chemotherapy-induced peripheral neuropathy of the left sciatic nerve is granted, subject to the applicable regulations concerning the payment of monetary benefits. From December 16, 2007, to the present, entitlement to a 20 percent evaluation, at least, for service-connected residuals of chemotherapy-induced peripheral neuropathy of the right anterior crural (femoral) nerve is granted, subject to the applicable regulations concerning the payment of monetary benefits. From December 16, 2007, to the present, entitlement to a 20 percent evaluation, at least, for service-connected residuals of chemotherapy-induced peripheral neuropathy of the left anterior crural (femoral) nerve is granted, subject to the applicable regulations concerning the payment of monetary benefits. REMANDED Entitlement to an evaluation in excess of 40 percent for service-connected residuals of chemotherapy-induced peripheral neuropathy of all right (major) radicular groups from December 16, 2007, to the present is remanded. Entitlement to an evaluation in excess of 30 percent for service-connected residuals of chemotherapy-induced peripheral neuropathy of all left (minor) radicular groups from December 16, 2007, to the present is remanded. Entitlement to an evaluation in excess of 20 percent for service-connected residuals of chemotherapy-induced peripheral neuropathy of the right sciatic nerve from December 16, 2007, to the present is remanded. Entitlement to an evaluation in excess of 20 percent for service-connected residuals of chemotherapy-induced peripheral neuropathy of the left sciatic nerve from December 16, 2007, to the present is remanded. Entitlement to an evaluation in excess of 20 percent for service-connected residuals of chemotherapy-induced peripheral neuropathy of the right anterior crural (femoral) nerve from December 16, 2007, to the present is remanded. Entitlement to an evaluation in excess of 20 percent for service-connected residuals of chemotherapy-induced peripheral neuropathy of the left anterior crural (femoral) nerve from December 16, 2007, to the present is remanded. Entitlement to a compensable evaluation for service-connected residuals of chemotherapy-induced peripheral neuropathy of the right obturator nerve from December 16, 2007, to the present is remanded. Entitlement to a compensable evaluation for service-connected residuals of chemotherapy-induced peripheral neuropathy of the left obturator nerve from December 16, 2007, to the present is remanded. Entitlement to a compensable evaluation for service-connected residuals of chemotherapy-induced peripheral neuropathy of the right external cutaneous nerve of the thigh from December 16, 2007, to the present is remanded. Entitlement to a compensable evaluation for service-connected residuals of chemotherapy-induced peripheral neuropathy of the left external cutaneous nerve of the thigh from December 16, 2007, to the present is remanded. Entitlement to a compensable evaluation for service-connected residuals of chemotherapy-induced peripheral neuropathy of the right ilio-inguinal nerve from December 16, 2007, to the present is remanded. Entitlement to a compensable evaluation for service-connected residuals of chemotherapy-induced peripheral neuropathy of the left ilio-inguinal nerve from December 16, 2007, to the present is remanded. FINDINGS OF FACT 1. The most probative evidence reflects that the Veteran's service-connected residuals of chemotherapy-induced peripheral neuropathy of all right (major) radicular groups is manifested by at least moderate incomplete paralysis of the affected nerve groups throughout the pendency of the appeal. 2. The most probative evidence reflects that the Veteran's service-connected residuals of chemotherapy-induced peripheral neuropathy of all left (minor) radicular groups is manifested by at least moderate incomplete paralysis of the affected nerve groups throughout the pendency of the appeal. 3. The most probative evidence reflects that the Veteran's service-connected residuals of chemotherapy-induced peripheral neuropathy of the right sciatic nerve is manifested by at least moderate incomplete paralysis of the affected nerve throughout the pendency of the appeal. 4. The most probative evidence reflects that the Veteran's service-connected residuals of chemotherapy-induced peripheral neuropathy of the left sciatic nerve is manifested by at least moderate incomplete paralysis of the affected nerve throughout the pendency of the appeal. 5. The most probative evidence reflects that the Veteran's service-connected residuals of chemotherapy-induced peripheral neuropathy of the right anterior crural (femoral) nerve is manifested by at least moderate incomplete paralysis of the affected nerve throughout the pendency of the appeal. 6. The most probative evidence reflects that the Veteran's service-connected residuals of chemotherapy-induced peripheral neuropathy of the left anterior crural (femoral) nerve is manifested by at least moderate incomplete paralysis of the affected nerve throughout the pendency of the appeal. CONCLUSIONS OF LAW 1. The criteria for a 40 percent evaluation, at least, for service-connected residuals of chemotherapy-induced peripheral neuropathy of all right (major) radicular groups are met from December 16, 2007, to the present. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8513. 2. The criteria for a 30 percent evaluation, at least, for service-connected residuals of chemotherapy-induced peripheral neuropathy of all left (minor) radicular groups are met from December 16, 2007, to the present. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8513. 3. The criteria for a 20 percent evaluation, at least, for service-connected residuals of chemotherapy-induced peripheral neuropathy of the right sciatic nerve are met from December 16, 2007, to the present. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8520. 4. The criteria for a 20 percent evaluation, at least, for service-connected residuals of chemotherapy-induced peripheral neuropathy of the left sciatic nerve are met from December 16, 2007, to the present. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8520. 5. The criteria for a 20 percent evaluation, at least, for service-connected residuals of chemotherapy-induced peripheral neuropathy of the right anterior crural (femoral) nerve are met from December 16, 2007, to the present. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8526. 6. The criteria for a 20 percent evaluation, at least, for service-connected residuals of chemotherapy-induced peripheral neuropathy of the left anterior crural (femoral) nerve are met from December 16, 2007, to the present. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8526. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Air Force from April 1969 to July 1993, to include service in Southwest Asia Theater of operations during the Persian Gulf War. As the Veteran’s appealed issues, and the Board’s dispositions thereof, are highly dependent on the complex procedural history of the Veteran’s appeal, the Board concludes that a brief recitation of pertinent facts is necessary. The Veteran’s service treatment records reflect that right testicular seminoma was diagnosed during active duty, necessitating a right orchiectomy in October 1990 and a subsequent 12-week course of chemotherapy treatment. Shortly after completion of the Veteran’s chemotherapy regimen, he began experiencing neurological symptoms (pain, numbness, and itching) of his upper and lower extremities; however, he endured such and voluntarily retired from the Air Force in July 1993. Within his initial post-service year, he filed a claim seeking disability benefits from the Department of Veterans Affairs (VA) for neurological symptoms of the upper and lower extremities, claimed as chemotherapy residuals, among other disabilities. The Veteran’s reported symptoms were noted upon VA examination in February 1994, and in a February 1994 rating decision, the Agency of Original Jurisdiction (AOJ) established service connection for “chemotherapy residuals, including ulnar neuropathy and thigh numbness;” a noncompensable (zero percent) initial evaluation was assigned under Diagnostic Codes 8716-8729 from August 1, 1993 – the day after the Veteran’s separation from the United States Air Force. The Veteran did not express disagreement with any determination of the February 1994 rating decision or submit new and material evidence within the appeal period of such, and thus, the February 1994 rating decision became final. On December 16, 2008, the AOJ received a claim from the Veteran seeking and increased evaluation for his service-connected ulnar neuropathy and thigh numbness, among other benefits. This claim was denied by the AOJ in a June 2009 rating decision. The Veteran expressed timely disagreement with this determination, and the present appeal ensued. The Veteran’s appeal was previously before the Board in March 2017 and June 2020, and it was concluded that remand was necessary to ensure that VA fulfilled its duty to assist the Veteran in substantiating his appeal. Consequent to the Board’s June 2020 remand, the Veteran was provided a VA examination in connection with his appeal in August 2020. In pertinent part, the August 2020 VA examiner noted the progression of the Veteran’s neurologic chemotherapy residuals and opined that the associated symptoms met the criteria of a diagnosis of chemotherapy-induced peripheral neuropathy affecting all paired (bilateral) nerves comprising the three radicular groups (upper, lower, and middle), sciatic nerves, anterior crural (femoral) nerves, obturator nerves, external cutaneous nerves of the thighs, and ilio-inguinal nerves. Based on the above findings, the AOJ partially granted the Veteran’s appeal in an August 2020 Decision Review Officer (DRO) decision which bifurcated the Veteran’s appealed issue to assign separate evaluations for each of the nerves noted above (some compensable and others not); all awards effective from December 16, 2008 – the date that the AOJ received the Veteran’s claim for an increased evaluation. As these actions did not amount to a full allowance of the benefits sought on appeal, the Veteran’s appeal remains in appellate status and has been returned to the Board. AB v. Brown, 6 Vet. App. 35, 38-39 (1993). In addition to the twelve paired (bilateral) nerve groups and nerves for which service connection was established in the August 2020 DRO decision, the August 2020 VA examiner noted that the Veteran’s service-connected chemotherapy-induced peripheral neuropathy also affects the bilateral external popliteal (common peroneal), musculocutaneous (superficial peroneal), anterior tibial (deep peroneal), internal popliteal (tibial), posterior tibial, and interior saphenous nerves. There are five nerve branches in the lower extremities. Each branch has its separate and distinct functions. The sciatic branch includes the sciatic nerve, external popliteal nerve (common peroneal), musculocutaneous (superficial peroneal), anterior tibial nerve (deep peroneal), internal popliteal (tibial), and posterior tibial nerves. The femoral branch includes the anterior crural (femoral) and the internal saphenous nerves. The obturator, external cutaneous thigh, and ilio-inguinal nerve branches only include one nerve each. For rating purposes, VA regulations preclude the assignment of separate evaluations for the same disability affecting different nerves of the same nerve branch, as such would amount to impermissible pyramiding. 38 C.F.R. § 4.14. Accordingly, separate evaluations for disabilities of these nerves, although affected by the same service-connected disability, were not assigned. As will be explained in further detail below, the record for review is insufficient to readjudicate the totality of the Veteran’s appeal, which is now comprised of at least 12 issues; however, the Board may undertake actions to appropriately evaluate several of the disabilities at issue, resulting in further partial allowances. As the balance of each partially allowed issue is being remanded for further development, the Veteran is not prejudiced by the Board’s actions in this regard. Bernard v. Brown, 4 Vet. App. 384, 394 (1993). 1. Entitlement to an evaluation of 40 percent for service-connected residuals of chemotherapy-induced peripheral neuropathy of all right (major) radicular groups is granted. 2. Entitlement to an evaluation of 30 percent for service-connected residuals of chemotherapy-induced peripheral neuropathy of all left (minor) radicular groups is granted. 3. Entitlement to an evaluation of 20 percent for service-connected residuals of chemotherapy-induced peripheral neuropathy of the right sciatic nerve is granted. 4. Entitlement to an evaluation of 20 percent for service-connected residuals of chemotherapy-induced peripheral neuropathy of the left sciatic nerve is granted. 5. Entitlement to an evaluation of 20 percent for service-connected residuals of chemotherapy-induced peripheral neuropathy of the right anterior crural (femoral) nerve is granted. 6. Entitlement to an evaluation of 20 percent for service-connected residuals of chemotherapy-induced peripheral neuropathy of the left anterior crural (femoral) nerve is granted. Disability evaluations are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (rating schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Separate evaluations may be assigned for separate periods of time based on the facts found. In other words, the evaluations may be "staged." Hart v. Mansfield, 21 Vet. App. 505 (2007) (staged ratings are appropriate when the factual findings show distinct period where the service- connected disability exhibits symptoms that would warrant different ratings.); see also Fenderson v. West, 12 Vet. App. 119, 126 (2001). The Veteran’s service-connected chemotherapy-induced peripheral neuropathy of the paired (bilateral) nerves comprising the three radicular groups (upper, lower, and middle), sciatic nerves, and anterior crural (femoral) nerves are currently evaluated under the criteria of 38 C.F.R. § 1.124A Diagnostic Codes 8513, 8520, and 8526, pertaining to paralysis (complete or incomplete) of this nerve group and the individual sciatic and anterior crural (femoral) nerves, respectively. The Board observes that the August 2020 VA examiner opined that the Veteran’s chemotherapy-induced peripheral neuropathy affected the six bilateral nerves (radial, medial, ulnar, circumflex (axillary), long thoracis, and musculocutaneous) which comprise the upper, middle, and lower, radicular groups. To this point, a Note to 38 C.F.R. § 4.124A provides that combined nerve injuries, such is at issue in the present case, should be rated by reference to the major involvement, or if sufficient in extent, consider radicular group ratings. Further, the Court has referred to “the canon of interpretation that the more specific trumps the general.” Zimick v. West, 11 Vet. App. 45, 51 (1998) ("'a more specific statute will be given precedence over a more general one . . . . ") (quoting Busic v. United States, 446 U.S. 398, 406 (1980)]; see also Kowalski v. Nicholson, 19 Vet. App. 171, 176-7 (2005). In such cases, VA’s rating schedule includes Diagnostic Code 8513, which pertains to disabilities of “all radicular groups,” and provides a 20 percent rating is warranted for mild incomplete paralysis of all radicular groups (major and minor). For moderate incomplete paralysis of all radicular groups, a 40 percent rating is warranted for the major extremity, and a 30 percent rating is warranted for the minor extremity. For severe incomplete paralysis of all radicular groups, a 70 percent rating is warranted for the major extremity, and a 60 percent rating is warranted for the minor extremity. For complete paralysis of all radicular groups, the maximum schedular rating of 90 percent is warranted for the major extremity, and an 80 percent rating is warranted for the minor extremity. 38 C.F.R. § 4.124a, DC 8513. The terms “major” and “minor” are used in the rating criteria to refer to the dominant or non-dominant upper extremity. 38 C.F.R. § 4.69. In the present case, the record unambiguously reflects that the Veteran is right-hand dominant. Under Diagnostic Code 8520, complete paralysis of the sciatic nerve, which is rated as 80 percent disabling, contemplates foot dangling and dropping, no active movement possible of muscles below the knee, and flexion of the knee weakened or (very rarely) lost. Incomplete paralysis of the nerve warrants a 60 percent evaluation if it is severe with marked muscular atrophy, a 40 percent evaluation if it is moderately severe, a 20 percent evaluation if it is moderate or a 10 percent evaluation if it is mild. Under Diagnostic Code 8526, complete paralysis of the anterior crural (femoral) nerve is rated 40 percent disabling, severe incomplete paralysis is rated 30 percent disabling, moderate incomplete paralysis is rated 20 percent disabling. The preface to 38 C.F.R. § 4.124a states that when the involvement is wholly sensory, the rating should be for the mild, or at the most, the moderate degree. In addition, the preface states that the term “incomplete paralysis” indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. 38 C.F.R. § 4.124a. The Court recently held in Miller v. Shulkin, 28 Vet. App. 376 (2017), that the language of 38 C.F.R. § 4.124a provides for a maximum 20 percent rating for peripheral neuropathy when the involvement is wholly sensory. Pursuant to 38 C.F.R. § 4.123, however, the maximum rating that may be assigned for neuritis not characterized by organic changes will be that for moderate, or with sciatic nerve involvement, for moderately severe, incomplete paralysis, i.e., no more than 40 percent. The Board acknowledges that the terms “mild,” “moderate,” and “severe” are not defined in the Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are “equitable and just.” 38 C.F.R. § 4.6. The use of terminology such as “moderate” or “severe” by VA examiners and others, although an element of evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. 38 C.F.R. §§ 4.2, 4.6. The Board does note, for reference and illustrative purposes only, that the definitions for “mild” includes not very severe. WEBSTER'S II NEW COLLEGE DICTIONARY at 694 (1995). The Board also notes that a synonym for “mild” is "slight" and definitions for "slight" includes small in size, degree, or amount. Id. at 1038. The definitions for “moderate” includes of average or medium quantity, quality, or extent. Id. at 704. Finally, definitions for “severe” includes extremely intense. Id. at 1012. It is also noted that the term “moderately severe” includes impairment that is considered more than “moderate” but not to the extent as to be considered “severe.” Analysis As outlined in the Introduction, the Veteran’s claim for an increased evaluation was received by the AOJ on December 16, 2008. Accordingly, the appeal period for consideration by VA with regard to this appeal is from December 16, 2007, to the present, which includes the one-year look back period prior to the Veteran’s filing. Gaston v. Shinseki, 605 F.3d 979, 984 (Fed. Cir. 2010). In view of this fact, the AOJ’s partial allowances of the Veteran’s appealed issues, all effective from December 16, 2008, resulted in “staged” evaluations for each issue for consideration. Hart, supra. The Veteran asserts that the manifestations of his service-connected chemotherapy-induced peripheral neuropathy are more significant than reflected by the currently assigned staged evaluations. For the reasons discussed below, the Board concludes that the most probative evidence of record bolsters this contention, resulting in a partial allowance of the benefits sought regarding each appealed issue. The August 2020 VA examination report reflects that the Veteran’s service-connected chemotherapy-induced peripheral neuropathy of the nerves of the bilateral radicular groups, sciatic nerves, and anterior crural (femoral) nerves results in mild constant pain, moderate intermittent pain, moderate paresthesias and/or dysesthesias, and mild-to-moderate numbness of the upper and lower extremities. Muscle strength testing was normal in all four extremities, but hyperactive reflexes were noted in the triceps, ankles, and brachioradialis, and the Veteran demonstrated decreased sensation of the hands, feet, and lower legs. Ultimately, the August 2020 VA examiner opined that this disability’s impact on each nerve for consideration is “mild” in severity. The Board acknowledges and appreciates the above findings and opinions; however, a closer reading of the August 2020 VA examination report reflects a more significant disability picture regarding the functional impact downstream from these disabilities. Specifically, several of the Veteran’s neurologic symptoms of the radicular groups, sciatic nerves, and anterior crural (femoral) nerves was noted to be moderate in severity, frequency, and duration. Moreover, in a September 2020 statement, the Veteran competently and credibly endorsed pain, tingling, numbness, in his extremities that the Board, as the ultimate finder of fact, finds to more closely approximate moderate impairment, at minimum, regarding each of these nerves. As will be discussed in further detail below, the evidence or record does not currently address whether the Veteran’s service-connected chemotherapy-induced peripheral neuropathy of the radicular groups, sciatic nerves, and anterior crural (femoral) nerves results in symptoms beyond “wholly sensor,” and thus, the Board must remand further entitlement regarding these issues for additional development. Nonetheless, the Board finds that the most probative evidence reflects the Veteran’s service-connected chemotherapy-induced peripheral neuropathy results in, at least, moderate incomplete paralysis of the bilateral radicular groups, sciatic nerves, and anterior crural (femoral) nerves throughout the entire of the appeal period (since December 16, 2007). Accordingly, the Board concludes that partial allowances of these issues are warranted for service-connected chemotherapy-induced peripheral neuropathy of all right (major) radicular groups to 40 percent, all left (minor) radicular groups to 30 percent and bilateral sciatic and anterior crural (femoral) nerves to 20 percent, each – all awards effective from December 16, 2007. This finding does not abrogate the remainder of the benefits sought on appeal, which will be addressed in the remand section, below. REASONS FOR REMAND 1. Entitlement to an evaluation in excess of 40 percent for service-connected residuals of chemotherapy-induced peripheral neuropathy of all right (major) radicular groups from December 16, 2007, to the present is remanded. 2. Entitlement to an evaluation in excess of 30 percent for service-connected residuals of chemotherapy-induced peripheral neuropathy of all left (minor) radicular groups from December 16, 2007, to the present is remanded. 3. Entitlement to an evaluation in excess of 20 percent for service-connected residuals of chemotherapy-induced peripheral neuropathy of the right sciatic nerve from December 16, 2007, to the present is remanded. 4. Entitlement to an evaluation in excess of 20 percent for service-connected residuals of chemotherapy-induced peripheral neuropathy of the left sciatic nerve from December 16, 2007, to the present is remanded. 5. Entitlement to an evaluation in excess of 20 percent for service-connected residuals of chemotherapy-induced peripheral neuropathy of the right anterior crural (femoral) nerve from December 16, 2007, to the present is remanded. 6. Entitlement to an evaluation in excess of 20 percent for service-connected residuals of chemotherapy-induced peripheral neuropathy of the left anterior crural (femoral) nerve from December 16, 2007, to the present is remanded. 7. Entitlement to a compensable evaluation for service-connected residuals of chemotherapy-induced peripheral neuropathy of the right obturator nerve from December 16, 2007, to the present is remanded. 8. Entitlement to a compensable evaluation for service-connected residuals of chemotherapy-induced peripheral neuropathy of the left obturator nerve from December 16, 2007, to the present is remanded. 9. Entitlement to a compensable evaluation for service-connected residuals of chemotherapy-induced peripheral neuropathy of the right external cutaneous nerve of the thigh from December 16, 2007, to the present is remanded. 10. Entitlement to a compensable evaluation for service-connected residuals of chemotherapy-induced peripheral neuropathy of the left external cutaneous nerve of the thigh from December 16, 2007, to the present is remanded. 11. Entitlement to a compensable evaluation for service-connected residuals of chemotherapy-induced peripheral neuropathy of the right ilio-inguinal nerve from December 16, 2007, to the present is remanded. 12. Entitlement to a compensable evaluation for service-connected residuals of chemotherapy-induced peripheral neuropathy of the left ilio-inguinal nerve from December 16, 2007, to the present is remanded. As discussed above, the dispositive matter regarding these appealed issues is whether the Veteran’s service-connected chemotherapy-induced peripheral neuropathy is productive of complete or “sever” incomplete paralysis of the affected nerves. To this point, while the medical evidence of record reflects sensory deficits due to these service-connected neurological disabilities, it is unclear whether such results in functional impairment beyond “wholly sensory” symptoms. In other words, the evidence of record, to include the August 2020 VA examination, does not comment on whether the Veteran’s service-connected disabilities at issue result in non-sensory manifestations, such as difficulty grasping or manipulating objects with his hands, standing, walking, running, and/or squatting. As such evidence is critical in the current matters, a remand for additional VA examination is necessary. Miller v. Shulkin, 28 Vet. App. 376, 380 (2017). Further, in a September 2020 statement, the Veteran asserted that the VA examiners who have conducted the VA examinations during the pendency of his appeal have failed to consider the ameliorative effects of his prescribed pain medications when discerning the frequency, severity, and duration, of the symptoms associated with his service-connected disabilities. To this point, the Veteran’s post-service treatment records confirm his prescription for, and usage of, several medications for management of the symptoms associated with these service-connected disabilities, and the rating criteria for consideration do not contemplate such and thus must be discounted. Accordingly, remand is necessary to provide the Veteran with another VA examination which adequately addresses the severity, frequency, and duration, of the Veteran’s symptoms in light of the holding in Jones v. Shinseki, 26 Vet. App. 56 (2012). The matters are REMANDED for the following actions: 1. The AOJ must obtain and associate with the file updated VA and private treatment records pertinent to the disabilities subject to this remand, with the Veteran’s assistance regarding the latter. 2. Thereafter, the AOJ must request that the Veteran be scheduled for a VA examination to determine the nature and severity of the Veteran’s service-connected chemotherapy-induced peripheral neuropathy. After a review of the file, examination of the Veteran, and any additional testing deemed necessary, the examiner is requested to address the following: a. Describe the frequency, severity, and duration, of all manifestations of the Veteran’s service-connected chemotherapy-induced peripheral neuropathy affecting the: i. The nerves comprising all right (major) radicular groups (radial, medial, ulnar, circumflex (axillary), long thoracis, and musculocutaneous); ii. The nerves comprising all right (major) radicular groups (radial, medial, ulnar, circumflex (axillary), long thoracis, and musculocutaneous); iii. The right sciatic nerve; iv. The left sciatic nerve; v. The right anterior crural (femoral) nerve; vi. The left anterior crural (femoral) nerve; vii. The left obturator nerve; viii. The right obturator nerve; ix. The right external cutaneous nerve of the thigh; x. The right cutaneous nerve of the thigh; xi. The right ilio-inguinal nerve; and x. The left ilio-inguinal nerve. b. Comment on whether the Veteran’s service-connected disability of any of the above nerve groups or nerve results in symptoms beyond that which are “wholly sensory.” In other words, comment on whether the Veteran’s service-connected disability of any one or more nerve(s) include non-sensory manifestations resulting in functional impairment, such as difficulty grasping or manipulating objects with his hands, standing, walking, running, and/or squatting. If such impairment is identified, the examiner is asked to specifically identify which nerve and/or nerves are productive of such. In addition, while the Veteran’s post-service treatment records confirm his prescription for, and usage of, several medications for management of the symptoms associated with these service-connected disabilities, because the rating criteria for consideration do not contemplate medication, the ameliorative effects of medication must be discounted. If the examiner cannot provide the requested opinion without resorting to mere speculation, this should be so stated along with supporting rationale. In so doing, the examiner 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. 3. After undertaking any additional development deemed appropriate and giving the Veteran full opportunity to supplement the record, readjudicate the Veteran's pending issues in light of any additional evidence added to the record. If any benefit sought on appeal is not granted to the fullest extent, the Veteran and his representative should be furnished with a copy of the readjudication and be afforded the applicable opportunity to respond. Michael J. Skaltsounis Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Scott W. Dale, 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.