Citation Nr: 21025240 Decision Date: 04/27/21 Archive Date: 04/27/21 DOCKET NO. 14-40 936 DATE: April 27, 2021 REMANDED Service connection for peripheral neuropathy of the right upper extremity Service connection for peripheral neuropathy of the left upper extremity. Service connection for peripheral neuropathy of the left lower extremity. Service connection for peripheral neuropathy of the right lower extremity. REASONS FOR REMAND The Veteran had active service from June 1964 to April 1967. The case is on appeal from a May 2013 rating decision. In September 2016, the Veteran testified at a Board hearing before a Veterans Law Judge (VLJ) who is retired from the Board. In a March 2021 letter, the Veteran was notified that he could request another hearing by another VLJ. The letter indicated that if there was no response, it would be assumed that he did not want another hearing. There has been no response and the Board may proceed to adjudicate the claims. The matter was previously before the Board and remanded for further development in May 2018, October 2019, and November 2020. 1. Service connection for peripheral neuropathy of the right upper extremity. 2. Service connection for peripheral neuropathy of the left upper extremity. 3. Service connection for peripheral neuropathy of the left lower extremity. 4. Service connection for peripheral neuropathy of the right lower extremity. The Board finds there was not substantial compliance with the Board’s May 2018, October 2019, or November 2020 remand directives where the Board directed the RO to obtain a new VA medical opinion. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The Board observed that the earlier examination did not discuss the Veteran’s statements of numbness and paresthesia of his upper extremities, as well as the April 2014 private testing results showing severe generalized sensory-motor neuropathy with a superimposed left median nerve at the wrist, compatible with left carpal tunnel syndrome (CTRS). The Board also noted that the finding of superimposed CTS inherently indicated there is another underlying condition with similar symptomology. Upon remand, a new VA medical examination was provided in December 2020. While the examiner opined that the Veteran’s peripheral neuropathy of the bilateral upper and lower extremities was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. As rationale, the examiner provided “There is no specific evidence, gathered from this Veteran’s history, or cited in this Veteran’s medical records to show that the noted idiopathic progressive polyneuropathy of the bilateral lower extremities, is related to his active duty military service, to include as due to herbicide agent exposure. Moreover, VA guideline regulations, note the condition must be at least 10 percent disabling, and noted within one year of contact with herbicide exposure. There is no specific evidence, gathered from this Veteran’s history, or cited in this Veteran’s medical records to show that the noted bilateral carpal tunnel syndrome is related to his active duty military service, to include as due to herbicide agent exposure.” It should be noted that the examiner addressed neither the Veteran’s lay statements nor specific evidence regarding left CTS and its underlying condition. As the examiner failed to comply with the Board’s remand directives, an addendum opinion is necessary. See Stegall, 11 Vet. App. at 268; Barr v. Nicholson, 21 Vet. App. 303, 311-12 (2007) (holding that once VA undertakes the effort to provide an examination when developing a claim, even if not statutorily obligated to do so, VA must ensure that the examination provided is adequate). In light of the remand, updated VA treatment records should be obtained. The matters are REMANDED for the following action: 1. Obtain outstanding VA treatment records dated from March 2019. 2. Provide a copy of the file, including a copy of this remand to an appropriately qualified examiner for opinions regarding the nature and etiology of the Veteran’s claimed peripheral neuropathy of the upper extremities and lower extremities. The examiner should review the entire claims file and should indicate that such review was completed in the opinion report. If deemed appropriate, the examiner should contact the Veteran for additional information or examination. The examiner is asked to provide an addendum opinion to the November 2020, January 2020, and April 2019 opinions as to whether it is at least as likely as not (i.e., 50 percent or greater probability) that any current neurologic condition, to include peripheral neuropathy, of the upper and/or lower extremities is related to his active duty military service, to include as due to herbicide agent exposure. Consideration should be given to all relevant evidence of record, including the Veteran’s lay statements and medical evidence, citing to specific evidence where appropriate. The examiner should specifically discuss the Veteran’s statements concerning his current symptoms and should discuss any differences of opinion with other relevant diagnoses of record, such as the April 2014 private record indicating multiple conditions affecting the left upper extremity. The examiner is reminded that failing to meet the criteria for presumptive service connection for a condition does not preclude entitlement on a direct basis. The examiner is advised that the Veteran is competent to report symptoms, treatment, and injuries observable to a layperson. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The examiner is also reminded that the absence of documented treatment in service or thereafter is not fatal to a service connection claim, and the absence of evidence in the service treatment records is an insufficient basis, by itself, for a negative opinion. See Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). Thus, the examiner is to consider the totality of the record, and not just the absence of clinical treatment, in weighing the Veteran’s statements asserting symptomatology. A complete rationale should be provided for any opinion reached. RYAN T. KESSEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Becton, 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.