Citation Nr: 21025495 Decision Date: 04/28/21 Archive Date: 04/28/21 DOCKET NO. 13-27 544 DATE: April 28, 2021 REMANDED Entitlement to service connection for neuropathy of the left lower extremity, to include as secondary to service-connected dermatophytosis, chronic, mild of right hand and feet, and plantar warts, right foot, and pressure callouses, left foot is remanded. Entitlement to service connection for neuropathy of the right hand, to include as secondary to service-connected dermatophytosis, chronic, mild of right hand and feet, and plantar warts, right foot, and pressure callouses, left foot is remanded. Entitlement to service connection for neuropathy of the right lower extremity, to include as secondary to service-connected dermatophytosis, chronic, mild of right hand and feet, and plantar warts, right foot, and pressure callouses, left foot is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1953 to February 1957. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2010 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In August 2017, the Board of Veterans’ Appeals (Board) issued a decision denying the claim for service connection for the Veteran’s neuropathy claims. The Veteran appealed that decision to the United States Court of Appeals for Veterans Claims (Court). In March 2018, the parties filed a Joint Motion for Partial Remand (JMPR) moving for vacatur of the August 2017 decision’s denial of entitlement to service connection for neuropathy of the left lower extremity, right lower extremity, and right hand. On March 8, 2018, the Court issued an Order granting the JMPR and remanding the matter to the Board for further development and proceedings pursuant to 38 U.S.C. § 7252(a). In July 2018, the Board re-adjudicated the matter, where it was remanded for further development. In December 2019, the Board of Veterans’ Appeals (Board) issued a decision denying the claim for service connection for the Veteran’s neuropathy claims. The Veteran appealed that decision to the Court. In November 2020, the parties filed a JMPR moving for vacatur of the December 2019 decision’s denial of entitlement to service connection for neuropathy of the left lower extremity, right lower extremity, and right hand. On November 18, 2020 the Court issued an Order granting the JMPR and remanding the matter to the Board for further development and proceedings pursuant to 38 U.S.C. § 7252(a). 1. Entitlement to service connection for neuropathy of the left lower extremity, to include as secondary to service-connected dermatophytosis, chronic, mild of right hand and feet, and plantar warts, right foot, and pressure callouses, left foot is remanded. 2. Entitlement to service connection for neuropathy of the right hand, to include as secondary to service-connected dermatophytosis, chronic, mild of right hand and feet, and plantar warts, right foot, and pressure callouses, left foot is remanded. 3. Entitlement to service connection for neuropathy of the right lower extremity, to include as secondary to service-connected dermatophytosis, chronic, mild of right hand and feet, and plantar warts, right foot, and pressure callouses, left foot is remanded. The Veteran contends that he has neuropathy of the left lower extremity, right lower extremity, and right hand that is related to his military service, to include as secondary to his service-connected dermatophytosis, plantar warts, and/or pressure callouses. Service treatment records (STRs) are silent for any complaints, treatment, or diagnosis of neuropathy of the lower extremities and/or right hand. Post-service VA and private treatment records reflect complaints of longstanding burning pain and numbness in the hands and feet since the 1950s; however, the earliest clinical findings of neuropathy were in 2003, more than 40 years after military separation. However, in an April 2004 private treatment record, the physician indicated that the Veteran’s neuropathy was related to his dermatophytosis, and prescribed medication for relief. In May 2010, the Veteran was afforded a VA examination to assess the nature and etiology of his neuropathy. The examiner noted the Veteran reported having trouble with his feet since the 1950s/1960s, with pain and numbness in his soles and balls of the foot, and pain in the right hand. Upon examination, the examiner assessed the Veteran with having polyneuropathy with mild to moderate incomplete sensory loss in the feet, and patch sensory loss in the hands. The examiner opined that it was less likely as not that the Veteran’s service-connected skin conditions caused his neuropathy. As to the rationale, the examiner stated that the Veteran’s sensory loss in the hands and feet do not conform to the distribution of the skin conditions. Notably, that portions of the right-hand rash were spared, and the extent of sensory loss in the feet was far beyond the distribution of the skin rash itself. The examiner added that the superficial rash might be expected to cause superficial sensory loss, but was not expected to cause deep sensory loss with involvement of deep tissues. Furthermore, the examiner opined that the Veteran’s neuropathy is unlikely the cause of his pain. The examiner explained, He has patchy bilateral sensory loss in the hands, but only has pain in the right hand. He has rather widespread sensory loss in the feet and legs, but the pain is confined to the soles. Thus, the pain appears confined to areas that were affected by the rash but does not conform to the areas of sensory loss. In August 2019 and September 2019, VA secured addendum opinions regarding the Veteran’s neuropathy claims. Upon review, the examiner opined that it was less likely than not that the Veteran’s neuropathy was caused or aggravated by his service-connected rash, warts, and/or callouses. As to the rationale, the examiner stated that the Veteran’s “sensory loss in the hands and feet does not conform to the distribution of the rash and other lesions with much the same symptoms in areas with lesions as without.” The examiner also noted that there were no motor abnormalities; sensory was intact to fine touch and position; temperature sense was decreased in a patchy fashion in the hands on both sides; in a stocking distribution to the lower calf; vibration sense was mildly impaired at the ankles; and reflexes were trace to absent and equal. In the JMPR, the parties agreed that the May 2010 VA examination and August 2019 and September 2019 addendum opinions, which the Board relied upon in denying the Veteran’s claims were inadequate. Specifically, the August 2019 VA medical opinion was not adequate as to whether the Veteran’s service-connected skin conditions aggravated the Veteran’s neuropathy of the bilateral lower extremities and right hand, as contemplated by 38 C.F.R. § 3.310(b). The examiner stated that the Veteran’s skin disabilities do not conform precisely to the same areas as his sensory loss, but did not address whether the Veteran’s skin disorders aggravated his sensory loss in those parts of his body, where the skin disorders are in fact, present. The VA examiner did not provide an opinion on whether the Veteran’s superficial sensory loss could conceivably aggravate the Veteran’s neuropathy related sensory loss where both neuropathy and a skin disorder are present and overlapping. The Board cannot make a fully informed decision on the issues of neuropathy of the left lower extremity, right lower extremity, and right hand without a new examination. Thus, a remand is required prior to adjudication. The matter is REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of his neuropathy of the left lower extremity, right lower extremity, and right-hand condition. (a.) The clinician should also provide an opinion as to whether it is at least as likely as not that the Veteran’s the neuropathy of the left lower extremity, right lower extremity, and right-hand condition is (1) proximately due to, or (2) aggravated beyond its natural progression by the Veteran’s service-connected dermatophytosis, chronic, mild of right hand and feet, and plantar warts, right foot, and pressure callouses, left foot disabilities. i. The examiner must reconcile the Veteran’s lay testimony and the notation by the April 2004 private physician, that the Veteran’s neuropathy was related to his dermatophytosis. ii. The examiner must note and address the contentions made in the November 2020 JMPR including: (1) addressing whether the Veteran’s skin disorders aggravated his sensory loss in those parts of his body, where the skin disorders are in fact, present; (2) whether the Veteran’s superficial sensory loss could conceivably aggravate the Veteran’s neuropathy related sensory loss where both neuropathy and a skin disorder are present and overlapping. A complete rationale must be provided for any opinion or conclusion expressed. The clinician must note that a lack of contemporaneous medical evidence does not, in and of itself, render lay evidence not credible. See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006). If the examiner is unable to provide any requested opinion, he or she must provide a thorough explanation. If the examiner is unable to provide this opinion without resorting to speculation, he or she must indicate why this is so. If aggravation is shown, the examiner should quantify the degree of aggravation, if possible. The question of secondary aggravation must be addressed separately from the question of secondary causation. The examiner must note that an opinion to the effect that one disability is not “caused by,” “a result of,” or “secondary to” another disability does not answer the question of aggravation and will necessitate a further opinion. 2. The AOJ must review this opinion to ensure it is adequate and complies with the Board’s specific remand directives herein. If deficient in any manner, corrective action must be taken at once. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding that AOJ compliance with Board remand directives is not discretionary or optional). 3. Thereafter, readjudicate the claim. If the benefits sought on appeal remain denied, issue a supplemental statement of the case to the Veteran and his representative. Then return the appeal to the Board for further appellate review. MICHAEL MARTIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Quist 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.