Citation Nr: 21025592 Decision Date: 04/28/21 Archive Date: 04/28/21 DOCKET NO. 14-15 730 DATE: April 28, 2021 REMANDED Entitlement to service connection for right lower extremity peripheral neuropathy, as secondary to service-connected right hammertoe disability, is remanded. Entitlement to service connection for left lower extremity peripheral neuropathy, as secondary to service-connected left hammertoe disability, is remanded. REASONS FOR REMAND The Veteran served on active duty in the Army from October 1968 to September 1970, and in the Navy from November 1971 to July 1973. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2018 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). These matters were previously before the Board in April 2020 and December 2020, where they were remanded for additional development. The Board notes that there was not substantial compliance with its December 2020 remand directives, and regrettably finds another remand is necessary prior to readjudication of the claim. See Stegall v. West, 11 Vet. App. 268, 271 (1998); D’Aries v. Peake, 22 Vet. App. 97, 105 (2008). In the most recent remand, the Board requested that the RO obtain an addendum VA medical opinion that adequately addresses the Veteran’s claims on a secondary basis. The basis for this remand was due to the June 2020 VA examiner failing to provide an adequate rationale regarding the aggravation prong of a secondary service connection claim. Specifically, the Board relayed that the June 2020 VA examiner merely checked the box on the examination reporting that the Veteran’s service-connected hammertoe disability did not aggravate his peripheral neuropathy; however, the rationale cited for this conclusion only discussed causation. See Board Decision, December 2020; see also C&P Exam, June 2020. In March 2021, an addendum VA medical opinion was completed in response to the Board’s December 2020 remand. However, upon review, the Board finds this opinion to be inadequate for adjudicative purposes, as the examiner, once again, provided a rationale regarding aggravation that only discussed causation. Additionally, the Board notes that the March 2021 examiner failed to provide any etiology opinion regarding the Veteran’s peripheral neuropathy of the right lower extremity, citing that she did not find any objective evidence of right lower extremity radiculopathy on the examination. However, the Board notes that the claim is not of radiculopathy, but that of peripheral neuropathy; and such, a lack of diagnosis of radiculopathy should not negate an opinion regarding neuropathy. Also, a review of the examination reflects that the examiner noted “Bilateral neuropathy, left lower extremity” in the diagnosis section. Thus, the Board is unclear whether the examiner meant to exclude a diagnosis of right lower extremity neuropathy or not. Nevertheless, the Board finds that given the Veteran has received a diagnosis of right lower extremity peripheral neuropathy within the record during the appeal period, a medical opinion regarding that diagnosis should have been given. If not supported by the medical evidence, the examiner was required to give an adequate rationale for the change in diagnosis from that which was previously given – which the Board notes the examiner did not do. Moreover, the record reveals that in June 2012, the Veteran’s treating VA podiatrist, who is a surgeon and VA Chief of Podiatry, provided an opinion stating that “it is at least as likely as not that the neuropathy in this Veteran’s feet and toes was caused by surgery performed in 1972 on his feet.” See VA treatment record, June 2012. However, to date, no VA examiner has considered and/or discussed this favorable VA medical opinion. When VA provides the Veteran with an examination in a service connection claim, the examination must be adequate. Barr v. Nicholson, 21Vet. App.303, 311 (2007). As such, the Board finds that the Veteran should be provided another addendum VA medical opinion that adequately addresses the etiology of his claims, prior to re-adjudication of the claims and in compliance with Stegall Accordingly, a remand is necessary to adequately address the matters discussed above. The matters are REMANDED for the following action: 1. Request the Veteran to identify all medical providers (VA and private) from whom he has received treatment for his peripheral neuropathy of the bilateral lower extremities and obtain any outstanding records and associate them with the Veteran’s claims file. 2. After associating all newly acquired records with the claims file, send the claims file back to the March 2021 VA examiner to obtain an addendum VA medical opinion regarding the etiology of the Veteran’s peripheral neuropathy of the bilateral lower extremities. If the March 2021 VA examiner is unavailable, forward the claims file to another appropriate clinician. The entire claims file, including a copy of this remand, must be made available to the examiner, and note review of the record in the examination report. Any indicated tests or studies should be performed, and all material relevant evidence should be discussed. All pertinent medical complaints, symptoms, and clinical findings must be reported in detail. The Veteran should be scheduled for another examination if deemed necessary by the person providing the addendum report to address the following: (a) Opine whether it is at least as likely as not (50 percent or greater probability) the Veteran’s peripheral neuropathy of the bilateral lower extremities was proximately caused or aggravated by the Veteran’s service-connected bilateral hammertoe disability. Please note: the examiner must address both causation and aggravation in providing the opinions requested above. Additionally, the examiner must address the positive June 2012 VA medical opinion. (b) Any opinion should include a detailed rationale. The examiner should consider the entire claims file, and discuss the Veteran’s lay statements regarding the nature, onset, and chronicity of symptoms. The examiner is advised that the Veteran is competent to report symptoms, and that his reports must be considered in formulating the requested opinion. (Continued on the next page) (c) If the examiner is unable to offer the requested opinion, it is essential that the examiner offer a rational for the conclusion that an opinion could not be provided without resorting to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Hodges, 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.