Citation Nr: 21027912 Decision Date: 05/07/21 Archive Date: 05/07/21 DOCKET NO. 16-19 013A DATE: May 7, 2021 REMANDED Entitlement to service connection for peripheral neuropathy of the left lower extremity, to include as due to exposure to herbicide agents, is remanded. Entitlement to service connection for peripheral neuropathy of the right lower extremity, to include as due to exposure to herbicide agents, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from January 1966 to January 1968, to include service in Vietnam. His decorations include the National Defense Service Medal and the Vietnam Campaign Medal. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a November 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office in St. Paul, Minnesota. This case was previously before the Board in September 2018 and June 2020, when it was remanded to the agency of original jurisdiction (AOJ) for additional development. On both occasions, after taking further action, the AOJ confirmed and continued the prior denial and returned the case to the Board. Although the Board sincerely regrets the additional delay, a remand is necessary to ensure that there is a complete record upon which to decide the Veteran's claim and to afford him every possible consideration. 1. Entitlement to service connection for peripheral neuropathy of the left lower extremity, to include as due to exposure to herbicide agents, is remanded. 2. Entitlement to service connection for peripheral neuropathy of the right lower extremity, to include as due to exposure to herbicide agents, is remanded. The Veteran contends that he has peripheral neuropathy of the lower extremities that is due to service. In pertinent part, he has contended that his symptoms began in service and have continued since. The evidence reflects that the Veteran served on active duty in the Republic of Vietnam between January 9, 1962, and May 7, 1975. As such, he is presumed to have been exposed to herbicide agents. See 38 C.F.R. § 3.307(a)(6)(iii). The Board last remanded this case in June 2020, in part, to obtain an addendum medical opinion to address the relationship between the Veteran's presumed exposure to herbicide agents and the diagnosed peripheral neuropathy of his lower extremities. The examiner was instructed to consider the Veteran's lay statements regarding symptoms of tingling in the bilateral lower extremities, which he has stated began during service and have continued to the present. Pursuant to the Board's remand, an in-person VA examination was conducted in February 2021. The examiner diagnosed peripheral neuropathy of the bilateral lower extremities and offered a negative nexus opinion, finding that it was "less likely as not" that the Veteran's bilateral peripheral neuropathy had its onset in service, or was otherwise related to the Veteran's active service, including his presumed exposure to herbicide agents. In reaching her conclusion, the examiner noted, in part, that "there is no direct pathophysiologic relationship between the neuropathy of lower extremity condition and the herbicide agent exposure." Early-onset peripheral neuropathy is one of the conditions presumptively associated with herbicide exposure. See 38 C.F.R. §§ 3.307, 3.309(e). As noted, the Veteran has reported that he has had symptoms of neuropathy since service. Such complaints could be at least theoretically consistent with early onset peripheral neuropathy. The examiner did not address the theory of early onset peripheral neuropathy, and her statement that there is no direct pathophysiologic relationship between the neuropathy of lower extremity condition and herbicide agent exposure appears to be at least facially inconsistent with the fact that early-onset peripheral neuropathy is recognized as presumptively associated with such exposure. Under the circumstances, a new examination is required. Barr v. Nicholson, 21 Vet. App. 303 (2007) (if VA provides a medical examination or medical opinion, the duty to assist mandates that it be adequate). These matters are REMANDED for the following action: 1. Obtain copies of records pertaining to any VA treatment the Veteran has received since the time that such records were last procured, following the procedures set forth in 38 C.F.R. § 3.159. The evidence obtained, if any, should be associated with the record. 2. After the foregoing development has been completed to the extent possible, arrange for the claims file to be reviewed by the VA examiner who prepared the February 2021 VA examination report (or a suitable substitute if that examiner is unavailable) for the purpose of preparing an addendum opinion. If the examiner finds that another examination of the Veteran is required, one should be undertaken. After reviewing the record, the examiner should offer another opinion as to whether it is at least as likely as not (i.e., whether it is 50 percent or more probable) that the Veteran's bilateral peripheral neuropathy had its onset in, or is otherwise attributable to, his period of active service, to include his presumed in-service exposure to herbicide agents. In so doing, the examiner should discuss the medical significance, if any, of the Veteran's lay statements regarding symptoms of tingling in the bilateral lower extremities, which he has reported began during service and have continued to the present. The examiner is asked to specifically address whether it is at least as likely as not that the Veteran has early-onset peripheral neuropathy of either lower extremity. In assessing the Veteran's lay statements with respect to continuity of symptoms since service, the examiner should refrain from discounting the lay statements solely on the basis that there are no medical records available to corroborate them. A complete medical rationale for all opinions expressed must be provided. 3. After completing the above, and any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraphs, the issues on appeal should be readjudicated based on the entirety of the evidence. If any benefit sought remains denied, the Veteran and his representative should be issued a supplemental statement of the case. An appropriate period of time should be allowed for response. DAVID A. BRENNINGMEYER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Joseph T. Leonard, 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.