Citation Nr: 21030482 Decision Date: 05/19/21 Archive Date: 05/19/21 DOCKET NO. 14-43 493 DATE: May 19, 2021 REMANDED Entitlement to an initial compensable disability rating for left upper extremity peripheral neuropathy prior to September 28, 2011, and in excess of 20 percent thereafter is remanded. Entitlement to an initial compensable disability rating for right upper extremity peripheral neuropathy prior to September 28, 2011, and in excess of 20 percent thereafter is remanded. Entitlement to an initial compensable disability rating for left lower extremity peripheral neuropathy prior to September 28, 2011, and in excess of 10 percent prior to April 22, 2014, and in excess of 20 percent prior to December 21, 2020, and in excess of 40 percent thereafter is remanded. Entitlement to an initial compensable disability rating for right lower extremity peripheral neuropathy prior to September 28, 2011, and in excess of 10 percent prior to April 22, 2014, and in excess of 20 percent prior to December 21, 2020, and in excess of 40 percent thereafter is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) prior to August 15, 2015 for service-connected disabilities is remanded. Entitlement to special monthly compensation (SMC), based on the need for aid and attendance or housebound status, due to service-connected disabilities is remanded. INTRODUCTION The Veteran served on active duty from September 1964 to January 1965 and March 1966 to March 1969. In June 2017, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. When this case was previously before the Board in May 2018, the above-noted issues were remanded for additional development. The case has since been returned for further appellate review. REASONS FOR REMAND While additional delay is unfortunate, the Board finds further development is required before the Veteran's claims are decided. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Further, a remand by the Board confers upon the claimant, as a matter of law, the right to compliance with the remand instructions, and imposes upon VA a concomitant duty to ensure compliance with the terms of the remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998). In the course of the May 2018 decision, the Board found a VA examination by a Board Certified Neurologist was necessary in order to assist in determining the extent and severity of the Veteran's service-connected disabilities. The Board also specifically requested retrospective medical opinions from the Neurologist, with respect to the impairments the Veteran has faced, to include whether those impairments resulted in his inability to obtain and maintain substantially gainful employment or required the aid and attendance of another. The Board observed that during a January 2014 VA examination, the examiner found the Veteran had a severe right upper extremity incomplete paralysis, as well as a moderately severe bilateral lower extremity incomplete paralysis. Additionally, the Veteran previously provided two VA Form 21-2680 Examinations for Housebound Status or Permanent Need for Aid and Attendance that were completed by his treating clinician. These examinations show the Veteran exhibited decreased strength and endurance of the upper and lower extremities, loss of balance, and an impaired gait. In addition, these examinations show the Veteran required the use of a rollator walker to ambulate. Unfortunately, these examinations did not focus solely on the Veteran's service-connected peripheral neuropathies and appeared to take into consideration impairments caused by non-service connected disabilities. Following the May 2018 remand, the Veteran underwent several VA examinations in July 2019, December 2020, and March 2021. Initially, the Board notes the July 2019 and December 2020 VA examinations were performed by Nurse Practitioners, and as such, do not comply with the Board's remand instructions. Nonetheless, the Board does note the December 2020 VA examiner found that as a result of the Veteran's service-connected disabilities he walked slowly with an antalgic gait, scraped his feet, and had decreased coordination and balance. During examination the Veteran reported that he required assistance with meal preparation, and the examiner found the Veteran required assistance with dressing/undressing, bathing, grooming, and cleaning. The examiner further stated the Veteran had restrictions with grip, fine movements, shaving, locomotion/propulsion, and weight-bearing. Curiously, the December 2020 examiner found there was a 50 percent or better probability that the Veteran's service-connected polyneuropathies were sufficient to preclude him from obtaining or maintaining any form of substantially gainful employment prior to August 17, 2015, but then stated that could be the date upon which the Veteran was precluded from substantially gainful employment. The Veteran underwent VA aid and attendance and peripheral nerves examinations with a Board Certified Neurologist in March 2021. Following those examinations, the examiner also provided two medical opinions with respect to the Veteran's ability to maintain gainful employment. In the course of his aid and attendance examination, the examiner found the Veteran holds the wall and walks cautiously when he ambulates. The examiner also indicated the Veteran does require assistance with his activities of daily living. During his peripheral nerves assessment, the examiner acknowledged the Veteran is "barely able to walk and can't use his hands safely." The examiner further indicated that as a result of his polyneuropathies, the Veteran was not able to perform even sedentary employment, because weakness, pain, and sensory changes would make such endeavors unsafe. Unfortunately, none of the above-noted VA examiners provided the comprehensive retrospective medical opinions previously requested, and as such, a remand is required in order to obtain addendum statements from the Neurologist who provided the March 2021 examinations. Accordingly, this case is REMANDED for the following actions: 1. Obtain addendum medical opinions from the March 2021 Board Certified Neurologist, if available, and if unavailable from another Board Certified Neurologist with sufficient expertise to determine the current severity of his service-connected upper and lower extremity peripheral neuropathies throughout the period under appeal. Another examination of the Veteran should be performed only if deemed necessary by the examiner providing the requested opinions. The electronic records should be made available to and reviewed by the examiner. a) The examiner is asked to review the Veteran's complete file, with particular attention to prior assessments of the Veteran's polyneuropathies, to specifically include all prior VA examinations, outpatient treatment records from the Houston, Shreveport, and Little Rock VAMCs, Social Security Administration records, and aid and attendance assessments performed by the Veteran's treating clinician in April 2015 and May 2016. Following a complete review of the Veteran's medical history, the examiner is asked to provide a retrospective opinion addressing the Veteran's functional impairments throughout the period of appeal, which began in September 2010. In this respect, the examiner is asked to provide concrete examples of the Veteran's functional abilities throughout this period, such as how long he could stand or sit, distance the Veteran could ambulate, in the case of his feet. The examiner should also state whether the Veteran experienced difficulties with his hands with activities such as grasping and manipulation as a result of his peripheral neuropathy. b) Additionally, the examiner is asked to comment on whether there was a 50 percent or better probability that the Veteran's service-connected polyneuropathies, either singularly or in concert, were sufficient to preclude him from obtaining or maintaining any form of substantially gainful employment consistent with his education and occupational background prior to August 17, 2015. If so, the examiner should provide a date upon which the Veteran was precluded from substantially gainful employment if possible. T. REYNOLDS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board G. Fraser, 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.