Citation Nr: 21032422 Decision Date: 05/27/21 Archive Date: 05/27/21 DOCKET NO. 13-23 432 DATE: May 27, 2021 REMANDED Entitlement to a separate rating for right lower extremity (RLE) radiculopathy/ neuropathy associated with service-connected low back disability is remanded. Entitlement to service connection for bilateral upper extremity (BUE) peripheral neuropathy, to include as due to exposure to herbicide agents, is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1969 to February 1985. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a May 2012 rating decision issued by a Department of Veterans' Affairs (VA) Regional Office. In November 2014, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. In May 2015, January 2018 and February 2020, the Board remanded the case for additional development and it now returns for further appellate review. 1. Entitlement to a separate rating for RLE radiculopathy/neuropathy associated with service-connected low back disability. 2. Entitlement to service connection for BUE peripheral neuropathy, to include as due to exposure to herbicide agents. In February 2020, the Board remanded the issues on appeal due to inconsistencies in the record that needed to be reconciled. In this regard, the Board noted that, based on reported symptoms of mild constant pain, moderate intermittent pain, mild paresthesias and/or dysesthesias, and moderate numbness in the RLE, an August 2015 VA examiner indicated that the Veteran had generalized peripheral neuropathy in the lower extremities; however, he then reported that the Veteran did not have RLE neuropathy. The Board further observed that the August 2015 VA examiner diagnosed generalized BUE peripheral neuropathy, but concluded there was no evidence of a neuropathy that began in service, as there was no documentation of such disorder while in service or years after, or was related to the Veteran's acknowledged in-service exposure to herbicide agents as such was not presumptively related to such exposure; however, he did not offer an opinion as to whether such disorder was directly related to the Veteran's in-service exposure to herbicide agents. The Board also observed that, in an attempt to reconcile the conflicting findings rendered at the August 2015 VA examination in regard to the presence of RLE radiculopathy/neuropathy, a February 2018 VA examiner opined that there was no evidence of a RLE radiculopathy or other peripheral neuropathy related to the Veteran's back disability. Additionally, in regard to whether the Veteran's BUE peripheral neuropathy was related to his acknowledged in-service exposure to herbicide agents, the February 2018 VA examiner opined that, while he had such diagnosis, there was no evidence of a peripheral nerve injury or disability, causative association between herbicide exposure and later development of neuropathy, or nexus or current pathology to link peripheral neuropathy to the Veteran's military service. Then, in an April 2019 addendum opinion, the same VA examiner found that the Veteran did not have evidence of RLE or BUE neuropathies at the August 2015 VA examination. Thus, as the February 2018/April 2019 VA examiner did not reconcile the August 2015 finding of generalized peripheral neuropathy of the lower extremities with the ultimate conclusion that the Veteran did not have RLE neuropathy, the Board remanded the issue to obtain another addendum opinion addressing such matter. Furthermore, as additionally received service treatment records (STRs) reflected complaints referable to the RLE and BUE, the Board remanded both issues for an addendum opinion that considered such newly received relevant evidence. Thereafter, the Veteran underwent VA back and peripheral neuropathy examinations in December 2020, at which time no evidence of RLE radiculopathy or any peripheral neuropathy disorder, to include such affecting the RLE and BUE, was found. Further, the VA examiner opined that the Veteran's claimed disorders were unrelated to his military service as there was no evidence of a current disability. In this regard, he observed that there were no findings on physical examination to warrant a diagnosis of RLE radiculopathy or RLE or BUE peripheral neuropathy, and an EMG in 2012 of the RLE was negative for any such findings. However, the December 2020 VA examiner did not reconcile his determination that the Veteran did not have RLE or BUE peripheral neuropathy with the August 2015 VA examination findings of generalized lower and upper extremity peripheral neuropathy. Thus, there has not been substantial compliance with the February 2020 Remand directives and another remand is necessary in order to obtain an addendum opinion addressing such matter. Stegall v. West, 11 Vet. App. 268, 271 (1998). The matters are REMANDED for the following action: Return the file, to include a copy of this Remand, to the December 2020 VA examiner, or an appropriate substitute if he is unavailable, for another addendum opinion addressing the nature and etiology of the Veteran's claimed RLE radiculopathy/neuropathy and BUE peripheral neuropathy. Following a review of the record, the examiner should address the below inquires: (A) (1) Does the Veteran has RLE radiculopathy and/or neuropathy associated with his back disability that has been present at any time proximate to his May 2010 claim, even if such is asymptomatic or has resolved? If the examiner finds that the Veteran does not have a diagnosis of RLE radiculopathy and/or neuropathy, he or she should reconcile such determination with the finding of generalized peripheral neuropathy of the lower extremities noted at the August 2015 VA examination. Further, the examiner is advised that, while the Veteran has a separate diagnosis of meralgia paresthetica unrelated to his back disability, such affects the thigh, and the Veteran has consistently reported radiating pain down the leg and numbness of the feet. (2) If the Veteran has RLE radiculopathy and/or neuropathy associated with his back disability, the examiner should indicate whether such is characterized by mild incomplete paralysis, moderate incomplete paralysis, moderately severe incomplete paralysis, severe incomplete paralysis or complete paralysis of the affected nerve. The examiner should clearly delineate all functional impairments caused by the RLE. (B) (1) Does the Veteran have BUE peripheral neuropathy that has been present at any time proximate to his May 2010 claim, even if such is asymptomatic or has resolved? If the examiner finds that the Veteran does not have a diagnosis of BUE peripheral neuropathy, he or she should reconcile such determination with the finding of generalized BUE peripheral neuropathy noted at the August 2015 VA examination. (2) If so, is it at least as likely as not (i.e., at least a 50 percent probability or greater) that the Veteran's BUE peripheral neuropathy had its onset in, or is otherwise related to, his military service, to include his acknowledged in-service exposure to herbicide agents? In offering such opinion, the examiner is advised that the sole basis for a negative opinion cannot be that BUE peripheral neuropathy is not on the list of diseases subject to presumptive service connection based on exposure to herbicide agents. The examiner is also advised that, in addressing the opinions requested in (A)(1) and (B)(2), he or she should consider the Veteran's STRs reflecting complaints of contralateral pain in the RLE and radiculitis of the bilateral lower extremities, both of which were associated with the evaluation of his back disability, in August 1984 and November 1984, and reports of weakness in the upper right extremity in August 1984; a July 1987 VA examination reflecting complaints of numbness in the right leg and left arm/hand; and the August 2015 VA examination showing a finding of generalized lower and upper extremity peripheral neuropathy. A rationale for any opinion offered should be provided. A. JAEGER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Spielmann, Jill F. 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.