Citation Nr: 21039685 Decision Date: 07/01/21 Archive Date: 07/01/21 DOCKET NO. 17-00 430 DATE: July 1, 2021 REMANDED Entitlement to service connection for peripheral neuropathy of the left lower extremity is remanded. Entitlement to service connection for peripheral neuropathy of the right lower extremity is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1969 to March 1971, to include service to the Republic of Vietnam. He contends that his peripheral neuropathy of the bilateral lower extremities is related to his active duty service. Alternatively, the evidence of record reasonably raises a possible secondary service connection theory of entitlement. Specifically, the Veteran stated in his December 2016 VA Form 9 that he was told by his private doctor that his peripheral neuropathy could be attributable to his service-connected disabilities stemming from gunshot wounds he sustained to his stomach in service. In October 2016, the Veteran underwent a VA examination in which he was diagnosed with "idiopathic sensory motor polyneuropathy." However, the examiner's opinion conflates the issues of direct and secondary service connection, stating generally that the "cause is not from the left side belly [service connected] wound" because there was no "nerve anatomy" in the "belly that would cause or contribute to a lower extremity issue." No further explanation was provided as to how the examiner arrived at this conclusion, which leaves the Board in the prohibited position of substituting its own medical judgment to evaluate the veracity of the underlying rationale. Additionally, the examiner failed to address whether the Veteran's conceded exposure to herbicides while serving in Vietnam may have been the cause of his diagnosed peripheral neuropathy. As such, the October 2016 VA examiner's opinion is inadequate to adjudicate the claim. Remand is needed to afford the Veteran a new VA examination with a more thoroughly reasoned opinion that considers all theories of entitlement. Remand is also needed to obtain any outstanding VA and private treatment records. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records dated from November 2020 to the present and associate those documents with the Veteran's claims file. 2. Ask the Veteran to complete a VA Form 21-4142 identifying his private medical providers. Make two requests for the authorized records unless it is clear after the first request that a second request would be futile. 3. Schedule the Veteran for a VA examination to determine the nature and etiology of his bilateral lower extremity peripheral neuropathy. The claims file and a copy of this remand will be made available to the examiner, who will acknowledge receipt and review of these materials. The examiner should then answer the following questions: (a.) Please identify all diagnoses related to the Veteran's bilateral lower extremity peripheral neuropathy. (b.) Is it as likely as not (50 percent or greater probability) that any diagnosed condition identified above either had its onset in or is otherwise related to the Veteran's active duty service, to include his conceded exposure to herbicides while serving in Vietnam, as well as his in-service gunshot wounds to the stomach? (c.) Is it as likely as not (50 percent or greater probability) that any diagnosed condition identified above was caused or aggravated (i.e., any increase in disability) by his service-connected disabilities, particularly his residuals of a perforation of the stomach and transverse colon or retained metallic body near the fourth left rib? A complete rationale should be provided for any opinion. If the examiner cannot provide an opinion without resort to speculation, the examiner should provide an explanation as to why this is so and note what, if any, evidence would permit such an opinion to be made. (Continued on the next page) 4. Confirm that the VA medical opinions provided comport with this remand. Specifically, ensure that the standard for secondary aggravation opinions is any increase in disability, not the standard of "beyond the natural progression" as noted on the examination form itself. If the incorrect standard is applied, obtain an addendum opinion prior to readjudication of the claim. J. Komperda Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Jarman, 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.