Citation Nr: 21040868 Decision Date: 07/07/21 Archive Date: 07/07/21 DOCKET NO. 16-45 040 DATE: July 7, 2021 REMANDED Entitlement to service connection for peripheral neuropathy of the bilateral lower extremities is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from April 1969 to November 1970. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a September 2013 rating decision issued by a regional office (hereinafter agency of original jurisdiction or AOJ) of the Department of Veterans Affairs (VA). The Board previously remanded these issues, as well as entitlement to service connection for a duodenal ulcer, for further development in November 2018. In a July 2020 rating decision, the AOJ granted entitlement to service connection for a duodenal ulcer, effective the date of the Veteran's initial claim. This constitutes a full grant of the benefits sought. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997). 1. Entitlement to service connection for peripheral neuropathy of the bilateral lower extremities is remanded. The Board previously remanded this issue in November 2018 in order to obtain additional examination and opinion evidence regarding the nature and etiology of the Veteran's bilateral lower extremity peripheral neuropathy. The remand directives instructed the VA examiner to provide an opinion with regard to both neuropathy and, if applicable, muscle atrophy of the bilateral lower extremities. The Veteran was afforded a VA peripheral nerve examination in December 2019. The examiner recorded a diagnosis of bilateral lower extremity neuropathy and noted the Veteran reported first experiencing an intense burning sensation in his legs in the 1970's. The examiner opined that the Veteran's right lower extremity neuropathy was less likely than not due to service, as there was no evidence of a diagnosis of neuropathy during service or within one year of separation. This opinion did not address the Veteran's left lower extremity neuropathy, or the bilateral calf muscle atrophy identified upon examination. The Board is obligated by law to ensure that the AOJ complies with its directives; where the remand orders of the Board are not complied with, the Board errs as a matter of law when it fails to ensure compliance. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Therefore, remand is necessary to obtain an addendum VA medical opinion in compliance with the Board's November 2018 remand directives. Additionally, the Board observes that the Veteran has alternatively reported the onset of peripheral neuropathy symptoms in the 1970's or early 1980's, and December 2009 VA treatment records note "suspected hereditary sensorimotor polyneuropathy." The Board further observes that early onset peripheral neuropathy is a condition listed in 38 C.F.R. § 3.309(e) as presumptively caused by herbicide exposure, and the Veteran's in-service exposure to tactical herbicides has been conceded. As such, the examiner should address whether the Veteran's bilateral lower extremity neuropathy is considered "early onset" for the purposes of presumptive service connection. 2. Entitlement to a TDIU is remanded. The lay and medical evidence of record indicates the Veteran's peripheral neuropathy of the bilateral lower extremities creates significant functional impairment. As a decision on this issue could significantly impact a decision on the issue of entitlement to a TDIU, they are inextricably intertwined. See Harris v. Derwinski, 1 Vet. App. 180 (1991). As such, the Board defers consideration of this issue at this time. The matters are REMANDED for the following action: 1. Obtain and associate with the claims folder all updated VA treatment records. Ask the Veteran to complete a VA Form 21-4142 for his non-VA medical care providers following his discharge from service until the present, to the best of his recollection, for any relevant private treatment records, particularly those documenting the onset of his peripheral neuropathy symptoms. 2. Then, forward the claims file to a qualified VA examiner in order to obtain an addendum opinion. The need for an additional examination is left to the discretion of the examiner. The examiner is asked to clarify, based on the lay and medical evidence of record, the nature of the Veteran's bilateral lower extremity neuropathy, to include whether it can be characterized as "early-onset." The examiner is then asked to opine: (a.) Whether the Veteran's bilateral lower extremity neuropathy with associated muscle atrophy at least as likely as not (50 percent or greater probability) first manifested in or is otherwise due to his active service, to include whether it is as least as likely as not to have been caused by his conceded in-service herbicide exposure. A complete rationale must be provided for any conclusion(s) reached. In formulating the requested opinion(s), the examiner is asked to specifically discuss: The Veteran's lay statements reporting a 1970's or early 1980's onset of peripheral neuropathy symptoms. December 2009 VA treatment records noting suspected hereditary polyneuropathy as well as July 2014 records noting no nerve root impingement and the absence of a diagnosis of diabetes mellitus. 3. Then, readjudicate the issues on appeal. Idongesit T. Umo Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. C. Schumacher, 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.