Citation Nr: 21040965 Decision Date: 07/07/21 Archive Date: 07/07/21 DOCKET NO. 13-28 224 DATE: July 7, 2021 REMANDED Entitlement to service connection for a nerve disorder of the right upper extremity, to include peripheral neuropathy and carpal tunnel syndrome and as due to exposure to herbicide agents, is remanded. REASONS FOR REMAND The Veteran served honorably in the United States Army from February 1965 to February 1969, to include foreign service in Vietnam. This case comes before the Board of Veterans' Appeals (Board) on appeal of an April 2012 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). When this case was last before the Board in January 2021, it was remanded for additional development. The case has now been returned to the Board for further appellate consideration. The Veteran contends that his peripheral neuropathy and carpal tunnel syndrome are related to exposure to herbicide agents during his service in Vietnam. Service in Vietnam is confirmed by the Veteran's DD Form 214. As such, exposure to herbicide agents is conceded. Although VA has established a presumption of service connection due to herbicide agent exposure for some disorders, carpal tunnel syndrome is not on the list. 38 C.F.R. § 3.309 (e). Additionally, peripheral neuropathy is presumed service-connected due to herbicide agent exposure if it manifests to a degree of 10 percent or more within a year after the Veteran's herbicide agent exposure. 38 C.F.R. § 3.307 (a)(6)(ii). Nevertheless, a Veteran is not precluded from establishing service connection on a direct basis if the most probative evidence supports an etiological nexus between his current disability and herbicide agents. Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). In an addendum medical opinion provided in April 2021, the VA examiner stated that the Veteran's disability is less likely than not caused by his military service, stating that while the Veteran's statements about his symptoms are deemed credible, the veteran is not qualified to ascribe those symptoms to a diagnosis or etiology. Further, the Veteran's report that the symptoms began during active duty service are not corroborated by his service treatment records or post service medical records. However, the Veteran stated he sought medical treatment in service, because he had a tingling and sometimes a "pins and needles" sensation and experienced an unusual weakness and pain in the lower part of his right arm and hand. See Correspondence received May 2012. The Veteran stated the physician told him it was probably just a reaction to spending too much time on the machine gun, and it would subside overtime. This matter is REMANDED for the following action: 1. Schedule the Veteran for a VA examination to determine the nature and etiology of his nerve disorder of the right upper extremity. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file, including a copy of this remand, the Veteran's service treatment records, post-service medical records, and statements. After examining the Veteran, and considering his pertinent medical history and lay statements regarding his reported symptoms, the examiner should opine as to: a. Whether it is at least as likely as not (a 50 percent probability or greater) that his nerve disorder of the right upper extremity was etiologically related to his military service, to include exposure to herbicide agents. The examiner should also consider the Veteran's statements that pain began in service, he sought medical treatment for his tingling sensation and unusual weakness and pain in the lower part of his right arm and hand, and the medic's statement that the pain was due to the amount of time the Veteran spent on the machine gun. 2. A complete rationale should be provided for his/her opinion. The clinician is encouraged to cite to medical/scientific information to support his/her opinion as appropriate. The clinician is advised that a rationale that service connection for carpal tunnel syndrome is not appropriate because VA has not established a presumption for the disorder, or for peripheral neuropathy as it did not manifest within one year from service is insufficient and may require further development. B. G. LeMoine Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Townsend, 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.