Citation Nr: 21041432 Decision Date: 07/09/21 Archive Date: 07/09/21 DOCKET NO. 17-63 601 DATE: July 9, 2021 REMANDED Service connection for numbness, left lower extremity (claimed as left leg, ankles, and toes) is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1988 to July 1991. This matter comes before the Board of Veterans' Appeals (Board) from a September 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In October 2019, the Veteran testified before the undersigned Veterans Law Judge. The Board, in pertinent part, denied service connection for the issue on appeal in a February 2020 decision. The Veteran appealed the decision to the United States Court of Appeals for Veterans Claims (the Court). In a March 2021 Joint Motion for Partial Remand (JMPR), the Court vacated the February 2020 decision as it pertains to this matter and remanded the appeal for action consistent with the JMPR. Service connection for numbness, left lower extremity (claimed as left leg, ankles, and toes) is remanded. The Veteran contends his left lower extremity numbness, which reportedly affects his left leg, ankles, and toes is secondary to his service-connected tibia and fibula disabilities. See, e.g., October 2019 Board hearing transcript at 18. Alternatively, he contends his numbness is due to environmental exposures in Southwest Asia. In the March 2021 JMPR, the Court found the Board relied on an inadequate July 2017 VA medical examination and opinion. The JMPR indicates the examiner did not provide a well-reasoned medical explanation for her findings that the medical literature does not support an etiological link between left lower extremity numbness and service in Southwest Asia and that the Veteran has a diagnosable chronic multi symptom illness with a partially-explained etiology. Accordingly, the Court directed that a new examination must be obtained, and the opinion provided must be supported with a well-reasoned medical explanation. The matters are REMANDED for the following action: Schedule the Veteran for an appropriate examination to determine the nature and etiology of his claimed left lower extremity numbness. The examiner must review the claims file. The examiner should conduct all appropriate diagnostic testing. The examiner should then record all noted signs and reported symptoms, document all clinical findings, and provide a diagnosis if possible. The examiner is asked to provide responses to the following: A) Identify the Veteran's objective indications of a disability. "Objective indications" of a qualifying chronic disability include both objective evidence perceptible to an examining physician and other non-medical indicators that are capable of independent verification. 38 C.F.R. § 3.317(a)(3). Non-medical indicators include evidence such as time lost form work, the veteran having sought treatment for his symptoms, and change in the veteran's appearance, physical abilities, and mental or emotional attitude. 60 Fed. Reg. 6661, 6663 (Feb. 3, 1995). B) By history, physical examination, or laboratory testing, can the Veteran's objective indications of a left lower extremity numbness disability be attributed to a known clinical diagnosis? If the signs and symptoms are not characteristic of a known clinical diagnosis, the examiner should so indicate. There is no requirement that the examiner provide a diagnosis of undiagnosed illness. C) If the Veteran's objective indications cannot be attributed to a known clinical diagnosis, is there affirmative evidence that the undiagnosed illness is not incurred during active service during the Persian Gulf War or that it was caused by a supervening condition or event that occurred since the Veteran's departure from service during the Persian Gulf War? The examiner should note that a positive response to this question requires affirmative evidence. The mere absence of evidence is not sufficient. D) If the Veteran's objective indications can be attributed to a known clinical diagnosis, is the etiology of the Veteran's condition (1) inconclusive, (2) partially understood, or (3) fully understood? This determination as to each must be based on the Veteran's specific case and cannot be based on the etiology of the disease or disability population as a whole. E) If the Veteran's objective indications can be attributed to a known clinical diagnosis, is the pathophysiology of the Veteran's condition (1) inconclusive, (2) partially understood, or (3) fully understood? This determination as to each must be based on the Veteran's specific case and cannot be based on the pathophysiology of the disease or disability population as a whole. F) If both the etiology and pathophysiology are partially understood or fully understood, then is it at least as likely as not (a 50 percent or greater probability) that the Veteran's diagnosed condition was incurred in, or is otherwise related to, his active service and the environmental exposures in Southwest Asia? A well-explained rationale must be provided for all opinions expressed. If the requested opinions cannot be provided without resorting to speculation, the examiner should provide an explanation as to why speculation is required. D. JOHNSON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M.Aoughsten, 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.