Citation Nr: 22011307 Decision Date: 02/28/22 Archive Date: 02/28/22 DOCKET NO. 16-16 777 DATE: February 28, 2022 REMANDED Entitlement to service connection for complex regional pain syndrome with peripheral neuropathy of the left lower extremity is remanded. REASONS FOR REMAND The Veteran served on active duty in the Army from September 1984 to July 1987, and in the Marine Corps from December 1987 to December 1991. This case comes before the Board of Veterans' Appeals (Board) on appeal from a December 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Buffalo, New York, which denied complex regional pain syndrome (claimed as neuropathy). In a November 2018 decision, the Board remanded the appeal for additional development. In an October 2021 rating decision, the RO granted service connection for complex regional pain syndrome with peripheral neuropathy of the lower right extremity and assigned a 10 percent disability rating from April 7, 2014. That matter has accordingly been resolved. See Grantham v. Brown, 114 F.3d 1136 (Fed. Cir. 1997) (where an appealed claim for service connection is granted during the pendency of the appeal, a second notice of disagreement must thereafter be timely filed to initiate appellate review of "downstream" issues such as the compensation level assigned for the disability or the effective date of service connection). A supplemental statement of the case (SSOC)) was issued in October 2021, which continued to deny service connection for complex regional pain syndrome with peripheral neuropathy of the left lower extremity. The Veteran's VA claims file has been returned to the Board for further appellate proceedings. After review of the record, the Board regrets that another remand is necessary prior to readjudication of the remaining matter on appeal. In August 2021, the Veteran underwent a VA peripheral nerves condition examination to address the current nature and etiology of his claimed condition. Upon examination, the examiner diagnosed the Veteran with bilateral complex regional pain syndrome and bilateral lower extremity peripheral neuropathy; however, he failed to provide a nexus opinion as to the left lower extremity. In fact, the record reveals the examiner only provided an opinion regarding the etiology of the Veteran's right lower extremity, without any further discussion and/or consideration of his left lower extremity as it relates to his active duty service or his service-connected disabilities. Therefore, the Board finds that a remand is necessary to obtain a VA medical opinion regarding the etiology of the Veteran's claimed complex regional pain syndrome with peripheral neuropathy of the left lower extremity, in accordance with VA's duty to assist. The matters are REMANDED for the following action: Provide the Veteran with a VA medical opinion by an appropriate clinician to determine the nature and etiology of his claimed complex regional pain syndrome with peripheral neuropathy of the left lower extremity. The entire claims file, including a copy of this remand, must be made available to the examiner, and note review of the record in the examination report. Any indicated tests or studies should be performed, and all material relevant evidence should be discussed. All pertinent medical complaints, symptoms, and clinical findings must be reported in detail. If the examiner deems that another VA examination is needed to provide such opinion, schedule the Veteran for an examination. Following complete review of the record, the examiner must address the following: (a) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's complex regional pain syndrome with peripheral neuropathy of the left lower extremity had its onset during any period of active duty or is otherwise etiologically related to his active duty service, to include any in-service injuries to the left foot/ankle. (b) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's complex regional pain syndrome with peripheral neuropathy of the left lower extremity was proximately caused or aggravated by his service-connected disabilities, to include right ankle disability and complex regional pain syndrome with peripheral neuropathy of the right lower extremity. Please note: the examiner must address both causation and aggravation in providing the requested opinion. (c) Any opinion should include a detailed rationale. The examiner should consider the entire claims file, and discuss the Veteran's lay statements regarding the nature, onset, and chronicity of symptoms. The examiner is advised that the Veteran is competent to report symptoms, and that his reports must be considered in formulating the requested opinion. (d) If the examiner is unable to offer the requested opinion, it is essential that the examiner offer a rational for the conclusion that an opinion could not be provided without resorting to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. Katherine Kiemle Buckley Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Carter, 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.