Citation Nr: 22019979 Decision Date: 04/03/22 Archive Date: 04/03/22 DOCKET NO. 18-15 015 DATE: April 3, 2022 REMANDED Entitlement to service connection for left lower extremity peripheral neuropathy is remanded. Entitlement to service connection for right lower extremity peripheral neuropathy is remanded. INTRODUCTION The Veteran served on active duty from January 1964 to December 1966, with service in the Republic of Vietnam. REASONS FOR REMAND Although unfortunate, the Board finds additional development is required prior to final adjudication of this matter. The Veteran asserts service connection is warranted for his bilateral lower extremity peripheral neuropathy. In particular, he claims the conditions were either caused by his exposure to herbicides in service, or alternatively, he claims they are consequentially related to his service-connected diabetes mellitus. Initially, the Board notes the RO has not obtained a legally sufficient medical opinion addressing the Veteran's claims. As such, a remand is required. The Board notes the Veteran underwent a VA diabetic peripheral neuropathy examination in June 2015. Initially, the examiner found the Veteran's peripheral neuropathy "developed well prior to the onset of diabetes," and as such, could not be attributed to that condition. In this regard, the examiner acknowledged the Veteran's reports that his lower extremity numbness first started around 2008. A review of the Veteran's private treatment records corroborates the Veteran's reports, showing he received treatment for numbness and tingling in October 2008. However, contrary to the June 2015 examiner's report, the Veteran also provided glucose test results from October 2008, which show highly elevated readings. This evidence casts doubt upon the June 2015 examiner's finding that the Veteran's peripheral neuropathy began well prior to the onset of diabetes. An opinion based upon an inaccurate factual premise has no probative value. Reonal v. Brown, 5 Vet. App. 458, 461 (1993). Next, the Board notes the June 2015 examiner indicated the delay in many years between the Veteran's exposure to herbicides and the development of his peripheral neuropathy made herbicide exposure an unlikely cause. Unfortunately, the examiner wholly failed to explain how or why he came to that conclusion. To be considered adequate, medical examination reports must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Based on the foregoing insufficiencies, the Board finds a remand is required in order to obtain a new examination and medical opinions. Accordingly, this case is REMANDED for the following actions: Afford the Veteran a VA examination by an Endocrinologist with sufficient expertise, who has not previously examined the Veteran, to determine the nature and etiology of the Veteran's claimed lower extremity neuropathy disabilities. All pertinent evidence of record must be made available to and reviewed by the examiner. Any required studies should be performed, and all clinical findings should be reported in detail. Based on a review of the evidence of record, lay statements, and examination results, the examiner should opine as to whether the Veteran's bilateral lower extremity peripheral neuropathies at least as likely as not (a 50 percent probability or greater): a) were incurred in service or are otherwise etiologically related to the Veteran's active service, to include as a result of his exposure to herbicides therein; b) are proximately due to his service-connected type II, diabetes mellitus; or c) were aggravated to any degree by his service-connected type II, diabetes mellitus. For these opinions, the examiner should note that the Veteran is competent to attest to factual matters of which he has first-hand knowledge, including events and symptoms. The examiner is asked to consider and expressly discuss the Veteran's reports relative to the onset of the claimed disabilities. Additionally, the examiner is asked to consider and expressly discuss the October 2008 medical reports from the Crossgates River Oaks Hospital, indicating the Veteran reported numbness and tingling in his legs at that time, and also had extensively elevated glucose levels on testing. The examiner must provide a complete rationale for all proffered opinions. If the examiner cannot provide the required opinions without resorting to speculation, he or she shall provide a complete explanation as to why that is the case and state whether the inability to provide the required opinions is based on a lack of knowledge among the medical community at large. T. REYNOLDS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board G. Fraser, 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.