Citation Nr: 23057749 Decision Date: 10/24/23 Archive Date: 10/24/23 DOCKET NO. 17-14 242 DATE: October 24, 2023 REMANDED Entitlement to service connection for radiculopathy of the left upper extremity is remanded. Entitlement to service connection for radiculopathy of the left lower extremity is remanded. Entitlement to service connection for a prostate condition, excluding erectile dysfunction, is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1972 to November 1972. These matters are before the Board of Veterans' Appeals (Board) on appeal from a February 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In March 2013 and August 2019, hearings were held before a Veterans Law Judge (VLJ). Transcripts of the hearings are in the record. In September 2023, the Veteran was informed that the VLJ who presided over the hearings was no longer employed by the Board. He was advised to submit a request for another hearing within 30 days if he wished to have one. In a September 2023 correspondence, the Veteran indicated that he did not wish to appear at another Board hearing. Therefore, the Board will proceed with adjudication of the claims. A March 2023 rating decision awarded service connection for posttraumatic stress disorder (PTSD) and assigned a 70 percent rating, effective March 28, 2013, and a 50 percent rating, effective January 19, 2023. A June 2023 rating decision awarded service connection for arteriosclerotic heart disease and assigned a 100 percent evaluation, effective January 23, 2014. A July 2023 rating decision awarded an increased 50 percent rating (the maximum schedular rating), effective March 28, 2013, for the Veteran's service-connected migraine headaches. The decision also awarded a total disability rating for individual unemployability (TDIU), effective March 28, 2013. As the decisions constitute a full grant of the claims previously before the Board, the matters are no longer before the Board and will not be discussed further. REFERRED During the August 2019 Board hearing, the Veteran's attorney indicated that the Veteran wished to recharacterize his claim seeking service connection for numbness of the left leg and left arm to a claim seeking service connection for the bilateral upper and lower extremities. He asked that any claims the Board did not have jurisdiction to review be referred to the RO for adjudication. In February 2015, the Veteran filed a claim seeking service connection for "peripheral neuropathy." In a February 2017 letter, the Veteran was asked to clarify whether he intended to file claims for peripheral neuropathy of the right upper and right lower extremities as claims for the left upper and left lower extremities were already on appeal. In a February 2017 response, the Veteran and his attorney stated that they wished to file claims for peripheral neuropathy of the right upper and lower extremities. However, in a March 2017 letter, the RO informed the Veteran that the claim needed to be submitted on a standardized form. Thus, the claim seeking service connection for peripheral neuropathy of the right upper and lower extremities was never adjudicated. As the record indicates that the Veteran intended to file a claim seeking service connection for peripheral neuropathy of the right upper and lower extremities, the Board has referred the issue to the RO for appropriate action. ? 1. Entitlement to service connection for radiculopathy of the left upper extremity is remanded. 2. Entitlement to service connection for radiculopathy of the left lower extremity is remanded. 3. Entitlement to service connection for a prostate condition, excluding erectile dysfunction, is remanded. The Board finds further development is required before a decision can be made on the Veteran's claims. First, the Veteran submitted VA Form 21-4142 in February 2015, authorizing VA to obtain private treatment records from Dr. W.P. A February 2015 notice from the Private Medical Records Retrieval Center to the RO indicates that the authorization form had expired, but the RO did not notify the Veteran so that he could submit an updated request. Therefore, the Board finds remand is required to allow the Veteran to submit another VA Form 21-4142 to allow the RO to obtain any authorized records of private treatment, including records from Dr. W.P. Second, the Veteran reported receiving VA treatment at the Nashville VA Medical Center beginning in March 2013. However, the earliest VA treatment records included in the file are from January 2014. On remand, the RO should attempt to obtain any outstanding VA treatment records for the period from March 2013 to January 2014. Third, and finally, in the August 2020 remand, the Board, in pertinent part, asked that the RO schedule the Veteran for VA examinations to determine the etiology of his claimed numbness in the left arm and leg. Specifically, a VA examiner was asked to provide an opinion as to whether it is at least as likely as not the Veteran's claimed conditions onset during service, manifested within a year of discharge from service, or were noted in service with continuity of the same symptomatology since service. Additionally, the examiner was asked to opine on whether it is at least as likely as not the Veteran's claimed conditions were caused or aggravated by his psychiatric disorder. In January 2023, the Veteran underwent a VA examination and was diagnosed with radiculopathy of the upper and lower extremities. The examiner then opined that it is less likely than not the Veteran's conditions began during service, manifested within a year of separation from service, and were noted during service with continuity of the same symptomatology since service. The examiner also opined that the conditions were not caused or aggravated by his psychiatric disorder. The examiner did not provide any rationale in support of the opinions. In February 2023, an addendum opinion was obtained, and the examiner opined that the Veteran's claimed conditions were not directly related to service or secondary to his psychiatric disorder as there is no medical evidence to support an injury that would have caused the radiculopathy that affects the left hand found from either the 9 months the Veteran served or after his release. The examiner also indicated that there is no mention of neck pain until 2013, which is 41 years after service. In June 2023, additional opinions were obtained, and an examiner opined that the Veteran's claimed conditions were less likely than not incurred in or caused by service and less likely than not caused or aggravated by his psychiatric disorders. The examiner summarized evidence in the record and then indicated that the Veteran's alcohol use raises concerns for alcoholic neuropathy as Healthline indicates that alcohol can be toxic to nerve tissue which can lead to feeling pain and tingling in the limbs, but then indicated that the Veteran has not been diagnosed with alcoholic neuropathy. Additionally, the examiner indicated that the Mayo Clinic does not demonstrate a correlation between radiculopathy and PTSD. The examiner then concluded that, while the Veteran has a diagnosis of PTSD and alcohol use disorder, there is no medical or scientific evidence showing a relationship between the Veteran's claimed conditions and the PTSD and/or alcohol use disorder. However, the Board finds the opinions inadequate as the examiners failed to provide adequate rationales in support of the opinions. In this regard, none of the examiners addressed the Veteran's testimony at the August 2019 Board hearing in which he indicated that he began experiencing symptoms related to his conditions during service and that the symptoms continued after his separation from service. Additionally, the examiners did not provide adequate rationale for the conclusions that the conditions were not caused or aggravated by the Veteran's psychiatric disorder. Therefore, remand for new medical opinions is necessary. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records, including for the period from March 2013 to January 2014 and from September 2023 to the present. Any negative search result should be noted in the record. 2. Ask the Veteran to complete a VA Form 21-4142 for any private treatment he has received for his claimed conditions, to include any records from Dr. W.P. Make two requests for any authorized records, unless it is clear after the first request that a second request would be futile. If any of the records requested are unavailable, clearly document the claims file to that effect and notify the Veteran of any inability to obtain these records, in accordance with 38 C.F.R. § 3.159(e). 3. After obtaining any additional records, forward the Veteran's claims file to an appropriate clinician (other than any examiner who has previously provided an opinion in these matters) for a medical opinion addressing the etiology of his radiculopathy of the left upper and lower extremities. An examination should only be scheduled if the examiner deems one is necessary to provide the requested opinion. Following a review of the claims file, the examiner is asked to respond to the following: **For the sake of clarity, please respond to each question separately.? Left Upper Extremity (a) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) the Veteran's left upper extremity radiculopathy onset during service, manifested within a year of discharge from service, or was noted in service with continuity of the same symptomatology since service. In providing this opinion, consider the Veteran's testimony at the August 2019 Board hearing that his symptoms onset during service and continued after separation from service. (b) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) the Veteran's left upper extremity radiculopathy was caused by his service-connected psychiatric disability? (c) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) the Veteran's left upper extremity radiculopathy was aggravated by his service-connected psychiatric disability? Left Lower Extremity (a) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) the Veteran's left lower extremity radiculopathy onset during service, manifested within a year of discharge from service, or was noted in service with continuity of the same symptomatology since service. In providing this opinion, consider the Veteran's testimony at the August 2019 Board hearing that his symptoms onset during service and continued after separation from service. (b) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) the Veteran's left lower extremity radiculopathy was caused by his service-connected psychiatric disability? (c) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) the Veteran's left lower extremity radiculopathy was aggravated by his service-connected psychiatric disability? A complete rationale for all opinions must be provided. M. SORISIO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S.J. 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.