Citation Nr: 24017131 Decision Date: 04/22/24 Archive Date: 04/22/24 DOCKET NO. 20-08 586 DATE: April 22, 2024 REMANDED Entitlement to service connection for bilateral upper extremity peripheral neuropathy is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from July 1966 to July 1968 and from February 1991 to May 1991 with additional periods of service in the Army National Guard from February 1974 to October 1998. He is in receipt of many awards and decorations for his honorable service, including the Combat Infantryman Badge and Bronze Star Medal. This case comes to the Board of Veterans' Appeals (Board) on appeal from a February 2018 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) which is the Agency of Original Jurisdiction (AOJ). The Veteran expressed timely disagreement with the AOJ's determination, and the present appeal ensued. The Veteran's claim was previously before the Board in May 2022, the Board reopened and remanded the Veteran's claim, among others. The Veteran's claim subsequently returned to the Board in June 2023, where it was remanded again for further development. 1. Entitlement to service connection for bilateral upper extremity peripheral neuropathy is remanded. Throughout the period on appeal, the Veteran has asserted that his bilateral upper extremity peripheral neuropathy is due to exposure to herbicide agents during his active service, and/or is due to his service-connected degenerative disc disease of the lumbar spine. Pursuant to the June 2023 Board remand directives, a medical addendum opinion was obtained in February 2024 to address the Veteran's contention that his bilateral upper extremity peripheral neuropathy is due to exposure to herbicide agents. It appears that the February 2024 examiner indicated that as of December 2015, there was no evidence of primary neuropathy or diabetic peripheral neuropathy. The examiner identified the findings to be consistent with minimal right L5 radiculopathy of the lower extremities and mild left C7 through T1 radiculopathy and concluded, "Veteran does not have a neuropathy other than impingement associated with degenerative spine disease affecting the cervical and lumbar spine, through December 2015." The examiner did not clarify if the diagnostic conclusion reached included a diagnosis of peripheral neuropathy of the bilateral upper extremities. The Board finds this statement from the examiner internally inconsistent and does not accurately reflect all of the evidence of record. Russo v. Brown, 9 Vet. App. 46 (1996); Thompson v. Gober, 14 Vet. App. 187, 188 (2000). In February 2023, a VA examiner indicated that the Veteran had a diagnosis of bilateral upper extremity peripheral neuropathy. In sum, the February 2024 examiner's internally inconsistent conclusion that the Veteran does not have a diagnosis of peripheral neuropathy renders the medical nexus opinion inadequate for the purpose of readjudicating the Veteran's appealed issue, and thus, another remand is necessary. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The matters are REMANDED for the following action: 1. Schedule the Veteran for appropriate VA examination, with a clinician other than the February 2024 examiner, if possible, to evaluate the Veteran's claimed peripheral neuropathy of the bilateral upper extremities. The complete electronic record must be made available to, and reviewed by, the VA examiner prior to conducting the examination. All necessary studies and tests should be conducted. After a thorough review of the medical and lay evidence of record, the examiner should address the following: (a.) Identify and determine the onset of any upper extremity peripheral neuropathy. *If the examiner concludes the Veteran does not have a diagnosis of upper extremity peripheral neuropathy, address the February 2023 VA examination, indicating that a diagnosis had been rendered. (b.) Whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's upper extremity disabilities are related to his active-duty service, to include conceded exposure to herbicide agents. (c.) Whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's upper extremity disabilities were caused by his service-connected degenerative disc disease. (d.) Whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's upper extremity disabilities were aggravated by his service-connected degenerative disc disease. *The standard to be applied for secondary service connection aggravation is whether there is any aggravation of the claimed disorder; aggravation need not be "beyond its natural course." Ward v. Wilkie, 31 Vet. App. 233, 240 (2019). 2. After ensuring the above development has been completed, readjudicate the issues on appeal. If the benefits sought on appeal are not granted to the Veteran's satisfaction, send the Veteran and his representative a supplemental statement of the case, provide an appropriate opportunity to respond, and thereafter return the case to the Board for further appellate review. Michael J. Skaltsounis Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. W. Morgan, 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.