Citation Nr: 0212967 Decision Date: 09/25/02 Archive Date: 10/03/02 DOCKET NO. 98-04 811A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Louisville, Kentucky THE ISSUE Entitlement to service connection for peripheral neuropathy, to include right trigeminal neuralgia, claimed due to exposure to herbicides. REPRESENTATION Veteran represented by: Paralyzed Veterans of America, Inc. WITNESSES AT HEARING ON APPEAL The veteran and his spouse ATTORNEY FOR THE BOARD Nancy S. Kettelle, Counsel INTRODUCTION The veteran had active service from December 1966 to December 1968. Service in Vietnam is indicated by the evidence of record. This matter came to the Board of Veterans' Appeals (the Board) on appeal from a November 1997 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Louisville, Kentucky which denied service connection for peripheral neuropathy, to include trigeminal neuralgia, as a result of exposure to herbicides. The veteran and his spouse testified at a hearing before a hearing officer at the RO in April 1998. The Board remanded the case to the RO in October 1998 and March 2000. The case was recently returned to the Board for further appellate consideration. The Board observes in passing that in a statement received at the RO in May 2002, the veteran stated that he has chronic obstructive pulmonary disease "which could also be caused from Agent Orange." It is unclear whether the veteran wishes to seek service connection for chronic obstructive pulmonary disease. If he does, he should contact the RO. FINDINGS OF FACT 1. In an unappealed April 1994 decision, the RO denied service connection for trigeminal neuralgia and peripheral neuropathy. 2. Evidence added to the record since the April 1994 RO decision is not cumulative of evidence previously of record, bears directly and substantially on the mater under consideration, and is so significant that it must be considered to fairly decide the claim. 3. The evidence does not demonstrate the presence of a neuropathy other than the veteran's right trigeminal neuralgia. 4. The medical and other evidence of record is in equipoise as to whether the veteran's diagnosed trigeminal neuralgia is a result of exposure to herbicides in service. CONCLUSIONS OF LAW 1. New and material evidence has been received to reopen the claim of entitlement to service connection for peripheral neuropathy, to include trigeminal neuralgia, claimed due to exposure to Agent Orange. 38 U.S.C.A. § 5108 (West 1991); 38 C.F.R. § 3.156(a) (2001). 2. Generalized peripheral neuropathy was not incurred in or aggravated by service, nor may it be presumed to have been incurred therein. 38 U.S.C.A. §§ 1110, 1116 (West 1991 & Supp. 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2001). 3. Right trigeminal neuralgia was incurred in service. 38 U.S.C.A. §§ 1110, 5107 (West Supp. 2002); 38 C.F.R. §§ 3.102, 3.303(d) (2001). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The veteran contends that his trigeminal neuralgia is associated with his active service. Specifically, he has argued that it is due to exposure to Agent Orange while he was in service in Vietnam. In the interest of clarity, the Board will review the law, VA regulations and other authority which may be relevant to this claim. The Board will then attend to certain preliminary matters and then proceed to analyze the claim and render a decision. Relevant law and regulations Service connection - in general In general, applicable laws and regulations state that service connection may be granted for disability resulting from a disease or injury incurred in or aggravated by military service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303. For certain chronic disorders, such as organic diseases of the nervous system, service connection may be granted on a presumptive basis if the disease is manifested to a compensable degree within one year following service discharge. 38 U.S.C.A. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. Service connection may also be granted for a disease first diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (2001). Service connection - Agent Orange exposure A veteran who had active service in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 5, 1975, will be presumed to have been exposed to an herbicide agent during that service. 38 U.S.C.A. § 1116(f) (West Supp. 2002). When such a veteran develops a disorder listed in 38 C.F.R. § 3.309(e), which disorders have been shown to be caused by exposure to Agent Orange, to a degree of 10 percent or more following his service in Vietnam, the disorder shall be presumed to have been incurred during service. 38 U.S.C.A. § 1116; 38 C.F.R. §§ 3.307, 3.309(e). In 67 Federal Register 42600-08 (June 24, 2002), the Secretary of VA determined that a presumption of service connection due to exposure to herbicides used in the Republic of Vietnam during the Vietnam era is not warranted for any condition for which the Secretary has not specifically determined that a presumption of service connection is warranted. The Secretary evaluated numerous studies and other scientific evidence and concluded that there was insufficient credible evidence to establish an association between herbicide exposure and any condition not specifically named in 38 C.F.R. § 3.309(e). Notwithstanding the foregoing, the United States Court of Appeals for the Federal Circuit has held that the Veteran's Dioxin and Radiation Exposure Compensation Standards (Radiation Compensation) Act, Pub. L. No. 98-542, § 5, 98 Stat. 2725, 2727-29 (1984) does not preclude a veteran from establishing service connection with proof of direct causation. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). Finality/new and material evidence In general, decisions of an agency of original jurisdiction, in this case the RO, become final if a notice of disagreement is not received within a year of notice of that decision. 38 U.S.C.A. § 7105; 38 C.F.R. §§ 3.104, 20.302. A final decision cannot be reopened unless new and material evidence is presented. Pursuant to 38 U.S.C.A. § 5108, VA must reopen a finally disallowed claim when new and material evidence is presented or secured with respect to that claim. Knightly v. Brown, 6 Vet. App. 200 (1994). Evidence presented since the last final denial on any basis (either upon the merits of the case, or upon a previous adjudication that no new and material evidence had been presented), will be evaluated in the context of the entire record. Evans v. Brown, 9 Vet. App. 273 (1996). New and material evidence is defined as evidence not previously submitted to agency decisionmakers which bears directly and substantially upon the specific matter under consideration; which is neither cumulative nor redundant; and which, by itself or in connection with evidence previously assembled, is so significant that it must be considered in order to fairly decide the merits of the claim. 38 C.F.R. § 3.156(a). In Hodge v. West, 155 F.3d 1356, 1363 (Fed. Cir. 1998), the Federal Circuit noted that new evidence could be sufficient to reopen a claim if it could contribute to a more complete picture of the circumstances surrounding the origin of an injury or disability, even where it would not be enough to convince the Board to grant a claim. If it is determined that new and material evidence has been submitted, the claim must be reopened. VA may then proceed to evaluate the merits of the claim on the basis of all the evidence of record, but only after ensuring that the duty to assist the appellant in developing the facts necessary for his claim has been satisfied. See Elkins v. West, 12 Vet. App. 209 (1999); but see 38 U.S.C.A. § 5103A (eliminates the concept of a well-grounded claim). For the purpose of establishing whether new and material evidence has been submitted, the credibility of the evidence, although not its weight, is to be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). Standard of review The determination as to whether the requirements for service connection are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. Baldwin v. West, 13 Vet. App. 1 (1999); 38 C.F.R. § 3.303(a). Once the evidence is assembled, the Board is responsible for determining whether the preponderance of the evidence is against the claim. If so, the claim is denied; if the evidence is in support of the claim or is in equal balance, the claim is allowed. 38 U.S.C.A. § 5107 ( West Supp. 2002); Ortiz v. Principi, 274 F.3d 1361, 1365-66 (Fed. Cir. 2001); 38 C.F.R. § 3.102 (as amended by 66 Fed. Reg. 45,620 (Aug. 29, 2001)). The VCAA On November 9, 2000, during the pendency of the veteran's appeal, the President signed into law the Veterans Claims Assistance Act of 2000 (VCAA), Pub. L. No. 106-475, 114 Stat. 2096 (2000) [codified as amended at 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126 (West Supp. 2002)]. The VCAA revises VA's obligations in two significant ways. First, VA has a duty to notify the appellant of any information and evidence necessary to substantiate and complete a claim for VA benefits. See 38 U.S.C.A. §§ 5102, 5103 (West Supp. 2002). Second, VA has a duty to assist the appellant in obtaining evidence necessary to substantiate the claim. See 38 U.S.C.A. § 5103A (West Supp. 2002). VA issued regulations to implement the VCAA in August 2001. See 66 Fed. Reg. 45,620 (Aug. 29, 2001) [codified as amended at 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a)]. The amendments became effective November 9, 2000, except for the amendment to 38 C.F.R. § 3.156(a), which became effective August 29, 2001. The Board has given consideration to the provisions of the VCAA as it applies to this case. See Holliday v. Principi, 14 Vet. App. 282-83 (2001) [the Board must make a determination as to the applicability of the various provisions of the VCAA to a particular claim]. In this regard, the Board notes that the VCAA appears to have left intact the requirement that an appellant must present new and material evidence in order to reopen a previously and finally denied claim under 38 U.S.C.A. § 5108. See 38 U.S.C.A. § 5103A(f). The amendments to 38 C.F.R. § 3.156(a), revising the definition of new and material evidence, apply only to claims filed on or after August 29, 2001. See 66 Fed. Reg. 45,620. Because the veteran's application to reopen his previously denied claim was filed in August 1996, which was well before August 29, 2001, the former provisions of 38 C.F.R. § 3.156(a) outlined earlier are for application in this case. The Board notes that the Court has recently held that 38 U.S.C.A. § 5103(a), as amended by the VCAA, and 38 C.F.R. § 3.159(b), as amended, which pertain to VA's duty to notify a claimant who had submitted a complete or substantially complete application, apply to those claimants who seek to reopen a claim by submitting new and material evidence pursuant to 38 U.S.C.A. § 5108. Quartuccio v. Principi, 16 Vet. App. 183 (2002). Before the veteran's claim may be further considered, therefore, it must be determined whether VA has fulfilled its statutory duty to notify the veteran under the VCAA. VA must notify the veteran of the evidence and information necessary to substantiate his claim and inform him whether he or VA bears the burden of producing or obtaining that evidence or information. 38 U.S.C.A. § 5103(a) (West Supp. 2002); 66 Fed. Reg. 45,620, 45,630 (Aug. 29, 2001) (to be codified as amended at 38 C.F.R. § 3.159(b)); Quartuccio v. Principi, 16 Vet. App. 183, 187 (2992). Review of the record shows that in its February 1998 statement of the case, the RO notified the veteran of information necessary to substantiate his claim and provided him comprehensive information pertaining to the laws and regulations pertinent to his claim. In a March 2000 letter, the Board provided the veteran's representative with a VA medical opinion concerning the veteran's claim and provided the opportunity for response. The representative provided additional argument and submitted an additional medical opinion in support of the veteran's claim. Further, in a February 2001 letter to the veteran, the RO notified him of the passage of the VCAA. In the letter, it again explained the criteria for establishment of service connection. The RO explained to the veteran that it was seeking an additional medical opinion in conjunction with his claim and invited him to submit any additional evidence he wanted considered in his claim. The RO explained to the veteran that he should submit the evidence or identify it and that the RO would attempt to obtain that evidence on his behalf. The RO explained to the veteran that although he was ultimately responsible for giving VA information and evidence in support of his claim, it would do its best to help him obtain evidence he identified, including medical records and statements from individuals. Thereafter, in a statement received in March 2001, the veteran stated that he had no more information to send. After careful consideration of the record, the Board believes that the notification requirements of the VCAA have been fulfilled in this case. It is clear that VA has amply informed the veteran of the types of evidence which should be submitted in support of his claim. The veteran, who has in fact submitted such evidence, does not appear to contend otherwise. Analysis Preliminary matter - finality/new and material evidence Review of the record shows that in a decision dated in October 1986, the Board denied entitlement to service connection for trigeminal neuralgia. In March 1990, the veteran filed a claim for service connection for residuals of exposure to Agent Orange and later specified that the disabilities for which he was seeking service connection included trigeminal neuralgia and peripheral neuropathy. In a rating decision dated in April 1994, the RO denied service connection for trigeminal neuralgia and peripheral neuropathy. In April 1994, the RO provided the veteran with a copy of the rating decision and notified him of his appellate rights. The veteran did not appeal, and that decision became final. 38 U.S.C.A. § 7105; 38 C.F.R. §§ 3.104, 20.302, 20.1103. In a letter dated in August 1996, the VA Under Secretary for Benefits notified the veteran that the Secretary had authorized expansion of the list of conditions presumed related to military service in Vietnam to include acute and subacute peripheral neuropathy based on exposure to herbicides. The Undersecretary advised the veteran to contact the RO to file a claim. In a letter received at the RO in August 1996, the veteran stated that he returned home from Vietnam in 1968 and started having a nerve problems in his head the following year. He said he was put on medication and eventually had surgery in 1988 to clip the trigeminal nerve to relieve the pain. He said that he was left with numbness in the right facial area and in the right side of the tongue. He stated that he believed this problem was caused by Agent Orange, with which he came in contact while in combat in Vietnam. In a rating decision dated in November 1997, the RO denied service connection of peripheral neuropathy to include trigeminal neuralgia. The matter of the finality of previous decisions and the submission of new and material evidence was not discussed. The veteran's disagreement with that decision led to this appeal. The RO decided the veteran's current claim on the merits, rather than exploring the matter of finality of previous decisions and submission of new and material evidence, presumably because of the addition of acute and subacute peripheral neuropathy to the list of conditions to for which service connection may be granted on a presumptive basis under 38 C.F.R. § 3.309(e). When there is an intervening change in the law or regulation creating a new basis for entitlement to benefits, the veteran's claim under the liberalizing regulation is a claim separate and distinct from the claim previously and finally denied prior to the liberalizing regulation and may be reviewed on a de novo basis. See Spencer v. Brown, 4 Vet. App. 283, 288-89 (1993), aff'd, 17 F.3d 368 (Fed. Cir. 1994), cert. denied, 513 U.S. 810 (1994). The Board is, however, under the statutory obligation to conduct a de novo review of the issue of whether new and material evidence has been submitted because this claim does not turn solely on the revised regulation. See Barnett v. Brown, 83 F.3d 1380, 1383 (Fed. Cir. 1996); see also 38 U.S.C.A. §§ 5108, 7104(b). In Barnett, the Federal Circuit determined that the issue of whether new and material evidence has been submitted is a matter of jurisdiction, and that the Board did not have the jurisdiction to consider a previously adjudicated claim unless new and material evidence had been submitted. Barnett, 83 F.3d at 1384. Hence, the Board will proceed first with a determination of whether new and material evidence has been submitted to reopen the claim of entitlement to service connection for peripheral neuropathy, to include trigeminal neuralgia, claimed due to exposure to Agent Orange. With regard to petitions to reopen previously and finally denied claims, the Board must conduct a two-step analysis. Manio v. Derwinski, 1 Vet. App. 140, 145 (1991). First, the Board must determine whether the evidence presented or secured since the prior final denial of the claim is "new and material." Colvin v. Derwinski, 1 Vet. App. 171, 174 (1991). If new and material evidence is presented or secured with respect to a claim that has been finally denied, the claim will be reopened and decided on the merits. 38 U.S.C.A. § 5108 (West 1991); 38 C.F.R. § 3.156(a) (1997); Stanton v. Brown, 5 Vet. App. 563, 566 (1993). Thus, if the Board determines that additionally submitted evidence is "new and material," it must reopen the claim and perform the second step in the two step analysis, evaluating the merits of the claim in view of all the evidence, both new and old. Masors v. Derwinski, 2 Vet. App. 181, 185 (1992). Evidence of record at the time of the April 1994 decision included the veteran's service medical records, VA examination reports dated in the 1970s and 1980s, private clinical records showing diagnosis and treatment of right trigeminal neuralgia in the 1980s, the transcript of a hearing at the RO in April 1985, and a 1991 letter from J.A.E., M.D., in which he stated that it was his opinion, and the opinion of two neurologists who had also treated the veteran, that the veteran's right trigeminal neuralgia was and unusual case of peripheral neuropathy of which they could determine no other cause than the possibility of exposure to some toxic agent such as exposure to Agent Orange. Evidence added to the record includes and additional opinion from Dr. J.A.E., the transcript of an April 1998 RO hearing, the report of a VA examination in November 2000, opinions in 2000 and 2001 from two VA physicians, and opinions in 1998 and 2000 from C.N.B., M.D., a private physician. Review of the evidence added to the record provides new evidence concerning the onset of symptoms of the veteran's right trigeminal neuralgia, new opinions concerning whether the veteran has peripheral neuropathy and new opinions concerning the etiology of the veteran's trigeminal neuralgia, including whether it is related to exposure to Agent Orange in service. This evidence is obviously new, and as it provides additional evidence concerning the presence of peripheral neuropathy and the etiology of the veteran's trigeminal neuralgia, the Board finds that it is so significant that it must be considered to fairly decide the merits of the claim. The Board concludes, therefore, that new and material evidence has be presented and the previously denied claim is reopened. In Bernard v. Brown, 4 Vet. App. 384, 394 (1993), the Court held that before the Board addresses in a decision a question that has not been addressed by the RO, it must consider whether the claimant has been given adequate notice of the need to submit evidence or argument, an opportunity to submit such evidence or argument, and an opportunity to address the question at a hearing, and whether the claimant has been prejudiced by any denials of those opportunities. Although the RO did not consider the matter of finality/new and material evidence in its November 1997 decision, a remand to the RO for readjudication is not necessary in this case. In this case, the RO decided the claim on the merits, giving the veteran's claim more consideration that it was due initially. Further, the Board's decision regarding new and material evidence is favorable to the veteran, so any failure on the part of the RO to adjudicate the preliminary matter of finality falls into the category of harmless error. As was explained earlier, the claimant has been afforded full procedural benefits with respect to his claim. In short, the veteran has not been prejudiced by any action of the RO, and further adjudication at the RO level is not necessary. At this juncture, the question of VA's duty to assist must be considered. The veteran has not identified, and the Board is not aware of, any additional evidence to be obtained in conjunction with this claim. VA has obtained various medical opinions, and the veteran has submitted extensive medical evidence and with his wife has provided hearing testimony. It is the Board's judgment that the facts relevant to the veteran's claim have been properly developed and that the development has met the provisions of the VCAA and the implementing regulations. VA has fully complied with the statutory duty to assist the veteran in the development of his claim, including further development mandated by the Board's remands in October 1998 and March 2000. Merits of the claim Having determined that new and material evidence has been presented to reopen the claim, the Board will consider the claim on its merits. The veteran is seeking entitlement to service connection for trigeminal neuralgia. He essentially contends that he has experienced symptoms of trigeminal neuralgia since shortly after service. In support of his claim, the veteran has submitted private treatment records showing treatment since 1980 and opinions of private physicians that the trigeminal neuralgia is related to his exposure to Agent Orange in service. The veteran and his wife have testified he has experienced facial pain since shortly after his discharge from service. It is the Board's primary responsibility to assess the weight and credibility of the evidence. See Madden, supra. Having reviewed the complete record in this case, for the reasons and bases below, the Board finds that the credible and probative evidence is in equipoise with the evidence against the claim of entitlement to service connection for trigeminal neuralgia, thereby warranting a grant of service connection for trigeminal neuralgia. In the absence of evidence indicating the existence of any other kind of peripheral neuropathy, service connection for any other peripheral neuropathy is denied. (i) Statutory presumptions The veteran was in Vietnam from June 1967 to June 1968. Under 38 U.S.C.A. § 1116(f) (West Supp. 2002) he is presumed to have been exposed to herbicide agents, including Agent Orange. If the veteran's trigeminal neuralgia is shown to be an acute or subacute peripheral neuropathy meeting certain conditions, then the trigeminal neuralgia would be presumed to have been the result of Agent Orange exposure in service and service connection could be granted on that basis. Under 38 C.F.R. § 3.309(e) Note 2, it is stated that under the regulation, the term acute and subacute peripheral neuropathy means transient peripheral neuropathy that appears within weeks or months of exposure to an herbicide agent and resolves within two years of the date of onset. The preponderance of the evidence shows there was no indication of the presence of a peripheral neuropathy that could be classified as acute or subacute under 38 C.F.R. § 3.309(e) Note 2. In this regard, the veteran's service medical records, including his December 1968 separation physical examination report, are silent as to the presence of any neurological symptom or abnormality. The veteran and his wife have testified that his symptoms and complaints of facial pain started in 1969, but at other times the veteran has been less clear about when they began and has referred to 1970 as when he first noticed symptoms. He has however, been steadfast in his reports that the right facial pain that began in 1969 or 1970 persisted for years after service and that it was in 1980 that he first sought medical assistance. His physician, Dr. J.A.E., has related those symptoms to the right trigeminal neuralgia diagnosed in 1980. The veteran's trigeminal neuralgia is thus obviously not a neuropathy of the type contemplated by 38 C.F.R. § 3.309(e), and there is, therefore, no presumptive basis for service connection. (ii) Combee considerations The Federal Circuit has determined that the regulations governing presumptive service connection for Agent Orange do not preclude a veteran from establishing service connection with proof of actual direct causation. Combee v. Brown, 34 F.3d 1039 (1994). Accordingly, the Board will proceed to evaluate the veteran's claim under the law and regulation governing direct service connection, 38 U.S.C.A. § 1110 and 38 C.F.R. § 3.303, to include 38 C.F.R. § 3.303(d). Various VA physicians have been requested to provide an opinion as to whether the veteran's right trigeminal neuralgia is due to exposure to Agent Orange in service. It was the opinion of the physician who examined the veteran in November 2000 that the veteran's trigeminal neuralgia was not in any way related to service. VA neurologists who reviewed the record in 2000 and 2001 explained that although trigeminal neuralgia is a manifestation of dysfunction of one or more branches of the trigeminal nerve, it is incorrect to classify this condition as a peripheral neuropathy. One physician found it unlikely that the veteran had symptoms of trigeminal neuralgia before seeking medical help while the other observed that the onset of severe symptoms was not until many years after exposure to herbicides. One suggested that the veteran's trigeminal neuralgia was of idiopathic etiology ["idiopathic" means of unknown causation, see Lathan v. Brown, 7 Vet. App. 359, 361 (1995)] while the other physician noted that the possibility that the veteran's symptoms could be related to vascular compression of the structures of the trigeminal nerve had not been ruled out. Both reasoned that the veteran's trigeminal neuralgia was not due to exposure to Agent Orange because trigeminal neuralgia is not on the VA list of conditions for which it has been determined there is a positive association between exposure to herbicides and the subsequent development of the condition. The Board must weigh these negative opinions against those of Drs. J.A.E. and C.N.B., which are supportive of the veteran's claim. It was from Dr. J.A.E. that the veteran first sought treatment for his right facial pain in July 1980. Clinical records from Dr. J.A.E. show that at that time, years before the veteran filed his original claim for service connection for trigeminal neuralgia, it was noted that the veteran had heavy exposure to defoliated areas while he was in Vietnam. In his 1991 letter Dr. J.A.E. reported that was his opinion and that of neurologists R.L.R., M.D. and P.R.M., M.D., who had also treated the veteran, that the veteran had a peripheral neuropathy of the trigeminal nerve on the right side. Dr. J.A.E. stated that according to the literature they had reviewed, the findings and timing of the veteran's trigeminal neuralgia (which was unusual in a patient of the veteran's age) were most consistent with the etiology being that of Agent Orange to which the veteran was exposed in Vietnam. Dr. J.A.E. emphasized that it was his opinion and that of the other physicians that this represented an unusual case for which they could arrive at no cause other than the possibility of exposure to some toxic agent such as Agent Orange. In a follow-up letter in December 1997, Dr. J.A.E. reiterated that he had followed the veteran since 1980 and that his symptoms of trigeminal neuralgia, which he termed a peripheral neuropathy, had been present for several years before he saw the veteran. Dr. J.A.E. stated that in retrospect he felt that the veteran had been having symptoms ever since he was discharged from service and that his trigeminal neuralgia progressed to the point that it required aggressive treatment. Dr. J.A.E. emphasized that it was very unusual to have a trigeminal neuralgia of this degree in a patient of the veteran's age, and he stated that he felt strongly that there was correlation between the veteran's trigeminal neuralgia and his exposure to Agent Orange in Vietnam. In letters dated in September 1998 and March 2000, Dr. C.N.B. provided a comprehensive review of the medical evidence of record and supported the arguments and opinions of Dr. J.A.E. Dr. C.N.B. argued that the veteran's trigeminal neuralgia was a neuropathy of a peripheral nerve and pointed out that Agent Orange was a known neurotoxin that could permanently damage ganglia and dermatone of affected nerves. He said that in the absence of any other causative factors and in light of the fact that the veteran incurred trigeminal neuralgia at a young age, it was his opinion that it is more likely than not that the veteran's trigeminal neuralgia and chronic peripheral neuropathy resulted from Agent Orange exposure while in service. After reviewing the medical opinion evidence, the Board is left with several impressions. First, this case presents an unusual medical situation in that the veteran's trigeminal neuralgia evidently first manifested at a relatively young age. Second, there appears to be no readily explainable cause for the trigeminal neuralgia; indeed, there is evidence of record that no cause can be identified. There is also the matter of whether trigeminal neuralgia is peripheral neuropathy, with medical opinion pro and con. Notwithstanding the somewhat unusual and controversial nature of this case, the Board is obligated to weigh the evidence and arrive at a decision. The Board finds, based on the discussions and opinions of VA physicians and private physicians, that the veteran's current disability is trigeminal neuralgia (and post-operative residuals thereof, since surgery has been preformed in 1988). There has been no showing of neuropathy of any nerve other than the right trigeminal nerve. Although the medical opinions in support of the veteran's claim classify trigeminal neuralgia as a form of peripheral neuropathy, these opinions do not indicate that any other form of peripheral neuropathy exists in this veteran. Since it has not been shown that the veteran has a generalized peripheral neuropathy, service connection may be granted for generalized peripheral neuropathy on any basis. The Board finds that the opinions as to the etiology of the veteran's trigeminal neuralgia are in relative equipoise. The VA physicians have essentially argued that the cause of the veteran's trigeminal neuralgia has not been determined and that it cannot be due to exposure to Agent Orange because it is not on the list of conditions for which VA has found a positive association between the condition and Agent Orange exposure. The private physicians cite that the unusual circumstances of the veteran's trigeminal neuralgia including its early onset. These physicians have indicated that, based on their expertise and review of the record, it is their opinion that the veteran's trigeminal neuralgia is related to his exposure to Agent Orange in service. Where there is a relative balance of evidence against and in favor of a claim, as here, the Board resolves doubt in favor of the veteran and concludes that service connection is warranted for right trigeminal neuralgia. See 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102. In summary, the Board has decided that service connection may be granted for right trigeminal neuralgia. To that extent, the appeal is allowed. ORDER Service connection for generalized peripheral neuropathy is denied. Service connection for right trigeminal neuralgia is granted. Barry F. Bohan Member, Board of Veterans' Appeals IMPORTANT NOTICE: We have attached a VA Form 4597 that tells you what steps you can take if you disagree with our decision. We are in the process of updating the form to reflect changes in the law effective on December 27, 2001. See the Veterans Education and Benefits Expansion Act of 2001, Pub. L. No. 107-103, 115 Stat. 976 (2001). In the meanwhile, please note these important corrections to the advice in the form: ? These changes apply to the section entitled "Appeal to the United States Court of Appeals for Veterans Claims." (1) A "Notice of Disagreement filed on or after November 18, 1988" is no longer required to appeal to the Court. (2) You are no longer required to file a copy of your Notice of Appeal with VA's General Counsel. ? In the section entitled "Representation before VA," filing a "Notice of Disagreement with respect to the claim on or after November 18, 1988" is no longer a condition for an attorney-at-law or a VA accredited agent to charge you a fee for representing you.