Citation Nr: 1044530 Decision Date: 11/29/10 Archive Date: 12/03/10 DOCKET NO. 05-05 774 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Montgomery, Alabama THE ISSUES 1. Entitlement to service connection for residuals of a left leg injury. 2. Entitlement to service connection for degenerative disc disease of the cervical spine, to include as due to exposure to Agent Orange in service. 3. Entitlement to service connection for degenerative disc disease of the lumbar spine, to include as due to exposure to Agent Orange in service. 4. Entitlement to service connection for peripheral neuropathy of the bilateral lower legs, to include as due to exposure to Agent Orange in service. 5. Entitlement to service connection for carpal tunnel syndrome of the bilateral upper extremities, to include as due to exposure to Agent Orange in service. 6. Entitlement to service connection for organic impotence, to include as due to exposure to Agent Orange in service. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD A. Hinton, Counsel INTRODUCTION The Veteran served on active duty from September 1965 to September 1967. This case comes before the Board of Veterans' Appeals (Board) from a rating decision of May 2004 from the Regional Office (RO) of the Department of Veterans Affairs (VA), in Montgomery, Alabama, which denied the claims on appeal. In September 2008, the Board remanded the case to the RO for additional development. The case has been returned to the Board for further appellate consideration. FINDINGS OF FACT 1. The competent evidence is against a finding that a left leg disorder is related to service, or that an organic disease of the nervous system involving the left leg manifested to a compensable degree within a year following separation from active duty. 2. The competent evidence is against a finding that degenerative disc disease of the cervical spine is related to service, or that arthritis manifested to a compensable degree within a year following separation from active duty. 3. The competent evidence is against a finding that degenerative disc disease of the lumbar spine is related to service, or that arthritis manifested to a compensable degree within a year following separation from active duty. 4. The competent evidence is against a finding that a peripheral neuropathy of the lower legs is related to service; or that an acute or subacute peripheral neuropathy, or other organic disease of the nervous system, manifested to a compensable degree within a year following separation from active duty. 5. The competent evidence is against a finding that carpal tunnel syndrome of the upper extremities is related to service; or that another organic disease of the nervous system, manifested to a compensable degree within a year following separation from active duty. 6. The competent evidence is against a finding that organic impotence is related to service. CONCLUSIONS OF LAW 1. A left leg disorder was not incurred in or aggravated during military service; and may not be presumed to have been so incurred. 38 U.S.C.A. §§ 1110, 1112, 1113, 5100, 5103, 5103A, 5107 (West 2002 & Supp. 2010); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2010). 2. Degenerative disc disease of the cervical spine was not incurred in or aggravated during military service; and may not be presumed to have been so incurred. 38 U.S.C.A. §§ 1110, 1112, 1113, 1116, 5100, 5103, 5103A, 5107 (West 2002 & Supp. 2010); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2010). 3. Degenerative disc disease of the lumbar spine was not incurred in or aggravated during military service; and may not be presumed to have been so incurred. 38 U.S.C.A. §§ 1110, 1112, 1113, 1116, 5100, 5103, 5103A, 5107 (West 2002 & Supp. 2010); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2010). 4. Peripheral neuropathy of the bilateral lower legs was not incurred in or aggravated during military service; and may not be presumed to have been so incurred. 38 U.S.C.A. §§ 1110, 1112, 1113, 1116, 5100, 5103, 5103A, 5107 (West 2002 & Supp. 2010); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2010). 5. Carpal tunnel syndrome of the bilateral upper extremities was not incurred in or aggravated during military service; and may not be presumed to have been so incurred. 38 U.S.C.A. §§ 1110, 1112, 1113, 1116, 5100, 5103, 5103A, 5107 (West 2002 & Supp. 2010); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2010). 6. Organic impotence was not incurred in or aggravated during military service; and may not be presumed to have been so incurred. 38 U.S.C.A. §§ 1110, 1112, 1113, 1116, 5100, 5103, 5103A, 5107 (West 2002 & Supp. 2010); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2010). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Preliminary Matters The Veterans Claims Assistance Act of 2000 (VCAA), codified in part at 38 U.S.C.A. §§ 5103, 5103A, and implemented at 38 C.F.R. § 3.159, amended VA's duties to notify and assist a claimant in developing the information and evidence necessary to substantiate a claim. Under 38 U.S.C.A. § 5103, VA must notify the claimant of any information or evidence not of record that is necessary to substantiate the claim, as well as what parts of that information or evidence VA will seek to provide, and what parts VA expects the claimant to provide. 38 C.F.R. § 3.159(b). VA must provide such notice to a claimant prior to an initial unfavorable decision on a claim for VA benefits by the AOJ, even if the adjudication occurred prior to the enactment of the VCAA. See Pelegrini v. Principi, 18 Vet. App. 112, 119-120 (2004). VCAA requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all elements of a claim for service connection, so that VA must provide notice that a disability rating and an effective date will be assigned if service connection is awarded. Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006); aff'd sub nom. Hartman v. Nicholson, 483 F.3d 1311 (2007). Though notification to the Veteran may not have met all of the requirements of the VCAA and related case law, the matters decided below may be addressed at this time, without further remand, because no errors in notice are prejudicial, and the Veteran has been provided all information needed for a reasonable person to prove the claim. In any event, the Federal Circuit recently vacated the previous decision by the United States Court of Appeals for Veterans Claims (Court) in Vazquez-Flores v. Peake, 22 Vet. App. 37 (2008), concluding that generic notice in response to a claim for an increased rating is all that is required. See Vazquez-Flores v. Shinseki, No. 08-7150 (Fed. Cir. Sept. 4, 2009). VA notified the Veteran of the information and evidence needed to substantiate and complete a claim by way of letters sent to the Veteran in December 2003, January 2004, August 2004, and October 2008. These documents in combination provided notice of what part of that evidence is to be provided by the claimant, and notice of what part VA will attempt to obtain. By way of these letters the RO informed the Veteran of what evidence was required to substantiate claims for service connection. The RO has provided adequate notice of how effective dates are assigned. The claims were subsequently readjudicated most recently in a December 2009 supplemental statement of the case. To the extent the appellant did not receive full notice prior to the initial decision, after pertinent notice was provided, the claimant was afforded a meaningful opportunity to participate in the adjudication of the claim on appeal. In any event, the claimant has never alleged how any content error prevented him from meaningfully participating in the adjudication of his claim. As such, he has not established prejudicial error in the content of VCAA notice. See Shinseki v. Sanders / Simmons, 129 S. Ct. 1696 (2009). The claimant was provided the opportunity to present pertinent evidence. The record contains service treatment and personnel records, and records of medical treatment received privately and from VA, and VA examination reports. VA appropriately examined the medical history of the Veteran's claimed disability for compensation purposes addressing the claimed disorder relevant to the decision below. Findings from the report of VA examination in June 2009 are adequate for the purposes of deciding the claims on appeal decided below. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). A remand by the Board confers on the claimant, as a matter of law, the right to compliance with the remand orders. Stegall v. West, 11 Vet. App. 268, 271 (1998). In this regard the Board is satisfied as to compliance with the instructions from its September 2008 remand during the pendency of the appeal. The Board finds that the RO complied with these instructions. The Board remanded the case to the RO in September 2008, in part for the RO to obtain additional evidence including by providing a VA examination of the Veteran's claimed disabilities. Review of the record shows that the RO substantially complied with these orders on remand. The Veteran was also notified of the opportunity to present testimony before the Board, which he declined in his substantive appeal, VA Form 9, filed in February 2005. In sum, there is no evidence of any VA error in notifying or assisting the appellant that reasonably affects the fairness of this adjudication. VA has fulfilled its duty to assist the claimant by obtaining identified and available evidence needed to substantiate the claim, and, as warranted by law. Significantly, the Veteran has not identified, and the record does not otherwise indicate, that any additional evidence exists that has not been obtained and would be necessary for a fair adjudication of the claim. Hence, no further notice or assistance to the Veteran is required to fulfill VA's duty to assist the Veteran in the development of the claim. Smith v. Gober, 14 Vet. App. 227 (2000), aff'd 281 F.3d 1384 (Fed. Cir. 2002); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); see also Quartuccio v. Principi, 16 Vet. App. 183 (2002). II. Analysis The Veteran claims that he has the following disorders due to service: (1) residuals of a left leg injury; (2) degenerative disc disease of the cervical spine; (3) degenerative disc disease of the lumbar spine; (4) peripheral neuropathy of the bilateral lower legs; (5) carpal tunnel syndrome of the bilateral upper extremities; and (6) organic impotence. As reflected in his substantive appeal, VA Form 9, the Veteran claims that the claimed residuals of a left leg injury was due to a gunshot wound in service; and that the other claimed disabilities on appeal were due to exposure to Agent Orange in service. A. Governing Law and Regulations Service connection may be granted for disability resulting from a disease contracted or an injury sustained while on active duty in the military. See 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303(a). When determining service connection, all theories of entitlement, direct and secondary, must be considered by the Board if raised by the evidence of record, applying all relevant laws and regulations. Szemraj v. Principi, 357 F.3d 1370, 1371 (Fed. Cir. 2004). However, claims which have no support in the record need not be considered by the Board, as the Board is not obligated to consider "all possible" substantive theories of recovery. That is, where a fully developed record is presented to the Board with no evidentiary support for a particular theory of recovery, there is no reason for the Board to address or consider such a theory. Robinson v. Shinseki, 557 F.3d 1355, 1361 (Fed. Cir. 2009). To establish service connection, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). If a chronic disease is shown as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. 38 C.F.R. § 3.303(b). If a condition noted during service is not shown to be chronic, or the fact of chronicity in service is not adequately supported, then a showing of continuity of symptomatology after discharge is required to support the claim. Id. Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). If a veteran who served for ninety days on active duty, develops arthritis or organic diseases of the nervous system, to a degree of 10 percent or more within one year from separation from service, service connection may be presumed to have been incurred in service even though there is no evidence of such disease during the period of service. 38 U.S.C.A. §§ 1112, 1137; 38 C.F.R. §§ 3.307, 3.309. A veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the Vietnam era (beginning in January 1962 and ending in May 1975) shall be presumed to have been exposed during such service to herbicide agents, including an herbicide commonly referred to as Agent Orange. 38 U.S.C.A. § 1116(a)(3); 38 C.F.R. §§ 3.307, 3.309. If a veteran was exposed to an herbicide agent during active military service, the following diseases will be presumed to have been incurred in service if manifest to a compensable degree within specified periods, even if there is no record of such disease during service: chloracne or other acneform disease consistent with chloracne, Type 2 diabetes (also known as Type II diabetes mellitus or adult-onset diabetes), Hodgkin's disease, chronic lymphocytic leukemia, multiple myeloma, non-Hodgkin's lymphoma, acute and subacute peripheral neuropathy, porphyria cutanea tarda, prostate cancer, respiratory cancers (cancer of the lung, bronchus, larynx, or trachea), and soft-tissue sarcoma (other than osteosarcoma, chondrosarcoma, Kaposi's sarcoma, or mesothelioma). 38 U.S.C.A. § 1116(a)(2); 38 C.F.R. §§ 3.307(a)(6), 3.309(e). In addition, on October 13, 2009, in accordance with authority provided in 38 U.S.C. § 1116, the Secretary of VA announced his decision to establish presumptions of service connection, based upon exposure to herbicides within the Republic of Vietnam during the Vietnam era, for three new conditions: ischemic heart disease, Parkinson's disease, and B cell leukemia. 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. 38 C.F.R. § 3.309(e), Note 2. To qualify for entitlement to service connection on a presumptive basis under 38 C.F.R. § 3.307, the diseases listed at § 3.309(e) shall have become manifest to a degree of 10 percent or more at any time after service, except that chloracne or other acneform disease consistent with chloracne, porphyria cutanea tarda, and acute and subacute peripheral neuropathy shall have become manifest to a degree of 10 percent or more within a year after the last date on which the veteran was exposed to an herbicide agent during active military, naval, or air service. 38 C.F.R. § 3.307(a)(6)(ii). VA regulations specify that the last date on which a veteran shall be presumed to have been exposed to an herbicide agent shall be the last date on which he or she served in the Republic of Vietnam during the period beginning on January 9, 1962 and ending on May 7, 1975. 38 C.F.R. § 3.307(a)(6)(iii). VA's Secretary has determined that a presumption of service connection based on exposure to herbicides to include Agent Orange used in the Republic of Vietnam during the Vietnam era is not warranted for any condition for which the Secretary has not specifically determined a presumption of service connection is warranted. See Notice, 72 Fed. Reg. 32,395 (2007). Notwithstanding the aforementioned provisions relating to presumptive service connection, which arose out of the Veteran's Dioxin and Radiation Exposure Compensation Standards Act, Pub. L. No. 98-542, § 5, 98 Stat. 2,725, 2,727-29 (1984), and the Agent Orange Act of 1991, Pub. L. No. 102-4, § 2, 105 Stat. 11 (1991), the Federal Circuit has determined that a claimant is not precluded from establishing service connection with proof of direct causation. Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994); 38 C.F.R. § 3.303(d). Lay statements are considered to be competent evidence when describing the symptoms of a disease or disability or an injury that the Veteran is capable of perceiving; however, if the determinative issue involves a question of medical causation, only individuals possessing specialized training and knowledge are competent to render an opinion. Espiritu v. Derwinski, 2 Vet. App. 492 (1992). Lay assertions may serve to support a claim for service connection by establishing the occurrence of observable events or the presence of disability or symptoms of disability subject to lay observation. 38 U.S.C.A. § 1153(a) (West 2002); 38 C.F.R. § 3.303(a) (2010); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); see also Buchanan v. Nicholson, 451 F. 3d 1331, 1336 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). The United States Court of Appeals for the Federal Circuit (Federal Circuit) has clarified that lay evidence can be competent and sufficient to establish a diagnosis or etiology when (1) a lay person is competent to identify a medical condition; (2) the lay person is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). In evaluating the evidence in any given appeal, it is the responsibility of the Board to weigh the evidence and decide where to give credit and where to withhold the same and, in so doing, accept certain medical opinions over others. Schoolman v. West, 12 Vet. App. 307, 310-11 (1999). In this regard, the Board has been charged with the duty to assess the credibility and weight given to evidence. Davidson v. Shinseki, 581 F. 3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F. 3d 1331 (Fed. Cir. 2006); Charles v. Principi, 16 Vet. App. 370 (2002). In doing so, the Board is free to favor one medical opinion over another, provided it offers an adequate basis for doing so. Evans v. West, 12 Vet. App. 22, 30 (1998); Owens v. Brown, 7 Vet. App. 429, 433 (1995). 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. 38 U.S.C.A. § 7104(a); Baldwin v. West, 13 Vet. App. 1 (1999); 38 C.F.R. § 3.303(a). If there is an approximate balance of positive and negative evidence regarding any issue material to the claim, the claimant shall be given the benefit of the doubt in resolving each such issue. 38 U.S.C.A. § 5107; Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); 38 C.F.R. §§ 3.102 (2010). On the other hand, if the Board determines that the preponderance of the evidence is against the claim, it has necessarily found that the evidence is not in approximate balance, and the benefit of the doubt rule is not applicable. Ortiz, 274 F.3d at 1365. B. Factual Background and Analysis Service treatment records contain no indications of any complaints or findings regarding injury or disease associated with the claimed disorders on appeal. There is no medical evidence of any gunshot wound or other left leg injury, or relevant complaints or findings. There are no complaints or findings regarding injury or disease associated with the cervical or lumbar spine; peripheral nerves of the bilateral lower or upper extremities; or reproductive system referable to impotence. A September 1967 ETS (expiration of term of service) examination report of history shows that the Veteran reported he had had cramps in his legs, and a history of broken bones. He reported that he had not had any neuritis, bone, joint, or other deformity, recurrent back pain, or swollen or painful joints. The report of a September 1967 ETS examination report shows that on examination, evaluation was normal for upper and lower extremities, spine and other musculoskeletal system, and neurologic examination. The only identifying marks pertained to a tattoo of the left arm and right arm. The examination report contains no findings or diagnosis of any abnormality or injury involving any gunshot wound; or abnormality of the left leg, cervical or lumbar spine, peripheral nerves of the bilateral lower or upper extremities, or reproductive system. After service, the medical records on file include private and VA treatment records dated from 1970 to June 2005 showing treatment for various complaints and conditions; and reports of VA examinations in March 1985 and June 2009. Relevant medical records are discussed below. Private treatment records in December 1970 include the report of X-ray examination containing an impression of normal lumbar spine. Private treatment records dated in August 1977 show that the Veteran underwent a vasectomy with bilateral vas deferens removed. Subsequent treatment records in September 1977 show no findings of any residuals other than the expected zero sperm count. Private treatment records of hospitalization for a stomach condition include a report of a May 1981 examination, which contains findings that extremity and neurological evaluation was negative. Private treatment records from the provider who performed the vasectomy in 1977 show that when seen later in February 1982, the Veteran was having some problems with impotence for which he was given testosterone at that time and again in March 1982. Private treatment records in July 1984 show that the Veteran was seen for complaints of right costovertebral angle area pain when he moves and bends. The Veteran reported that he thought that he may have hurt it at work. After examination the diagnosis was lumbosacral strain. A September 1984 VA treatment record shows that the Veteran reported complaints including headaches, and having no energy and reduced sex drive. On evaluation, the diagnoses included reduced sex drive secondary to mild depression. VA treatment records include a March 1985 neurology progress note showing that the Veteran presented reporting a history of Agent Orange exposure, with complaints of headaches. After examination the provider's impression was that the Veteran had a normal neurological examination. The report of a March 1985 VA examination shows that the Veteran reported a number of complaints he associated with Agent Orange exposure, including numbness in his hand. On examination, no abnormal neurological findings were made; and genitourinary system was normal. After examination, the report contains a diagnosis indicating that except for conditions unrelated to this appeal, examination was within normal limits. Private treatment records in January 1995 show that the Veteran was seen for complaints including headaches, for which he requested X-ray examination of the neck to evaluate whether the neck was causing his headaches. He also reported complaints of hurting in the low back. The Veteran underwent X-ray examination of the cervical and lumbar spines at that time. The report of examination contains impressions, regarding the cervical spine, of (1) no fractures, and (2) advanced degenerative disc and joint disease change at C5-6; and regarding the lumbar spine, of (1) no fractures, and (2) no significant degenerative change for age. Private treatment records in August 2002 show that on X-ray examination of the lumbar spine, the impression was multilevel degenerative disc disease with interval progression at L3-4 and L5-S1. Private treatment records in April 2003 show that on X- ray examination of the cervical spine, the impression was moderate degenerative disc disease at C5-6 and C6-7. Private treatment records in 2003 show assessments including low back pain, muscle spasms, and organic impotence. Private treatment records beginning in September 2003 contain assessments including carpal tunnel syndrome (wrist/hand pain or numbness), hyperesthesias of the legs, and paresthesias of the arms. Private treatment records beginning in October 2003 contain assessments including neuritis (inflamed nerve which can cause pain, numbness or weakness). A September 2003 private electrodiagnostic evaluation report shows that the Veteran underwent nerve conduction studies/EMG of the bilateral upper and lower extremities. The report contains impressions of rule out bilateral carpal tunnel syndrome versus polyneuropathy; and rule out left lumbar radiculopathy. In a November 2003 letter, Eric R. Beck, M.D., Ph.D., stated that the Veteran was a patient under his care; and that the Veteran had a polyneuropathy. Dr. Beck stated that in service the Veteran was exposed to Agent Orange, which contains dioxin, which is an agent known to cause polyneuropathy. Dr. Beck noted that all other workup had been negative for another cause of the polyneuropathy. The report of a private neurologic examination in January 2004 contains an assessment that the neurological examination was reasonably normal without any clinical evidence of peripheral neuropathy; findings raised a possibility of meralgia paresthetica, an entrapment neuropathy of the lateral femoral cutaneous nerve of the thigh behind the inguinal ligament. The report of a private EMG nerve conduction studies examination in February 2004 contains a conclusion that findings were indicative of mild axonal loss type of peripheral polyneuropathy chiefly involving both lower extremities. An October 2004 VA neurology clinic note contains an assessment of very mild peripheral neuropathy; EMG/NCS shows polyneuropathy and possible bilateral carpal tunnel syndrome. The provider noted that the Veteran reported a history of Agent Orange exposure. The provider opined that the etiology of the peripheral neuropathy was unclear, however, he could not rule out Agent Orange exposure as a possible cause. The report of a June 2009 VA examination shows that the Veteran underwent examination of the claimed disorders subject to this appeal. The Veteran reported a number of complaints regarding each of these. Regarding the neck, the Veteran reported complaints of having started to have gradual onset of neck pain in the 1990s. He denied any accident or trauma at that time, or during service. He reported having daily pain. After examination, the report contains a diagnosis of degenerative disc disease of the cervical spine. Regarding the low back, the Veteran reported having low back pain in service but he could not remember any specific incident or trauma in service. He reported he started having chronic low back pain in the 1990s. After examination, the report contains a diagnosis of degenerative disc disease of the lumbar spine. Regarding the left lower leg, the Veteran reported that he was shot in the leg while in service, and this was treated at that time. The examiner noted that the Veteran stated he was not admitted for the gunshot wound and only had one treatment visit to assess and treat this. He reported having left leg pain and numbness since that time, and that the leg has been stable since then. The examiner noted on examination that he saw no scar or evidence of tissue damage over the left leg at the locations where the Veteran indicated he suffered a wound in service. After examination, the report contains a diagnosis of left leg meralgia paresthetica (lateral femoral cutaneous entrapment). The examiner opined that the etiology of this was the compression of the nerve over the inguinal ligament. Regarding bilateral hand and feet pain and numbness, the Veteran reported having these symptoms starting in the 1990s. He reported that he was working at that time building pallets and had a lot of prolonged standing and use of the hands. The Veteran reported that he had been found to have a low B12 vitamin level by VA Neurology in 2004 or 2005. The Veteran reported complaints of numbness, paresthesias, dysesthesias, and pain involving the feet and hands and left thigh. The examiner noted that nerve conduction studies in September 2003 showed findings of polyneuropathy diffuse, possible superimposed bilateral carpal tunnel syndrome; no left lumbosacral radiculopathy; and that EMG/NCS in February 2004 showed findings of normal sensory NCS of the left sural and sup peroneal; motor dysfunction consistent with mild axonal loss and diffuse peripheral neuropathy, mostly of the bilateral lower extremities. After examination the report contains a diagnosis of (1) mild sensory peripheral neuropathy of the feet and hands, and (2) carpal tunnel syndrome. The examiner opined that the etiology of the problem was a B12 deficiency. Regarding the genitourinary complaints, the Veteran reported that his erectile dysfunction started in the 1990s with a gradual onset of symptoms with issues with initiating and maintaining erections. He reported that ejaculation was normal. After examination the report contains a diagnosis of erectile dysfunction. The examiner opined that the most likely etiology was medication taken. At the conclusion of the report of a June 2009 VA examination the examiner provided the following opinions. First, that the diagnosed cervical spine, lumbar spine, and left leg conditions were not caused by or a result of the Veteran's time in service to include exposure to Agent Orange. In this regard, the examiner noted that the Veteran's degenerative disc disease of the cervical and lumbar spine was a form of arthritis, and that this occurs with aging and also due to the physical nature of the Veteran's occupations after service. The examiner also opined that there was no connection between Agent Orange and degenerative arthritis of the spine; and that there was no documented injury of the spine or left leg in service. Finally, the examiner opined that the left leg condition was meralgia paresthetica, which was due to compression of the left lateral femoral cutaneous nerve and unrelated to the back condition or Agent Orange exposure. The examiner opined that the bilateral feet/hand pain, was a chronic mild peripheral neuropathy that was etiologically related to low B12 level; and that the carpal tunnel syndrome was due to inflammation of the tendon sheath in the bilateral wrists, the flexor retinaculum, which was due to over use of the wrists in the work he was doing in the 1990s. In this regard, the examiner noted that these symptoms had diminished since the Veteran stopped his work. The examiner opined that the erectile dysfunction was due to the Veteran's medications taken for the Veteran's headaches and pain. In conclusion, the examiner noted that the Veteran did not have any symptoms of neuropathy, carpal tunnel syndrome or erectile dysfunction while in service; and by his own account and per records, the Veteran did not have any symptoms until the 1990s for these conditions. The examiner opined that the neuropathy was related to the B12 deficiency associated with the gastric resection in the 1980s. The examiner noted that Agent Orange exposure was not known to cause low B12, carpal tunnel syndrome or erectile dysfunction. Review of service records indicate that the Veteran served in Vietnam for a period of time during that war. Therefore, the Board may apply a legal presumption that a Veteran who served in the Republic of Vietnam during the Vietnam Era be presumed to have been exposed during such service to an herbicide agent (Agent Orange). 38 U.S.C.A. § 1116; 38 C.F.R. § 3.307(a)(6)(iii). The presumption of service connection based on service in Vietnam, however, only applies to certain specific disorders, and the disorders on appeal here are not covered. 38 C.F.R. § 3.309(e). Notably in this regard, as reflected in the medical evidence above, while the medical record evidence does show neurological diagnoses including peripheral neuropathy, there is no medical evidence of acute and/or subacute peripheral neuropathy. That is, there is no medical evidence of a transient peripheral neuropathy, which appeared within weeks or months of presumed inservice exposure to an herbicide agent, and resolved within two years of the date of onset. See 38 C.F.R. § 3.309(e), Note 2. Therefore, the evidence pertaining to the peripheral neuropathy claim does not warrant presumptive service connection under 38 C.F.R. §§ 3.307(a)(6), 3.309(e). Nevertheless, with respect to any of the claimed disorders subject to this decision, the Federal Circuit has determined that the regulations governing presumptive service connection for Agent Orange exposure do not preclude the Veteran from establishing service connection with proof of actual direct causation, as discussed below. See Combee v. Brown, 34 F.3d 1039, 1043-44 (Fed. Cir. 1994). (1) Residuals of a Left Leg Injury Service treatment records show no complaints, findings, or treatment for any injury or disease referable to the claimed residuals of a left leg injury. There is no medical evidence at all during or after service showing that the Veteran's left leg was injured by a gunshot wound during service. To that extent, though the Veteran is competent to provide lay evidence on this matter, the Veteran's assertions of a left leg gunshot wound in service are not credible given the absence of any medical record evidence of such injury in service. Therefore the Veteran's assertions as to such injury in service are not probative. The first treatment shown of any left leg symptomatology, ultimately diagnosed as meralgia paresthetica, occurred in the 2000s, almost four decades following discharge from service. In this regard, the Federal Circuit Court has determined that such a lapse of time is an important factor for consideration in deciding a service connection claim. See Maxson v. West, 12 Vet. App. 453 (1999), aff'd, 230 F.3d 1330 (Fed. Cir. 2000) (service incurrence may be rebutted by the absence of medical treatment of the claimed condition for many years after service). Subsequent VA treatment records show further treatment for the left leg condition. Overall, however, service connection may not be established in this case for residuals of a left leg injury based on chronicity in service or post-service continuity of symptomatology for a disorder seen in service. 38 C.F.R. § 3.303(b); Savage v. Gober, 10 Vet. App. 488, 495 (1997). The VA examiner in the June 2009 VA examination opined that the etiology of the left leg meralgia paresthetica, was the compression of the nerve over the inguinal ligament, and that the condition was unrelated to Agent Orange exposure. In this regard, the examiner also found that there was no documented injury of the left leg in service. There are no competent and credible opinions to the contrary. Here, despite the Veteran's assertions of a gunshot wound in service, there is simply no evidence in his service treatment records that support these assertions. No other post-service treatment records link his left leg meralgia paresthetica to military service. Thus, the Board finds that post-service medical records, as a whole, provide very negative evidence against the Veteran's claim as they reveal left leg symptomatology that began decades after service with no connection to service. (2) Degenerative Disc Disease of the Cervical Spine and Lumbar Spine Service treatment records show no complaints, findings, or treatment for any injury or disease referable to the claimed degenerative disc disease of the cervical spine and lumbar spine. The first treatment shown for symptomatology diagnosed as lumbosacral strain was in private treatment records in July 1984. The Veteran himself at that time stated that he may have hurt this at work. Subsequently, in January 1995 X-rays of the lumbar spine showed no fractures or significant degenerative change for the Veteran's age. Not until the 2000s do treatment records show degenerative disc disease involving the lumbar spine. The first treatment shown for cervical spine symptoms was in 1995, when the Veteran was seen for headaches, and at that time X-ray examination of the cervical spine showed advanced degenerative disc and joint disease at C5-6. The initial treatment for both segments of the spine were not until at least 17 years after service for the lumbar spine; and 28 years for the cervical spine. Such a lapse of time after service is an important factor for consideration in deciding a service connection claim. See Maxson v. West, 12 Vet. App. 453 (1999), aff'd, 230 F.3d 1330 (Fed. Cir. 2000). Subsequent treatment records show further treatment for the cervical and lumbar spine conditions. Overall, however, service connection may not be established in this case for degenerative disc disease of the cervical spine or of the lumbar spine based on chronicity in service or post-service continuity of symptomatology for a disorder seen in service. 38 C.F.R. § 3.303(b); Savage v. Gober, 10 Vet. App. 488, 495 (1997). The VA examiner in the June 2009 VA examination opined that the etiology of the degenerative disc disease of the cervical spine and degenerative disc disease of the lumbar spine, was that the arthritis of each of these segments of the spine occurred with aging and was also due to the physical nature of the Veteran's occupations after service. He also opined that the degenerative disc disease of the cervical spine and lumbar spine were unrelated to Agent Orange exposure; and that there was no documented injury of the spine in service. There are no competent and credible opinions to the contrary. Here, despite the Veteran's assertions essentially of having cervical and lumbar spine symptomatology since service, albeit more serious since the 1990s, there is no evidence in his service treatment records that support these assertions; and no other post-service treatment records link his degenerative disc disease of the cervical spine and lumbar spine to military service. Thus, the Board finds that post-service medical records, as a whole, provide very negative evidence against the Veteran's claim as they reveal degenerative disc disease of the cervical spine and lumbar spine symptoms that began long after service with no connection to service. (3) Peripheral Neuropathy of the Bilateral Lower Legs Service treatment records show no complaints, findings, or treatment for any injury or disease referable to the claimed peripheral neuropathy of the bilateral lower legs. The first treatment shown for peripheral nerve symptomatology of the lower extremities diagnosed later as peripheral neuropathy of the bilateral lower legs was in private treatment records in 2003, almost four decades after service. Such a lapse of time after service is an important factor for consideration in deciding a service connection claim. See Maxson v. West, 12 Vet. App. 453 (1999), aff'd, 230 F.3d 1330 (Fed. Cir. 2000). Subsequent treatment records show further treatment for the condition. Overall, however, service connection may not be established in this case for peripheral neuropathy of the bilateral lower legs based on chronicity in service or post-service continuity of symptomatology for a disorder seen in service. 38 C.F.R. § 3.303(b); Savage v. Gober, 10 Vet. App. 488, 495 (1997). Notably, a treating physician, E. R. Beck, M.D., provided a letter in November 2003 in which he stated that the Veteran had a polyneuropathy; had been exposed to Agent Orange, which contains dioxin, an agent known to cause polyneuropathy; and stated that all the workup had been negative for another cause of the polyneuropathy. Similarly, an October 2004 VA neurology clinic note shows that the provider stated that the etiology of the Veteran's peripheral neuropathy was unclear, but he could not rule out Agent Orange exposure as a possible cause. The Board, however, finds these comments to be ambivalent as to providing an opinion on the critical question at hand, and therefore to be of limited probative value. Neither statement actually provides an opinion linking any peripheral neuropathy of the bilateral lower legs to exposure to Agent Orange. In contrast, the VA examiner in the June 2009 VA examination opined that the etiology of the peripheral neuropathy of the bilateral lower legs, was the Veteran's low levels of B12. In this regard, the examiner noted that the Veteran reported that the symptoms started only in the 1990s, and that he was working at that time building pallets, with much time standing. The examiner also opined that Agent Orange exposure was not known to cause low levels of B12. Here, despite the Veteran's assertions that peripheral neuropathy of the bilateral lower legs was related to exposure to Agent Orange in service, the preponderance of the medical evidence is against that finding. Thus, the Board finds that post-service medical records, as a whole, provide very negative evidence against the Veteran's claim as they reveal peripheral neuropathy of the bilateral lower legs symptoms that began decades after service, and the preponderance of the evidence is against a finding of an etiological connection to service. (4) Carpal Tunnel Syndrome of the Bilateral Upper Extremities Service treatment records show no complaints, findings, or treatment for any injury or disease referable to the claimed carpal tunnel syndrome of the bilateral upper extremities. The first complaints of numbness in the hands was during a March 1985 VA examination; however, on examination at that time, no abnormal findings were made. This was about 18 years after service. The first treatment shown for carpal tunnel syndrome symptoms of the bilateral upper extremities-ultimately diagnosed as mild sensory peripheral neuropathy of the hands, and carpal tunnel syndrome-was in private treatment records in 2003, almost four decades after service. Such a lapse of time after service is an important factor for consideration in deciding a service connection claim. See Maxson v. West, 12 Vet. App. 453 (1999), aff'd, 230 F.3d 1330 (Fed. Cir. 2000). Subsequent treatment records show further treatment for the bilateral hands condition. Overall, however, service connection may not be established in this case for carpal tunnel syndrome of the bilateral upper extremities based on chronicity in service or post-service continuity of symptomatology for a disorder seen in service. 38 C.F.R. § 3.303(b); Savage v. Gober, 10 Vet. App. 488, 495 (1997). The VA examiner in the June 2009 VA examination opined that the etiology of the bilateral upper extremities disorder of the hands, was the Veteran's low levels of B12, regarding the mild sensory peripheral neuropathy of the hands; and inflammation of the tendon sheath in the bilateral wrists, due to over use of the wrists in the Veteran's job during the 1990s, regarding the carpal tunnel syndrome. The examiner noted in this regard, that the symptoms diminished after the Veteran stopped that work. The examiner also opined that Agent Orange exposure was not known to cause carpal tunnel syndrome. There are no competent and credible opinions to the contrary. Here, despite the Veteran's assertions that carpal tunnel syndrome of the bilateral upper extremities was related to exposure to Agent Orange in service, the preponderance of the medical evidence is against that finding. Thus, the Board finds that post-service medical records, as a whole, provide very negative evidence against the Veteran's claim as they reveal that the bilateral hand symptoms of carpal tunnel syndrome began a number of years after service, and the preponderance of the evidence is against a finding of an etiological connection to service. (5) Organic Impotence Organic impotence is defined as impotence caused by some physical disorder that affects the sexual apparatus, usually classified as either vasculogenic, neurogenic, or endocrinologic. It is sometimes caused by accidental or iatrogenic trauma or it may occur as a side effect of certain drugs. See Dorland's Illustrated Medical Dictionary 937 (31st ed. 2007). Service treatment records show no complaints, findings, or treatment for any injury or disease referable to the claimed organic impotence. The first treatment shown of any impotence symptoms occurred in the February 1982. At that time the Veteran was treated by the same provider who performed a vasectomy in August 1977. He was given testosterone at that time and again in March 1982. That initial treatment for impotence symptoms in February 1982 was about 15 years after service. Such a lapse of time is an important factor for consideration in deciding a service connection claim. See Maxson v. West, 12 Vet. App. 453 (1999), aff'd, 230 F.3d 1330 (Fed. Cir. 2000). Subsequent VA treatment records show further treatment for the organic impotence condition. Overall, however, service connection may not be established in this case for organic impotence based on chronicity in service or post-service continuity of symptomatology for a disorder seen in service. 38 C.F.R. § 3.303(b); Savage v. Gober, 10 Vet. App. 488, 495 (1997). During treatment by a VA treatment provider in September 1984 for complaints of reduced sex drive, the diagnosis was that the Veteran had reduced sex drive secondary to mild depression. The VA examiner in the June 2009 VA examination opined that the etiology of the organic impotence, was most likely medication the Veteran was taking for headaches and pain. The examiner also opined that Agent Orange exposure was not known to cause erectile dysfunction. Here, despite the Veteran's assertions that he has organic impotence due to exposure to Agent Orange in service, the preponderance of the medical evidence is against that finding. Thus, the Board finds that post-service medical records, as a whole, provide very negative evidence against the Veteran's claim as they reveal that the symptoms of organic impotence began about 15 years after service, and the preponderance of the evidence is against a finding of an etiological connection to service. C. Conclusions Regarding each of the claimed disabilities on appeal, while the Veteran has provided lay evidence of an etiological link to service, VA regards lay statements to be competent evidence of descriptions of symptoms of disease, disability, or injury, but not the determination of an issue involving a question of medical expertise. 38 C.F.R. § 3.159; Espiritu v. Derwinski, 2 Vet. App. 492, 494-95 (1992); but see Jandreau v. Nicholson, 492 F.3d1372, 1377 (Fed. Cir. 2007) (lay diagnosis is competent if: (1) lay person is competent to identify the medical condition; (2) lay person is reporting a contemporaneous medical diagnosis; or (3) lay testimony of symptoms at the time supports a later diagnosis by a medical professional). As the Veteran is not shown to be a medical expert, his opinion in these matters is of little probative value. While the Veteran's contentions have been considered carefully, these contentions are outweighed by the medical evidence of record, which does not demonstrate that any of the claimed disabilities on appeal is attributable to active service. See Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006) (noting that the absence of contemporaneous medical documentation may go to the credibility and weight of veteran's lay testimony, but the lack of such evidence does not, in and of itself, render the lay testimony incredible). See also Jandreau, supra (noting that lay evidence can be competent to establish a diagnosis when . . . a layperson is competent to identify the medical condition). The negative evidence of record is of greater probative value than the Veteran's statements in support of each of his claims on appeal. Further, there is no evidence of arthritis, or acute or subacute peripheral neuropathy, to a compensable degree within one year of service separation; this precludes granting service connection for any claimed arthritis, or acute or subacute peripheral neuropathy on the basis of pertinent presumptive regulations. 38 C.F.R. §§ 3.307, 3.309. After considering all the evidence of record, the Board finds that the preponderance of the evidence is against the claims for service connection for (1) residuals of a left leg injury; (2) degenerative disc disease of the cervical spine; (3) degenerative disc disease of the lumbar spine; (4) peripheral neuropathy of the bilateral lower legs; (5) carpal tunnel syndrome of the bilateral upper extremities; and (6) organic impotence. Therefore, the benefit-of-the-doubt rule does not apply, and these claims must be denied. 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). ORDER Service connection for residuals of a left leg injury is denied. Service connection for degenerative disc disease of the cervical spine is denied. Service connection for degenerative disc disease of the lumbar spine is denied. Service connection for peripheral neuropathy of the bilateral lower legs is denied. Service connection for carpal tunnel syndrome of the bilateral upper extremities is denied. Service connection for organic impotence is denied. ____________________________________________ A. BRYANT Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs