Citation Nr: 1304334	
Decision Date: 02/06/13    Archive Date: 02/19/13

DOCKET NO.  09-28 634	)	DATE
	)
	)

On appeal from the
Department of Veterans Affairs Regional Office in St. Petersburg, Florida


THE ISSUE

Entitlement to service connection for peripheral neuropathy, to include as due to herbicide exposure or secondary to service connected diabetes mellitus, Type II.  


REPRESENTATION

Appellant represented by:	Florida Department of Veterans Affairs


ATTORNEY FOR THE BOARD

C. C. Dale, Counsel






INTRODUCTION

The Veteran served on active duty from September 1965 to September 1967.

This matter comes before the Board of Veterans' Appeals (BVA or Board) on appeal from an October 2007 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida, which denied service connection for hepatitis, and in a June 2008 rating decision, which denied reopening the claim of service connection for bilateral peripheral neuropathy. 

In April 2011, the Board reopened the Veteran's claim of service connection for bilateral peripheral neuropathy.  The Board remanded the claims of service connection for bilateral peripheral neuropathy and hepatitis for additional development.

In April 2012, the Board awarded service connection for hepatitis B and remanded the issue of service connection for peripheral neuropathy for additional development.  Within the same month, the RO implemented the Board's award of service connection for hepatitis B and assigned a noncompensable initial rating.  

In May 2012, the Veteran's wife submitted a letter on his behalf in disagreement with the noncompensable initial rating.  Overall, her statements express a desire to submit additional evidence for the RO's consideration in assigning an initial rating for hepatitis B.  She did not express a desire for appellate review; hence, the statements do not meet the criteria for a notice of disagreement (NOD).  38 C.F.R. § 20.201.  She also raises an informal claim for service connection for fungus of the fingernails and toenails.  The issues of a higher initial rating for hepatitis B and service connection for fungus of the fingernails and toenails have been raised by the record, but have not been adjudicated by the Agency of Original Jurisdiction (AOJ).  Therefore, the Board does not have jurisdiction over them, and they are referred to the AOJ for appropriate action.  



FINDING OF FACT

The Veteran has not been demonstrated to have peripheral neuropathy incurred or aggravated by any incident of active service, to include herbicide exposure, or secondary to service connected diabetes mellitus, Type II.  


CONCLUSION OF LAW

The criteria for the establishment of service connection for peripheral neuropathy are not met.  38 U.S.C.A. §§ 1110, 5107(b) (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310 (2012).  


REASONS AND BASES FOR FINDING AND CONCLUSION

Duty to Notify and Assist

The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations imposes obligations on VA to provide claimants with notice and assistance.  38 U.S.C.A. §§ 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2012); 38 C.F.R §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). 

Proper VCAA notice must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide.  38 U.S.C.A. § 5103(a) (West 2002); 38 C.F.R. § 3.159(b)(1) (2012); Pelegrini v. Principi, 18 Vet. App. 112 (2004).

In Pelegrini, the United States Court of Appeals for Veterans Claims (Court) held that VCAA notice, as required by 38 U.S.C.A. § 5103(a), must be provided to a claimant before the initial unfavorable adjudication by the RO. 

The Court has also held that the VCAA notice requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a service connection claim.  Those five elements include: 1) veteran status; 2) existence of a disability; 3) a connection between the veteran's service and the disability; 4) degree of disability; and 5) effective date of the disability.  Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). 

The record indicates that the Veteran was provided with adequate VCAA notice in August 2006.  Specifically, the RO notified the Veteran of information and evidence necessary to substantiate his service connection claim.  He was notified of the information and evidence that VA would seek to provide and the information and evidence that he was expected to provide.  In November 2008, he was informed of the information and evidence necessary to substantiate a claim based upon a service connected disability.  While this letter was furnished after the issuance of the appealed rating decision, the appeal was subsequently readjudicated in a Supplemental Statement of the Case most recently issued in November 2012.  This course of corrective action fulfills VA's notice requirements.  See Mayfield v. Nicholson, 499 F.3d 1317 (Fed. Cir. 2007).  The duty to notify has been met. 

The Board further concludes that the duty to assist has also been met.  The Veteran's service treatment records, VA treatment records, Social Security Administration (SSA) records, state workers' compensation records, and private medical records have been obtained, in addition to various written statements by the Veteran himself.  He was afforded an appropriate VA examination for claimed peripheral neuropathy in May 2011 and a medical opinion adequate for adjudication purposes in May 2012.  Barr v. Nicholson, 21 Vet. App. 303 (2007).  Although the opinion accompanying the May 2011 clinical examination was inadequate for adjudication purposes, the clinical findings and statements made by the Veteran can be considered.  Id.  The Board further notes that the May 2012 VA examiner did not explicitly consider the Veteran's March 2012 statement asserting a continuity of symptomatology beginning in service.  However, as explained in detail below, the Board does not consider his statement credible and her omission in directly addressing this statement does not render her opinion inadequate.  Id. 

The Board also finds that the record reflects substantial compliance with the instructions in the April 2011 and April 2012 Board Remands.  D'Aries v. Peake, 22 Vet. App. 97, 105 (2008).  The evidence includes updated VA treatment records, an updated May 2012 VA medical opinion that is adequate for adjudication purposes, and issuance of a November 2012 supplemental statement of case.  The Board is satisfied that there was substantial compliance with its remand orders.  Id.; see Dyment v. West, 13 Vet. App. 141, 146-47 (1999); Stegall v. West, 11 Vet. App. 268, 271 (1998).

There is no indication that there is any relevant evidence outstanding for this claim, and the Board will proceed with consideration of the Veteran's appeal.

Laws and regulations

Service connection will be granted for a disability resulting from disease or injury incurred in or aggravated by active service.  38 U.S.C.A. § 1110; 38 C.F.R. § 3.303.  Establishing service connection generally requires (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 present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996) (table); see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); Hickson v. West, 12 Vet. App. 247, 253 (1999); 38 C.F.R. § 3.303.  

Under 38 C.F.R. § 3.303(b), an alternative method of establishing the second and third Shedden/Caluza element is through a demonstration of continuity of symptomatology.  Barr v. Nicholson, 21 Vet. App. 303 (2007); see Savage, 10 Vet. App. 488, 495-97 (1997); see also Clyburn v. West, 12 Vet. App. 296, 302 (1999). Continuity of symptomatology may be established if a claimant can demonstrate (1) that a condition was "noted" during service; (2) evidence of post- service continuity of the same symptomatology; and (3) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology.  Savage v. Gober, 10 Vet. App. 488, 495-96; see Hickson, 12 Vet. App. at 253 (lay evidence of in-service incurrence sufficient in some circumstances for purposes of establishing service connection); 38 C.F.R. § 3.303(b).

The Federal Circuit has held that "[l]ay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional."  Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); see also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) ("[T]he Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence").

"Symptoms, not treatment, are the essence of any evidence of continuity of symptomatology."  Savage, 10 Vet. App. at 496 (citing Wilson v. Derwinski, 2 Vet. App. 16, 19 (1991)).  Once evidence is determined to be competent, the Board must determine whether such evidence is also credible.  Layno v. Brown, 6 Vet. App. 465, 469 (distinguishing between competency ("a legal concept determining whether testimony may be heard and considered") and credibility ("a factual determination going to the probative value of the evidence to be made after the evidence has been admitted")).

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).

A Veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, shall be presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service.  See 38 U.S.C.A. § 1116(f) 
(West 2002), 38 C.F.R. § 3.307(a)(6) (iii) (2012).  The record shows that the Veteran had service during the requisite period in Vietnam, and he is presumed to have been exposed to herbicide in service.  See Personnel records documenting in-country Vietnam service.

If a Veteran was exposed to an herbicide agent during active military, naval, or air service, certain listed diseases shall be service connected.  Such diseases include acute and sub-acute peripheral neuropathy that manifested within the requisite time period.  See 38 U.S.C.A. § 1116 (West 2002), 38 C.F.R. § 3.309(e), Note 2 (2012).

Regardless of whether a claimed disability is recognized under 38 U.S.C.A. § 1116, pertaining to herbicide agent exposure presumptive diseases, a Veteran is not precluded from presenting evidence that a claimed disability was due to or the result of herbicide exposure.  Combee v. Brown, 34 F.3d 1039, 1044-45 (Fed. Cir. 1994); McCartt v. West, 12 Vet. App. 164, 167 (1999).

A disability which is proximately due to or the result of a service-connected disease or injury shall be service connected.  38 C.F.R. § 3.310(a).

Secondary service connection may also be established for a nonservice-connected disability which is aggravated by a service connected disability.  In this instance, the Veteran may be compensated for the degree of disability over and above the degree of disability existing prior to the aggravation.  Allen v. Brown, 7 Vet. App. 439 (1995).  VA has amended 38 C.F.R. § 3.310 to explicitly incorporate the holding in Allen, except that it will not concede aggravation unless a baseline for the claimed disability can be established prior to any aggravation.  38 C.F.R. § 3.310(b).  The regulation providing for service connection on an aggravation basis was amended effective October 10, 2006 to prohibit VA from conceding aggravation unless there is medical evidence showing the baseline level of the disability before its aggravation by the service-connected disability.  See 71 Fed. Reg. 52744 (September 7, 2006) (codified at 38 C.F.R. § 3.310(b)).  However, service connection is not being awarded on the basis of aggravation and further discussion of the amendment is not necessary.

In a claim for secondary service connection for a diagnosis clearly separate from the service-connected disorder, the Veteran must present evidence of a medical nature to support the alleged causal relationship between the service-connected disorder and the disorder for which secondary service connection is sought.  See Jones v. Brown, 7 Vet. App. 134 (1994); Waters v. Shinseki, 601 F.3d 1274, 1278 (Fed. Cir. 2010).

In relevant part, 38 U.S.C.A. 1154(a) (West 2002) requires that VA give "due consideration" to "all pertinent medical and lay evidence" in evaluating a claim for disability or death benefits.  Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009).

Factual background
      
Service treatment records do not show any complaints or treatment for peripheral neuropathy.  They reflect that in July 1967, the Veteran complained about a sprained foot.  He was given a cast and ace wrap.  His cast was removed three days later.  On his Report of Medical History for separation in September 1967 he denied having or ever having lameness, foot trouble, or neuritis.  Contemporaneous clinical examination did not reveal any neurological abnormality. 

The Veteran does not assert that he had peripheral neuropathy during service, rather he contends that it is related to herbicide exposure or secondary to service connected diabetes mellitus, Type II (diabetes).  Service records confirm that the Veteran served with the Army in the Republic of Vietnam from May to September 1967.  He is presumed to have been exposed to herbicide agents.  38 C.F.R. § 3.307(a)(6)(iii).  

Private medical records, dated in August 1991, reflect that the Veteran had an on the job crush injury between two large pipes the past May.  He broke several ribs and currently had neck and shoulder pain radiating to his right arm. Clinical examination showed a full range of motion for the right shoulder with pain throughout.  Neurovascular status was intact.  X-rays of the cervical spine and shoulder were normal.  The physician recommended physical therapy.  

In January 1995, the Veteran's treating physician summarized his recent course of medical care.  He noted a diagnosis of severe reflex sympathetic dystrophy affecting the right upper extremity and right side of the neck.  He was treated with a spinal cord nerve stimulator, but his increased arm pain made it ineffective.  He recommended a new stimulator or morphine pump for pain relief.  He concluded that this disease substantially interfered with the Veteran's life.  

VA treatment records from January 1995 to June 1999 show that the Veteran regularly sought treatment for chronic pain associated with reflex sympathetic dystrophy.

The Veteran underwent a state workers' compensation examination in November 1999.  He reported having reflex sympathetic dystrophy and low back pain.  Clinical examination showed a noticeable tremor for the right hand.  Extremities had palpable peripheral pulses without edema, cyanosis or clubbing.  He demonstrated full range of motion for all joints with the exception of his right upper extremity.  Throughout it, he had continuous shaking.  Lumbar spine was without tenderness and straight leg testing was negative.  Neurological findings showed normal motor function with the exception of the right upper extremity.  Coordination and gait were normal.  Sensation was normal to touch and pin with plantar reflexes downgoing bilaterally.  The examiner assessed reflex sympathetic dystrophy, chronic back pain, and depression.  He opined that the Veteran had complete disability in his right arm.  

In October 2006, the Veteran described having a severe right arm tremor.  

In November 2006, the Veteran sought medical attention at the VA neurology clinic.  He described a longstanding history of tingling and stinging sensations in both lower extremities.  He was not known to have diabetes.  He believed his neuropathic disorders were gradually increasing.  He recalled having sensations of "ants" and burning in his legs beginning 30 years ago and becoming persistent 10 years ago.  It was exacerbated by lumbar disc surgery.  He acknowledged having a significant history for alcohol consumption, including moonshine.  Currently, he drank six beers per day.  He also provided a history of a severe right arm injury, 

which developed into reflex sympathetic dystrophy syndrome.  Neurological examination showed light touch and position to be within normal limits.  Pinprick was diminished in the right leg below the calf, while left leg sensation was intact.  Temperature was also decreased in the right leg below the calf.  However, the Veteran exhibited full motor strength and tone bilaterally.  His right leg had diminished reflexes and ankle jerks were absent for both legs.  Gait was normal.  Laboratory testing showed normal B12, glucose, and thyroid readings.   EMG confirmed sensory neuropathy with axonal loss.  The examiner concluded that the symptoms were consistent with sensory neuropathy, but not as pronounced as would be expected from clinical observation.  He stated that most obvious cause is alcohol consumption.  He noted that there was not a family history for neuropathy.  Diabetes, B12, and folate disorders were not found.  He did not suspect heavy metal toxicity.  

The Veteran returned to the VA neurology clinic in April 2007.  He complained that his current mediation regimen was not working.  Despite the medication adjustment, his symptoms continued to persist and in July 2007 the healthcare provider recommended a referral to the Pain Clinic for long term opioid therapy.  

VA neurology treatment records from April 2008 show that the Veteran had increasing burning pain, which was greater in the right leg than the left leg.  He developed edema as a medication side effect.  The examiner observed that the Veteran had periodic hyperglycemia and that it may be diabetic peripheral neuropathy. 

The Veteran had EMG testing in May 2008.  The results confirmed sensorimotor neuropathy and axonal loss in the right lower extremity, but did not show right sided radiculopathy.  

VA primary care treatment records from August 2008 show that the Veteran was noted to have mild hyperglycemia and neuropathy.    

In October 2008, the Veteran reported that he had high blood sugars and was being further evaluated for diabetes.  

The Veteran had a VA diabetes examination in April 2009.  He was found to have diabetes.  Peripheral neuropathy was not noted as an associated symptom.  The examiner explained that the Veteran had intact monofilament testing.  

VA examined the Veteran for his claimed peripheral neuropathy in May 2011.  He reported noticing symptoms around 1991.  He complained about numbness in both feet with the right being worse.  He also described having "ants" from the foot to the knees in both legs.  He was unsure about neuropathy symptoms in his upper extremities, but confirmed right arm problems.  Sensory examination of both upper extremities showed normal vibration, light touch, and position sense.  Temperature was decreased for both hands.  Lower extremities showed absent vibration and position sense in both feet and decreased light touch in both feet.  Motor examination was normal for all extremities.  The examiner observed an antalgic gait due to joint condition.  The examiner reviewed August 2006 and 2008 EMG test results.  

The examiner diagnosed bilateral upper and lower peripheral neuropathy with an unknown etiology.  She opined that it was less likely related to service, including herbicide exposure.  She cited the reported onset following service and absence of evidence during service or shortly thereafter.  She noted that the earliest objective evidence of symptoms was from 1991 and that an alcohol etiology was initially suspected.  She commented that it was not medically sound to attribute the peripheral neuropathy to subsequently diagnosed diabetes.  She concluded that there was no objective evidence that peripheral neuropathy was due to or aggravated by service or a service connected disability.  

The Veteran visited the VA podiatry clinic in November 2011.  He was noted to have non insulin dependent diabetes with neuropathy.  

In March 2012, the Veteran reported that his neuropathic symptoms started in active service when he began noticing numbness in his feet and legs.  He reported occasional alcohol use, but denied abusing alcohol.  He asserted that his alcohol consumption was an insufficient etiology.  His wife also reported that she observed his legs and feet hurting for many years.  It was not until the 1990s he sought medical attention for it.  She attested that he never abused alcohol and had not had a beer in years. 

VA obtained an additional medical opinion in May 2012.  The examiner summarized the pertinent medical history.  She expressed an opinion that it was less likely that peripheral neuropathy occurred during service or was related to any in-service disease, event, or injury to include Agent Orange exposure.  She also opined that it was less likely that peripheral neuropathy was caused or aggravated by service connected diabetes.  She explained that there was no objective evidence that the Veteran had peripheral neuropathy during service.  Although he had symptoms prior to the diagnosis, his 2006 remarks indicate a history several years following service.  She noted that although diabetes frequently causes peripheral neuropathy, the evidence does not confirm that the later onset of diabetes aggravated the peripheral neuropathy.  She cited two EMG studies occurring before and after the diabetes diagnosis.  

Following the examination in May 2012, the Veteran recalled injuring his right foot and knee in service.  It turned his right leg black and blue.  He had X-rays, but never learned about the results.  

Analysis

The Veteran contends that his current peripheral neuropathy is related to service, including presumed herbicide exposure, or service connected diabetes.  As explained below, the preponderance of the evidence is against the claim, and it will be denied.  

Briefly, the Board notes that acute and subacute peripheral neuropathy are disabilities that are presumptively related to herbicide exposure.  38 C.F.R. § 3.309(e).  However, Note 2 specifies that acute and subacute peripheral neuropathy means transient peripheral neuropathy that appears within weeks of exposure to an herbicide agent and resolves within two of the date of onset.  Id.  The evidence does not show that the Veteran's peripheral neuropathy meets such criteria as the credible evidence suggests an onset at least several years following service.  Furthermore, its duration has been much greater than two years.  For these reasons, the Veteran's demonstrated peripheral neuropathy does not meet the presumptive criteria for acute and subacute peripheral neuropathy.  Id.

Most recently, the Veteran reports that his neurological symptoms began in service.  See March and May 2012 statements.  He is competent to report neurological symptoms, such abnormal sensations in his lower extremities and relate his medical history.  Kahana v. Shinseki, 24 Vet. App. 428, 438 (2011); Layno, 6 Vet. App. at 470.  However, the Board must weigh his reports against the additional evidence of record and overall plausibility.  Caluza, 7 Vet. App. at 510-511, aff'd, 78 F.3d 604 (Fed. Cir. 1996) (per curiam) (table); see Madden, 125 F. 3d at 1481 (Holding that the Board has the "authority to discount the weight and probative value of evidence in light of its inherent characteristics in its relationship to other items of evidence.").  

The Veteran's assertion of symptoms beginning in service is inconsistent with his prior statements, which either date an onset to several years following service or are uncertain as to onset.  See November 2006 VA neurology records; May 2011 VA examination report.  During service, he was found to have a sprained foot.  No neurological abnormalities were reported.  At separation, he specifically denied having lameness, foot trouble, or neuritis.  See September 1967 Report of Medical History; see Buczynski v. Shinseki, 24 Vet. App. 221, 224 (2011) (silence in medical records may be relevant evidence that symptoms were not present if the record would normally have recorded such symptoms).  Overall, the Veteran's assertion of a continuity of symptomatology beginning in service is inconsistent with the additional evidence of record and has minimal probative value.  Madden, 125 F. 3d at 1481.

While the Veteran is competent to report about his neuropathy symptoms and medical history, he is not shown to be a medical professional.  Kahana, 24 Vet. App. at 438.  Thus, his assertions are not competent evidence to address the complex medical question of whether the current peripheral neuropathy is related to presumed herbicide exposure many years ago or service connected diabetes.  See Davidson, 581 F.3d at 1316; Jandreau, 492 F.3d at 1376-77.  His reports of a nexus have no probative value.  See id.  

The competent medical evidence weighs against the claim on all theories of entitlement.  38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310.  By "competent medical evidence" is meant in part that which is provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions.  38 C.F.R. § 3.159(a).  

In November 2006, the VA neurologist suggested an alcohol etiology after ruling out several other known etiologies.  His opinion is consistent as the Veteran reported a significant history of alcohol use and laboratory testing ruled out other known etiologies.  The Board notes that the Veteran and his wife later disputed the frequency of his alcohol use.  Such statements are facially implausible as it is highly unlikely the Veteran would acknowledge extensive alcohol use to a treating physician if it had not occurred.  Madden, 125 F. 3d at 1481.  Furthermore, the Veteran and his wife have self-interest in denying an extensive alcohol use history to rule out a non-service etiology for the present claim.  See Cartwright v. Derwinski, 2 Vet. App. 24, 25 (1991) (VA cannot ignore a veteran's testimony simply because the veteran is an interested party; personal interest may, however, affect the credibility of the evidence).  Overall, the Veteran and his wife's recent denials of alcohol abuse have minimal probative value.  Id.; Madden, 125 F. 3d at 1481.  The November 2006 opinion is uncontroverted by the additional medical evidence.  It is probative and weighs against the claim.  Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007).

At the April 2009 VA diabetes examination, the examiner did not find active peripheral neuropathy on clinical examination.  He cited intact monofilament testing.  He declined to identify peripheral neuropathy as a diabetic complication citing contemporaneous clinical findings.  His opinion is also uncontroverted by the additional medical evidence.  The Board considers the assessment probative in showing that peripheral neuropathy is not a diabetic complication.  Id.

Briefly, there is a May 2011 VA medical opinion available.  The opinion itself is not adequate for adjudication purposes and will not be considered, but clinical findings and statements from the May 2011 VA examination are for consideration.

The May 2012 VA examiner expressed a negative opinion.  She carefully reviewed the claims folder, including the Veteran's statements.  She expressed a negative opinion for an etiology to presumed herbicide exposure.  She cited conflicting statements by the Veteran regarding onset and absence of clinical findings during service.  She explained that the clinical evidence reflected that peripheral neuropathy preexisted the onset of diabetes.  However, she declined to find aggravation as the EMG studies before and after the diabetes diagnosis did not show increased neuropathy.  Her opinions are based upon careful review of the record and the Veteran's statements, prior clinical findings, and are accompanied by a rationale that is consistent with the record.  See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (the probative value of a medical opinion depends on its rationale).  The Board finds the rationales and conclusions expressed in the May 2012 opinion probative.  

In summary, the competent medical evidence weighs against the claim on all theories of entitlement.  It is probative in showing that peripheral neuropathy is not related to any event, injury, or disease incurred during active service, including presumed herbicide exposure.  It is also probative in showing that peripheral neuropathy is not secondary to or aggravated by service connected diabetes.  

For the foregoing reasons, the preponderance of the evidence is against the Veteran's claim.  The benefit-of-the-doubt doctrine is therefore not applicable and the claim for service connection for peripheral neuropathy must be denied.  See 38 U.S.C.A. § 5107(b); see also Gilbert v. Derwinski, 1 Vet. App. at 55-57. 



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ORDER

Service connection for peripheral neuropathy is denied.  


______________________________________________
J. A. MARKEY
Veterans Law Judge, Board of Veterans' Appeals

Department of Veterans Affairs