Citation Nr: 18145638 Decision Date: 10/29/18 Archive Date: 10/29/18 DOCKET NO. 10-00 451A DATE: October 29, 2018 ORDER Entitlement to service connection for right lower extremity peripheral neuropathy, as secondary to service-connected diabetes mellitus, is granted. Entitlement to service connection for left lower extremity peripheral neuropathy, as secondary to service-connected diabetes mellitus, is granted. Entitlement to service connection for right upper extremity peripheral neuropathy, as secondary to service-connected diabetes mellitus, is granted. Entitlement to service connection for right upper extremity peripheral neuropathy, as secondary to service-connected diabetes mellitus, is granted. FINDINGS OF FACT 1. The evidence is in relative equipoise as to whether the Veteran’s bilateral lower extremity peripheral neuropathy was aggravated by his service-connected diabetes mellitus. 2. The evidence is in relative equipoise as to whether the Veteran’s bilateral upper extremity peripheral neuropathy was aggravated by his service-connected diabetes mellitus. CONCLUSIONS OF LAW 1. Resolving all reasonable doubt in the Veteran’s favor, the criteria for service connection for right lower extremity peripheral neuropathy have been met. 38 U.S.C. §§ 1101, 1110, 5103(a), 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310. 2. Resolving all reasonable doubt in the Veteran’s favor, the criteria for service connection for left lower extremity peripheral neuropathy have been met. 38 U.S.C. §§ 1101, 1110, 5103(a), 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310. 3. Resolving all reasonable doubt in the Veteran’s favor, the criteria for establishing entitlement to service connection for right upper extremity peripheral neuropathy have been met. 38 U.S.C. §§ 1101, 1110, 5103(a), 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310. 4. Resolving all reasonable doubt in the Veteran’s favor, the criteria for establishing entitlement to service connection for left upper extremity peripheral neuropathy have been met. 38 U.S.C. §§ 1101, 1110, 5103(a), 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1965 to November 1968. This matter comes before the Board of Veterans’ Appeals (Board) from a September 2008 rating decision of a Regional Office (RO) of the Department of Veterans Affairs (VA), which denied entitlement to service connection for bilateral peripheral neuropathy in both the upper and lower extremities. In July 2018, the Veteran testified before the undersigned Veterans’ Law Judge at a Travel Board hearing. A transcript is of record.   Service Connection The Veteran seeks entitlement to service connection for bilateral upper and lower extremity peripheral neuropathy, secondary to service-connected diabetes mellitus. The Veteran neither asserts, nor does the record show, diabetic neuropathy or related symptoms onset during miliary service. The Board has limited the discussion below to the relevant evidence required to support its finding of fact and conclusion of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008). Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service, even if the disability was initially diagnosed after service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection may also be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.310. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The Veteran’s VA treatment records show a diagnosis of bilateral upper and lower extremity peripheral neuropathy. Thus, there is evidence of a current disability. Additionally, the Veteran is service-connected for Type II diabetes mellitus. Accordingly, the question before the Board is whether a nexus, or causal relationship, between the Veteran’s current peripheral neuropathy and his service-connected diabetes has been shown. There are competing medical opinions of record in this is regard. The Veteran was afforded a VA examination in January 2008, where he reported neuropathy since the 1970s and described tingling and numbness of the hands and feet. The examiner diagnosed bilateral neuropathy of the upper and lower extremities and opined that while this condition was not a secondary complication of diabetes, it is aggravated by diabetes mellitus because neuropathy occurs due to metabolic changes associated with diabetes. The examiner explained that constant high blood sugar destroys both nerve fibers and the fatty insulation that surrounds it. Also, damaged nerves do not transmit proper signals, resulting in loss of sensation [and also cause] hyper sensation or pain. VA treatment records include medical problem lists which reflect findings of diabetic neuropathies. The Veteran was also afforded a VA examination in October 2011. The examiner opined that the Veteran’s peripheral neuropathy is not a complication of his diabetes mellitus. The examiner noted that it is plausible that the Veteran’s neuropathy is aggravated by his diabetes because there is no alternative cause on lab screens, no evidence of significant myelopathy, radiculopathy, or stroke residuals. However, the examiner expressed concern that the Veteran reported his symptoms began around 1969-1970 and became painful in 1973, well before any diagnosis of diabetes mellitus. The examiner found it significant that the Veteran was a heavy alcohol drinker after leaving the service and thus, believed it to be more likely than not that his alcohol use contributed the most to the development of his diabetic neuropathy. The examiner further opined that if the Veteran stopped alcohol for the long term, and his neuropathic pain continued to worsen, he would recommend reevaluation as the likelihood of a significant contribution attributable to diabetes would be enhanced. VA treatment records continue to reflect findings of diabetic neuropathies on the Veteran’s medical problem list after the 2011 VA examination. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The Veteran neither asserts, nor does the record, show that diabetic neuropathy or related symptoms onset during miliary service. Rather, consistent with the Veteran’s assertions, the evidentiary record appeals to reflect this manifested after service. The Veteran’s VA treatment records reflect diagnoses of diabetic neuropathies in his current medical problem list. See, e.g., April 2008, June 2008, December 2009, July 2010, October 2011, January 2013, June 2014, January 2015, December 2016, November 2017, and March 2018 VA Treatment Records. The Board finds both VA opinions are competent and responsive to the question at hand. The Board finds no adequate reason to find that the negative opinion outweighs the favorable opinion. Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997). Accordingly, the evidence is in least in relative equipoise as to whether the Veteran’s peripheral neuropathy was aggravated by his service-connected diabetes. When the evidence for and against the claim is in relative equipoise, by law, the Board must resolve all reasonable doubt in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Resolving all doubt in the Veteran’s favor, the Board finds that entitlement to service connection for bilateral peripheral neuropathy of the upper and lower extremities, as secondary to service-connected diabetes, is warranted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Aoughsten, Associate Counsel