Citation Nr: 18147581 Decision Date: 11/05/18 Archive Date: 11/05/18 DOCKET NO. 16-37 951 DATE: November 5, 2018 ORDER Entitlement to service connection for bilateral myelopathy of the upper extremities is granted. Entitlement to service connection for bilateral myelopathy of the lower extremities is granted. FINDINGS OF FACT 1. It is at least as likely as not that the Veteran’s bilateral myelopathy of the upper extremities is related to his active service. 2. It is at least as likely as not that the Veteran’s bilateral myelopathy of the lower extremities is related to his active service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for bilateral myelopathy of the upper extremities have been met. 38 U.S.C §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310. 2. The criteria for Entitlement to service connection for bilateral myelopathy of the lower extremities have been met. 38 U.S.C §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from June 1966 to May 1969 with confirmed service in Vietnam. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service. See 38 U.S.C § 1110; 38 C.F.R. § 3.303(a). “To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service’-the so-called ‘nexus’ requirement.” Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d); see Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). Furthermore, service connection can be established through application of statutory presumptions, to include those diseases associated with exposure to certain herbicide agents like Agent Orange. While the record indicates that the Veteran served in Vietnam during his active duty service, the Veteran’s myelopathy has not been associated with exposure to herbicides for the purpose of presumptive service connection and it is not among the diseases listed in 38 C.F.R. § 3.309(e). Nonetheless, the Veteran is presumed to have been exposed to herbicides, including Agent Orange, while stationed in Vietnam. Thus, he is not precluded from showing that his military service caused his current disability on a direct basis because the Board must consider entitlement to service connection on alternative bases. See Combee, 34 F.3d at 1043. When all the evidence is assembled, the Board is then responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether the preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Entitlement to service connection for bilateral myelopathy of the upper extremities and entitlement to service connection for bilateral myelopathy of the lower extremities The Veteran contends that his bilateral upper and lower extremity myelopathy is related to his exposure to certain herbicides in service. Upon review of the record, the Board finds that the evidence supports the Veteran’s contentions and that service connection is warranted. There is no dispute as to two of the elements of service connection. One, the Veteran has a current disability of myelopathy in his upper and lower extremity as noted in a June 2015 examination. Two, the Veteran’s personnel file details his serve in Vietnam from July 1968 to May 1969, and as such he is presumed to have been exposed to certain herbicides (i.e. Agent Orange). The only remaining element is a nexus between this exposure and the Veteran’s current disability. Turning to nexus, the Board notes that there is no negative opinion of record. Instead, the Veteran has provided a positive opinion from his primary care physician wherein he opined that it was at least as likely as not that the Veteran’s bilateral upper and lower extremity myelopathy was caused by his exposure to Agent Orange. The Board in weighing the probative value of this opinion recognizes the inherent and unique position the Veteran’s treating physician has in relation to the history and details of the Veteran’s disease. It is with this understanding that the Board finds that the Veteran’s treating physician’s opinion has the most probative value in the claim file. As such, the Board finds that all the components of service connection have been found and service connection is warranted. GAYLE STROMMEN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Acosta, Counsel