Citation Nr: 18148166 Decision Date: 11/06/18 Archive Date: 11/06/18 DOCKET NO. 16-48 640 DATE: November 6, 2018 ORDER Service connection for early-onset peripheral neuropathy, right upper extremity, as due to Agent Orange exposure is granted. Service connection for early-onset peripheral neuropathy, left upper extremity, as due to Agent Orange exposure is granted. Service connection for early-onset peripheral neuropathy, right lower extremity, as due to Agent Orange exposure is granted. Service connection for early-onset peripheral neuropathy, left lower extremity, as due to Agent Orange exposure is granted. FINDING OF FACT The Veteran’s early-onset peripheral neuropathy of the bilateral upper and lower extremities was incurred in service, as due to exposure to herbicide agents. CONCLUSIONS OF LAW 1. The criteria for service connection for early-onset peripheral neuropathy, right upper extremity, due to Agent Orange exposure are met. 38 U.S.C. §§ 1110, 1116, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017). 2. The criteria for service connection for early-onset peripheral neuropathy, left upper extremity, due to Agent Orange exposure are met. 38 U.S.C. §§ 1110, 1116, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017). 3. The criteria for service connection for early-onset peripheral neuropathy, right lower extremity, due to Agent Orange exposure are met. 38 U.S.C. §§ 1110, 1116, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017). 4. The criteria for service connection for early-onset peripheral neuropathy, left lower extremity, due to Agent Orange exposure are met. 38 U.S.C. §§ 1110, 1116, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017). REASONS AND BASES FOR FINDING AND CONCLUSIONS The Veteran served on active duty from November 1968 to October 1970 with service in the Republic of Vietnam. In pertinent part, the Veteran was awarded the National Defense Service Medal, the Vietnam Service Medal with combat operations, and the Vietnam Campaign Medal. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2015 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO) that denied service connection for bilateral upper and lower extremity peripheral neuropathy. Service Connection—Laws and Analysis The Veteran contends that he developed early onset peripheral neuropathy as a result of his exposure to herbicide agents while stationed in the Republic of Vietnam. In its August 2011 rating decision granting service connection for coronary artery disease, the RO determined that the Veteran served in the Republic of Vietnam and, thus, was presumed to have been exposed to herbicides such as Agent Orange. Service connection may be established for disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty, in the active military, naval, or air service. 38 U.S.C. § 1110. 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). Additionally, if a veteran was exposed to an herbicide agent during active military, naval, or air service, certain diseases are presumed to be service connected if the requirements of 38 C.F.R. § 3.307 (a)(6) are met, even though there is no record of the disease during service, provided that the rebuttable presumption provisions of 38 C.F.R. § 3.307 (d) are also satisfied. 38 C.F.R. § 3.309 (e) (2017). Early onset peripheral neuropathy is listed as a disease associated with exposure to herbicide agents. 38 C.F.R. § 3.309 (e). Pursuant to the authority granted by the Agent Orange Act of 1991, VA may determine that a presumption of service connection based on exposure to herbicides used in Vietnam is warranted for conditions that VA has found to have a statistically significant association with such exposure, including peripheral neuropathy. Effective for claims such as this one pending on September 6, 2013, VA replaced the term “acute and subacute peripheral neuropathy” with the term “early-onset peripheral neuropathy.” See Disease Associated With Exposure to Certain Herbicide Agents: Peripheral Neuropathy, 78 Fed. Reg. 54763 (Sept. 6, 2013). VA also removed Note 2 to § 3.309(e), which had required, in order for the presumption to apply, that the neuropathy be transient, appear within weeks or months of exposure to an herbicide agent, and resolve within two years of the date of onset. Under the new version of the regulation, early onset peripheral neuropathy will still need to become manifest to a degree of 10 percent or more within one year after the date of last exposure to herbicides in order to qualify for the presumption of service connection, but it no longer needs to be transient. Id. As an initial matter, the Board notes that the Veteran served in the Republic of Vietnam and exposure to herbicide agents, including Agent Orange, is presumed. The Veteran has also been diagnosed with peripheral neuropathy of the upper and lower extremities during the course of the appeal. See August 2015 VA examination report. The outcome of the case, therefore, turns on whether the Veteran’s peripheral neuropathy is early-onset and manifested to a compensable degree within a year of the last date on which he was exposed to herbicide agents. In his October 2016 statement, the Veteran reported that during service he began to experience occasional numbness in his upper extremities. Service treatment records confirm the Veteran’s statements. In a June 1969 service treatment record, the Veteran was seen for chest pain and dizziness. During the evaluation, the Veteran reported that “sometimes fingers also become numb.” The impression was noted as “anxiety reaction.” The Veteran submitted a February 2015 statement from Dr. Mravkov and corresponding nerve conduction studies. Dr. Mravkov indicated that given that chronic peripheral neuropathy was now recognized as presumptive Agent Orange exposure by VA and given that all other causes of the Veteran’s neuropathy had been ruled out by testing, it was more likely than not that the Veteran’s neuropathy was due to exposure to Agent Orange. An August 2015 VA examination confirmed diagnoses of peripheral neuropathy, but no opinion was provided as to the etiology of the Veteran’s disorder. Upon review of the evidence of record, the Board finds it significant that the Veteran reported that he did develop numbness in his hands during service, and service treatment records confirm his statements. The Board finds that the Veteran is competent to describe such symptomatology. In addition, he submitted a supporting medical opinion and nerve conduction studies, which weigh in favor of his claim. As such, it appears the record contains competent and credible evidence the Veteran developed symptomatology of the extremities during service, which was ultimately diagnosed as peripheral neuropathy. Thus, the record does appear to contain evidence indicative of early-onset peripheral neuropathy for the purposes of 38 C.F.R. §§ 3.307, 3.309(e). For these reasons, and resolving reasonable doubt in the Veteran’s favor, the Board finds that the competent and credible evidence of record reflects it is at least as likely as not the Veteran developed peripheral neuropathy of the extremities as a result of his active service. Therefore, service connection is warranted for this disability. J. GALLAGHER Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R. Casadei, Counsel