Citation Nr: 18156351 Decision Date: 12/11/18 Archive Date: 12/07/18 DOCKET NO. 16-49 786 DATE: December 11, 2018 ORDER Relevant service records have been received to reopen the claim of entitlement to service connection for peripheral neuropathy of the right hand. The appeal is granted to that extent only. Relevant service records have been received to reopen the claim of entitlement to service connection for peripheral neuropathy of the left hand. The appeal is granted to that extent only. Relevant service records have been received to reopen the claim for entitlement to service connection for peripheral neuropathy of the right foot. The appeal is granted to that extent only. Relevant service records have been received to reopen the claim of entitlement to service connection for peripheral neuropathy of the left foot. The appeal is granted to that extent only. Relevant service records have been received to reopen the claim of entitlement to service connection for erectile dysfunction. The appeal is granted to that extent only. Entitlement to service connection for peripheral neuropathy of the right hand, to include secondary to alcoholism, is denied. Entitlement to service connection for peripheral neuropathy of the left hand, to include secondary to alcoholism, is denied. Entitlement to service connection for peripheral neuropathy of the right foot, to include secondary to alcoholism, is denied. Entitlement to service connection for peripheral neuropathy of the left foot, to include secondary to alcoholism, is denied. Entitlement to service connection for erectile dysfunction, to include as secondary to posttraumatic stress disorder (PTSD), is denied. Entitlement to service connection for ischemic heart disease, to include as secondary to herbicide exposure, is denied. REMANDED Entitlement to service connection for erectile dysfunction, to include as secondary to PTSD, is remanded. FINDINGS OF FACT 1. By an August 2012 rating decision, the Veteran’s claim of entitlement to service connection for peripheral neuropathy of the right hand was denied. 2. Relevant service department records have been received which were not part of the evidence of record at the time of the August 2012 rating. 3. By an August 2012 rating decision, the Veteran’s claim of entitlement to service connection for peripheral neuropathy of the left hand was denied. 4. Relevant service department records have been received which were not part of the evidence of record at the time of the August 2012 rating. 5. By an August 2012 rating decision, the Veteran’s claim of entitlement to service connection for peripheral neuropathy of the right foot was denied. 6. Relevant service department records have been received which were not part of the evidence of record at the time of the August 2012 rating. 7. By an August 2012 rating decision, the Veteran’s claim of entitlement to service connection for peripheral neuropathy of the left foot was denied. 8. Relevant service department records have been received which were not part of the evidence of record at the time of the August 2012 rating. 9. By an August 2012 rating decision, the Veteran’s claim of entitlement to service connection for erectile dysfunction was denied. 10. Relevant service department records have been received which were not part of the evidence of record at the time of the August 2012 rating. 11. The Veteran’s peripheral neuropathy of the right and left hand is not related to active service nor is it secondary to a service connected disorder. 12. The Veteran’s peripheral neuropathy of the right and left foot is not related to active service nor is it secondary to a service connected disorder. 13. The Veteran’s erectile dysfunction is neither proximately due to nor aggravated beyond its natural progression by his service-connected PTSD, and is not otherwise related to an in-service injury, event, or disease. 14. The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of ischemic heart disease. CONCLUSIONS OF LAW 1. The August 2012 rating decision denying service connection for peripheral neuropathy of the right hand is final. 38 U.S.C. §§ 7104 (2012); 38 C.F.R. §§ 3.156, 20.200, 20.201, 20.302, 20.1103 (2017). 2. Relevant service department records have been received to reopen the claim of entitlement to service connection for peripheral neuropathy of the right hand and the claim is reopened. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156 (2017). 3. The August 2012 rating decision denying service connection for peripheral neuropathy of the left hand is final. 38 U.S.C. §§ 7104 (2012); 38 C.F.R. §§ 3.156, 20.200, 20.201, 20.302, 20.1103 (2017). 4. Relevant service department records have been received to reopen the claim of entitlement to service connection for peripheral neuropathy of left hand, and the claim is reopened. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156 (2017). 5. The August 2012 rating decision denying service connection for peripheral neuropathy of the right foot is final. 38 U.S.C. §§ 7104 (2012); 38 C.F.R. §§ 3.156, 20.200, 20.201, 20.302, 20.1103 (2017). 6. Relevant service department records have been received to reopen the claim of entitlement to service connection for peripheral neuropathy of the right foot, and the claim is reopened. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156 (2017). 7. The August 2012 rating decision denying service connection for peripheral neuropathy of the left foot is final. 38 U.S.C. §§ 7104 (2012); 38 C.F.R. §§ 3.156, 20.200, 20.201, 20.302, 20.1103 (2017). 8. Relevant service department records have been received to reopen the claim of entitlement to service connection for peripheral neuropathy of the left foot, and the claim is reopened. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156 (2017). 9. The August 2012 rating decision denying service connection for erectile dysfunction is final. 38 U.S.C. §§ 7104 (2012); 38 C.F.R. §§ 3.156, 20.200, 20.201, 20.302, 20.1103 (2017). 10. Relevant service department records have been received to reopen the claim of entitlement to service connection for erectile dysfunction, and the claim is reopened. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156 (2017). 11. The criteria for service connection for peripheral neuropathy of the right hand are not met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 12. The criteria for service connection for peripheral neuropathy of the left hand are not met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 13. The criteria for service connection for peripheral neuropathy of the right foot are not met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 14. The criteria for service connection for peripheral neuropathy of the left foot are not met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 15. The criteria for service connection for erectile dysfunction are not met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 16. The criteria for service connection for ischemic heart disease are not met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from July 1963 to October 1968 and April 1975 to February 1990. I. Reopening A claim may be considered on the merits only if new and material evidence has been received since the time of the prior adjudication. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a); Jackson v. Principi, 265 F.3d 1366 (Fed. Cir. 2001). An exception to this general rule occurs when VA receives or associates with a claim file relevant official service department records. A previously denied service connection claim is then readjudicated on a de novo basis. See 38 C.F.R. § 3.156 (c). In this case, VA received relevant official service department records consisting of the Veteran’s service treatment records. Therefore, the claims of entitlement to service connection for bilateral peripheral neuropathy of the hands and feet and entitlement to service connection for erectile dysfunction are reopened. II. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. § 1110, 1131; 38 C.F.R. § 3.303. “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. Shineski, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Secondary service connection may be established for a disability that is proximately due to, the result of, or aggravated beyond its natural progression by a service connected condition and shall be service connected on a secondary basis. 38 C.F.R. § 3.310(a); see also Allen v. Brown, 7 Vet. App. 439 (1995). Establishing secondary service connection requires evidence of: (1) a current disability (for which secondary service connection is sought); (2) an already service-connected disability; and (3) that the claimed disability was either caused or aggravated by the already service-connected disability. Id. A. Bilateral Peripheral Neuropathy of the Hands The Veteran contends his bilateral peripheral neuropathy of the hands and feet is secondary to alcoholism. Secondary service connection requires that the claimed disability is caused by or aggravated by an already service connected disability. Secondary service connection cannot be established if the underlying disability is not service connected. As the Veteran is not service connected for alcoholism, secondary service connection for bilateral peripheral neuropathy of the hands and feet is not warranted. 38 C.F.R. § 3.310(a). Service connection may also be granted on a direct basis, but the preponderance of the evidence is also against finding that the Veteran’s bilateral peripheral neuropathy of the hands and feet are related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). Review of the service treatment records reflects no complaints, treatments, or diagnoses related to peripheral neuropathy of the hands or feet. There is no objective evidence of record to establish that there was an in-service event, injury, or illness resulting in peripheral neuropathy of the hands and feet. The Board notes that the VA’s duty to provide a VA examination is not triggered in this case. In determining whether VA’s duty to assist requires a VA medical examination or medical opinion, four factors are for consideration: (1) whether there is competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) whether there is evidence establishing that an event, injury, or disease occurred in service, or evidence establishing certain diseases manifesting during an applicable presumption period; (3) whether there is an indication that the disability or symptoms may be associated with the veteran's service or with another service-connected disability; and (4) whether there otherwise is sufficient competent medical evidence of record to make a decision on the claim. 38 U.S.C. § 5103A (d) (2012); 38 C.F.R. § 3.159 (c)(4) (2017); see McLendon v. Nicholson, 20 Vet. App. 79 (2006). The evidence of record does not establish that the Veteran’s claimed disability manifested during service or is related to service. As such, a VA examination or opinion is not necessary. The Board finds that entitlement to service connection for bilateral peripheral neuropathy of the hands and feet is not warranted. B. Ischemic Heart Disease If the veteran was exposed to an herbicide agent (to include AO) during active service, ischemic heart disease shall be service-connected if the requirements of 38 C.F.R. § 3.307 (a)(6) are met, even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 C.F.R. § 3.307(d) are also satisfied. A veteran who, during active military, naval, or air service, served in the Republic of Vietnam between January 9, 1962 and May 7, 1975 is presumed to have been exposed to an herbicide agent if a listed chronic disease manifests to a degree of 10 percent disabling or more, unless there is affirmative evidence to the contrary. 38 C.F.R. § 3.307 (a). The presumption is rebuttable. 38 C.F.R. § 3.307(d). Service in the Republic of Vietnam includes service in the waters offshore and service in other locations, if the conditions of service involved duty or visitation in the Republic of Vietnam. 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. See 38 U.S.C. § 1116; 38 C.F.R. § 3.309(e). Where the evidence does not warrant presumptive service connection, a veteran is not precluded from establishing service connection for disability due to exposure to herbicides with proof of direct causation. Combee v. Brown, 34 F.3d 1039, 1041 (Fed. Cir. 1994). In other words, a presumption of service connection provided by law is not the sole method for showing causation in establishing a claim for service connection for disability due to herbicide exposure. The Board concedes herbicide exposure; however, the Veteran does not have a current diagnosis of ischemic heart disease and has not had one at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303(a), (d). In April 2013, a VA examination for ischemic heart disease was conducted. The examination report noted that the Veteran’s echocardiogram from January 2013 revealed hypertrophy or dilation and noted that there is no congestive heart failure or history of myocardial infarction. The examiner determined that the Veteran does not have a diagnosis of ischemic heart disease or any diagnoses pertaining to ischemic heart disease. Review of the medical treatment records confirms that the evidence of record does not contain a diagnosis of ischemic heart disease. To the extent that the Veteran alleges he has ischemic heart disease, this allegation is without probative value. The determination as to whether the Veteran has a diagnosis of ischemic heart disease is a complex medical question which requires specialized knowledge as well as pertinent testing to diagnose. As a lay person, the Veteran does not have the requisite knowledge to provide the diagnosis. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Therefore, the Board finds the evidence insufficient to establish a current disability. Congress has specifically limited entitlement to service connection to cases where such incidents have resulted in a disability. Brammer v. Derwinski, 3 Vet. App. 223, 255 (1992). In the absence of proof of a present disability there can be no valid claim. Id. As such, the preponderance of the evidence is against the claim for service connection for ischemic heart disease. REASONS FOR REMAND The Veteran underwent a VA examination for erectile dysfunction in June 2012. The VA examiner opined that the Veteran’s erectile dysfunction is less likely than not proximately due to or the result of the Veteran’s PTSD; however, the examiner did not provide an opinion as to whether the Veteran’s erectile dysfunction is aggravated by his PTSD. As such, a remand is necessary to obtain an addendum opinion addressing aggravation. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The matters are REMANDED for the following action: 1. Acquire updated VA and/or private treatment records. If such records are unavailable, the Veteran’s claim file must be clearly documented to that effect and the Veteran notified in accordance with 38 C.F.R. § 3.159(e). 2. Obtain an addendum opinion from a medical professional with appropriate expertise. The examiner should review the Veteran’s claims file, including a copy of this remand, and comment on the following questions: (a.) Is it at least as likely as not (i.e., probability of 50 percent or higher) that erectile dysfunction is aggravated (i.e., permanently or temporarily worsened) by the service-connected PTSD? (b.) If aggravation is found, the examiner should address the following medical issues: 1) the baseline manifestations of the disorder found prior to aggravation; and 2) the increased manifestations which, in the examiner's opinion, are proximately due to the service-connected disorder. If the examiner determines that an opinion cannot be provided without an examination, the Veteran should be scheduled for one. The term “aggravation” means a permanent increase in the claimed disability; that is, an irreversible worsening of the condition beyond the natural clinical course and character of the condition due to the service-connected disability as contrasted to a temporary worsening of symptoms. The examiner should consider and address any lay statements of record. If there is a medical basis to support or doubt any statements provided, the examiner should provide a fully reasoned explanation. The examination report must include a complete rationale for all opinions expressed. If the examiner feels that a requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e. no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e. additional facts are required, or the examiner does not have the needed knowledge or training). 3. Finally, readjudicate the appeal. If the service connection sought for erectile dysfunction remains denied, issue a supplemental statement of the case and return the case to the Board. G. A. WASIK Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. A. Prinsen, Associate Counsel