Citation Nr: 18156659 Decision Date: 12/11/18 Archive Date: 12/10/18 DOCKET NO. 16-42 323 DATE: December 11, 2018 ORDER Entitlement to service connection for idiopathic peripheral neuropathy of bilateral lower extremities, to include as due to an undiagnosed illness is denied. FINDING OF FACT The weight of the probative evidence of record is against a finding that the Veteran’s currently diagnosed idiopathic peripheral neuropathy of the lower extremities is due to a disease or injury during active service nor was idiopathic peripheral neuropathy of the lower extremities manifested to a compensable degree within one year of his discharge from active service. CONCLUSION OF LAW The criteria for service connection for idiopathic peripheral neuropathy have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1117 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.317. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from September 1972 to September 1974 and December 1990 to April 1991, to include service in the Southwest Asia Theater of Operations during the Persian Gulf War. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri. I. Service Connection- Pertinent Laws and Regulations Generally, service connection will be granted for a disability resulting from an injury or disease caused or aggravated by service. 38 U.S.C. § 1110 (2012). A grant of service connection for a disability requires: (1) a present disability or persistent or recurrent symptoms of a disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship ("nexus") between the present disability and the in-service event, injury, or disease. 38 C.F.R. § 3.303 (2017); see Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). In addition, the law provides that, where a veteran served ninety days or more of active service and certain chronic diseases become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 C.F.R. § 3.309(a). While the disease need not be diagnosed within the presumptive period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. Under 38 C.F.R. § 3.317, service connection may be granted on a presumptive basis if there is evidence (1) that the claimant is a Persian Gulf Veteran; (2) who exhibits objective indications of chronic disability resulting from an undiagnosed illness, a medically unexplained chronic multisymptom illness (such as chronic fatigue syndrome, fibromyalgia, or IBS) that is defined by a cluster of signs or symptoms, or resulting from an illness or combination of illnesses manifested by one or more signs or symptoms such as those listed in paragraph (b) of 38 C.F.R. § 3.317; (3) which became manifest either during active military, naval, or air service in the Southwest Asia Theater of Operations during the Persian Gulf War, or to a degree of 10 percent or more not later than December 31, 2021; and (4) that such symptomatology by history, physical examination, and laboratory tests cannot be attributed to any known clinical diagnosis. 38 U.S.C. §§ 1117, 1118; 38 C.F.R. § 3.317. The term "Persian Gulf veteran" means a veteran who served on active military, naval, or air service in the Southwest Asia Theater of Operations during the Persian Gulf War. The "Southwest Theater of Operations" refers to Iraq, Kuwait, Saudi Arabia, the neutral zone between Iraq and Saudi Arabia, Bahrain, Qatar, the United Arab Emirates, Oman, the Gulf of Aden, the Gulf of Oman, the Persian Gulf, the Arabian Sea, the Red Sea, and the airspace above these locations. 38 C.F.R. § 3.317(e). II. Analysis The Veteran seeks service connection for bilateral lower extremity peripheral neuropathy. The medical evidence of record shows the Veteran is currently diagnosed with idiopathic peripheral neuropathy of the lower extremities. Thus, a current disability is shown. The Veteran does not contend, and the service treatment records do not show that he manifested symptoms of the claimed disability during his military service or within a year of separation from service. Rather, he contends that his claimed disability is due to his exposure to environmental toxins during his service in the Persian Gulf War. As the Veteran is a “Persian Gulf veteran,” an in-service event is shown. In regard to a nexus between the claimed disability and the in-service event, post-service medical records show that in March 2011 the Veteran complained of an abnormal feeling in both his lower extremities for the past four years. The Veteran was prescribed Amitriptyline by Dr. J.M. A March 2012 Nerve Conduction and EMG report shows the Veteran reported symptoms present for the past 10 years. VA treatment records further show that neurologist Dr. B.F. noted an impression of peripheral neuropathy, etiology not clear in July 2012. The Veteran reported an onset of approximately 15 years ago. Records dated in October 2012 show Dr. B.F. noted the Veteran had peripheral neuropathy and he “suspect[ed] symptoms [were] due to pre-diabetic neuropathy.” An April 2013 record shows Dr. B.F. noted an impression of “neuropathy--probably HMSN plus prediabetic.” An October 2013 record shows Dr. B.F. noted an assessment of “peripheral neuropathy likely related to HMSN.” A March 2014 neurology note by neurologist Dr. B.B. shows that the Veteran reported that he was not aware of a family history of neuropathy. The assessment was “peripheral neuropathy likely related to HMSN vs cryptogenic.” The Veteran underwent a VA examination in September 2014. The examiner noted that the Veteran reported that his symptoms started approximately in 2005. The examiner provided the opinion that throughout the Veteran’s medical records post military, the Veteran’s idiopathic peripheral neuropathy was felt to be a combination of pre-diabetes and a hereditary motor and sensory neuropathy. It was noted that a conclusive etiology had not been made for this condition and was medically unexplained at this time. The Veteran had been prediabetic since 2009 although he stated his symptoms started prior to 2009. The condition was assumed to be hereditary but he denied a family history. The examiner maintained that an etiology had not been determined but based on the medical opinions noted in his file, this was a hereditary condition and there was no mention that this had been caused by prior environmental exposures during the military. The Board finds the September 2014 opinion of the VA examiner to be probative and persuasive as it is based on a review of the evidence of record and consistent with the opinions set forth in the VA treatment records. The medical opinion evidence of record shows that the Veteran’s peripheral neuropathy is not likely related to his military service exposures. The Board is cognizant of the argument made by the Veteran’s representative that the VA examination is inadequate. See briefs dated in October 2016 and April 2018. Specifically, the representative maintained that “the examiner relied upon an absence of medical records to support her conclusion that the veteran’s [disability] was not related to his military service.” Again, the examiner’s opinion is consistent with the opinions of the Veteran’s treatment providers. In sum, the preponderance of the competent, credible and probative evidence is against the claim, and service connection for bilateral lower extremity peripheral neuropathy is denied. In reaching this decision, the Board considered the doctrine of reasonable doubt; however, as the preponderance of the evidence is against the Veteran's service connection claim for bilateral lower extremity peripheral neuropathy, the doctrine is not for application. TANYA SMITH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. C. Roberson; Law Clerk