Citation Nr: 18161197 Decision Date: 12/31/18 Archive Date: 12/28/18 DOCKET NO. 16-50 087 DATE: December 31, 2018 ORDER Service connection for peripheral neuropathy of the left upper extremity (LUE) is denied. Service connection for peripheral neuropathy right upper extremity (RUE) is denied. REMANDED Service connection for post-traumatic stress disorder (PTSD) is remanded. Service connection for hypertension to include as secondary to PTSD is remanded. Service connection for erectile dysfunction (ED) to include as secondary to PTSD is remanded. Entitlement to total disability due to unemployability (TDIU) is remanded. FINDINGS OF FACT 1. 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 peripheral neuropathy of the LUE. 2. 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 peripheral neuropathy of the RUE. CONCLUSIONS OF LAW 1. The criteria for service connection for peripheral neuropathy of the LUE are not met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 2. The criteria for service connection for peripheral neuropathy of the RUE are not met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1969 to August 1972 in the United States Marine Corps. These matters come before the Board of Veterans’ Appeals (Board) on appeal from April 2015, June 2016, and March 2017 rating decisions issued by the Department of Veterans Affairs (VA). Service Connection 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 be granted for disability which is proximately due to or the result of service-connected disability. 38 C.F.R. § 3.310 (a). Additional disability resulting from the aggravation of a non-service-connected disability by a service-connected disability is also service-connected. 38 C.F.R. § 3.310 (b) (2017); Allen v. Brown, 7 Vet. App. 439 (1995). 1. Service connection for LUE peripheral neuropathy. 2. Service connection for RUE peripheral neuropathy. Issues 1-2. The Veteran seeks service connection for peripheral neuropathy of the upper extremities. He contends that this disability is secondary to diabetes. See Third Party Correspondence (October 2014). The question for the Board is whether the Veteran has a current peripheral nerve disability of either upper extremity, to include peripheral neuropathy, that either began in service or is otherwise related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current diagnosis of peripheral neuropathy in his left or right upper extremity 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). An April 2015 VA examination report reflects that, while the Veteran had subjective symptoms of numbness and tingling in the hands at night, the sensation was noted by him to resolve quickly and there were no objective signs or finding to support a diagnosis of peripheral neuropathy of either upper extremity. Further, VA treatment records do not contain a diagnosis of upper extremity peripheral neuropathy or any other nerve disorder of either upper extremity. The Board notes that the April 2015 VA examination revealed that the Veteran presented with mild diabetic peripheral neuropathy of his bilateral lower extremities for which he is assigned a 10 percent evaluation since September 30, 2014. However as noted above, a diagnosis of peripheral neuropathy of the bilateral upper extremities was not indicated. While the Veteran may believe he has peripheral neuropathy of the upper extremities due to his diabetes, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education involving the neurological system. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Therefore, the Veteran’s medical opinion that he has peripheral neuropathy of the upper extremities has no probative value. He has not presented any medical evidence showing that he has any nerve disorder of the upper extremities, to include peripheral neuropathy, to weigh in this appeal. The Board gives more probative weight to the April 2015 VA examination, which reflects no diagnosis for peripheral neuropathy of the upper extremities as it was prepared by a skilled, neutral medical professional after examining the Veteran and considering his medical history. It is noted that the existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C. §§ 1110, 1131; Degmetich v. Brown, 104 F. 3d 1328 (1997). In the absence of proof of a present disability due to disease or injury, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). On balance, the weight of the evidence is against the claims. Accordingly, the claims are denied. There is no doubt to resolve. 38 U.S.C. § 5107(b).   REASONS FOR REMAND 1. Entitlement to service connection for PTSD. 2. Entitlement to service connection for hypertension to include as secondary to PTSD. 3. Entitlement to service connection for ED to include as secondary to PTSD. 4. Entitlement to TDIU. Remanded Issues 1-4. To ensure that VA has met its duty to assist, the Board finds that remand is necessary to determine whether the Veteran meets the criteria for a diagnosis of PTSD due to his service in support of the Vietnam War in accordance with 4.125(a). See 38 C.F.R. § 3.159(c). The Veteran filed a claim for PTSD in September 2014. He submitted mental health treatment records which cite to a diagnosis of PTSD. He contends that his PTSD was caused by his service in support of the Vietnam War. In a February 2015 correspondence, he described his personal events from the March 1972 Easter Offensive. He described traumatic events which included being exposed to hostile enemy fire and observing fellow service-members get injured. He also described how he often experiences a heightened response to stimuli and nightmares, which he believes is due to his experiences during military service. There are conflicting medical opinions of record as to whether the Veteran meets the diagnostic requirements for PTSD. See April 2015 VA examination, June 2015 VA examination addendum, May 2015 disability benefits questionnaire, and May 2016 Medical Treatment records non-governmental. Further, there is no examination which assesses the Veteran’s PTSD as per the Diagnostic and Statistical Manual of Mental Disorders (DSM) 5th Edition. A June 2015 medical opinion found that the Veteran met the criteria for PTSD as per DSM-IV. In the report, Dr. JH noted that he was proficient in VA PTSD evaluations and had assessed more than 200 Veterans with the disability. He noted that the Veteran did meet the threshold for Criterion A for PTSD and noted the Veterans reports of experiencing rocket attacks during service. The Board finds further development is required to determine the following: 1) if the Veteran has a diagnosis of PTSD as per DSM-V criteria; and if so, 2) whether the Veteran’s hypertension was caused or aggravated by his PTSD; and 3) whether the Veteran’s ED was caused or aggravated by his PTSD. The VA must provide a medical examination with an opinion when such information is necessary to make a decision on the claim. In McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006), the Court held that an examination is required when there is (1) evidence of a current disability, (2) evidence establishing that an “in-service event, injury or disease,” or a disease occurred, and (3) an “indication” that the current disability may be related to service, but (4) there is not sufficient evidence to decide the case. See 38 U.S.C. § 5103A; 38 C.F.R. §§ 3.159 (c)(4), 3.326(a). The Veteran was denied service connection for PTSD because a diagnosis for the disability has not been established as per DSM-V guidelines as required by §4.125(a). There is an indication that he meets the guidelines for PTSD as confirmed by the June 2015 disability benefits questionnaire performed by Dr. JH which confirmed a diagnosis of PTSD as per DSM-IV criteria. The Board notes that VA has conceded hostile military activity; therefore, additional verification of the Veteran’s stressors is not necessary. The Veteran’s claim for service connection for hypertension and ED along with his claim for TDIU are “inextricably intertwined” with the outcome of his claim for service connection for PTSD. See Parker v. Brown, 7 Vet. App. 116 (1994); Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (issues are “inextricably intertwined” when a decision on one issue would have a “significant impact” on a Veteran’s claim for the second issue). The matters are REMANDED for the following action: 1. Schedule the Veteran for a psychiatric examination to determine the nature and etiology of any PTSD. If the Veteran is diagnosed with PTSD in accordance with DSM-V, the examiner must explain how the diagnostic criteria are met and opine whether it is at least as likely as not related to a verified in-service stressor (fear of hostile military activity). (a.) If the Veteran is diagnosed with a personality disorder and PTSD - The examiner must opine whether the PTSD was at least as likely as not superimposed on a personality disorder during active service and resulted in additional disability. (b.) If any other acquired psychiatric disorders are diagnosed, the examiner must opine whether each diagnosed disorder is at least as likely as not related to an in-service injury, event, or disease, to include the Veteran’s service in support of the Vietnam War and the conceded in-service stressor of fear of hostile military activity. (Continued on the next page)   2. Conduct any other development deemed necessary. 3. Readjudicate. C.A. SKOW Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. A. Macek, Associate Counsel