Citation Nr: 18129705 Decision Date: 08/27/18 Archive Date: 08/27/18 DOCKET NO. 06-07 029A DATE: August 27, 2018 ORDER Entitlement to service connection for restless leg syndrome is denied. FINDING OF FACT The Veteran’s restless leg syndrome was not incurred during active duty and is not otherwise related to military service, to include as a result of presumed herbicide agent exposure or secondary to a service-connected disability. CONCLUSION OF LAW The criteria for entitlement to service connection for restless leg syndrome are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from April 1969 to November 1970, including combat service in Vietnam. Among his decorations are the Air Medal, Bronze Star Medal, and the Combat Infantryman Badge. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2008 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a hearing before the undersigned Veterans Law Judge in January 2011. In April 2011 and January 2016, the Board remanded the issue on appeal for further development 1. Entitlement to service connection for restless leg syndrome. The Veteran asserts that his restless leg syndrome is related to service, to include exposure to herbicide agents therein. In the alternative, he states that it is secondary to his service-connected diabetes, including anxiety disorder, diabetes, and peripheral neuropathy. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Establishing service connection generally requires evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). For purposes of establishing service connection for a disability resulting from exposure to a herbicide agent, a veteran who, during active military, naval, or air service, served in the Republic of Vietnam beginning on January 9, 1962, and ending on May 7, 1975, shall be presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to establish that the Veteran was not exposed to any such agent during that service. 38 C.F.R. § 3.307(a)(6)(iii). Diseases presumptively associated with herbicide agent exposure do not include restless leg syndrome. Even if a veteran is found not to be entitled to a regulatory presumption of service connection, the claim must still be reviewed to determine if service connection can be established on a direct basis. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). Service connection may also be established on a secondary basis for a disability proximately due to or aggravated by a service-connected disease or injury. See 38 C.F.R. § 3.310; see also Allen v. Brown, 7 Vet. App. 439 (1995) (en banc). To establish secondary service connection, a Veteran must show: (1) the existence of a present disability; (2) the existence of a service-connected disability; and (3) a causal relationship between the present disability and the service-connected disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). Regarding the first element of service connection, the Veteran is currently diagnosed with restless leg syndrome. See February 2008 and June 2015 VA examination reports. Additionally, he is service-connected for anxiety disorder, diabetes, and peripheral neuropathy of the bilateral lower extremities. Therefore, the first element of direct service connection is established, as well as the first two elements of secondary service connection. Turning to the second element, in-service incurrence of a disease or injury, the Veteran does not report, nor do his service treatment records (STRs) identify any complaints, treatment for, or diagnosis of restless leg syndrome or symptoms indicative of the same. However, an injury in the form of exposure to herbicide agents during his service in Vietnam is presumed. As such, element two of direct service connection is also met. Regarding the final element of direct and secondary service connection, nexus, the only competent opinions of record are against the claim. (In this regard, the March 2012, June 2015, and August 2015 VA opinions against the claim are inadequate for rating purposes.) Specifically, the March 2017 VA examiner, opined that it was less likely than not that the Veteran’s restless leg syndrome was related to service, to include presumed exposure to herbicide agents. The examiner, who acknowledged consideration of the Veteran’s history, found no evidence to suggest the development or onset of restless leg syndrome while in service, and highlighted the negative STRs. Also, based on a current review of medical literature, the examiner noted that there was no evidence that exposure to herbicide agents was an etiological factor in the development or aggravation of restless leg syndrome. Regarding secondary nexus, the March 2017 VA examiner found that restless leg syndrome was not related to Veteran’s service-connected disabilities. The examiner noted that risk factors for restless leg syndrome did not include mental health conditions, and thus, his psychiatric disorder did not cause or aggravate his restless leg syndrome. Furthermore, although the examiner noted an association between restless leg syndrome and certain conditions, such as diabetes and neuropathy, she explained that since a cause and effect relationship had not been established, there was no evidence to support the notion that diabetes or peripheral neuropathy caused or aggravated the Veteran’s restless leg syndrome. The Board affords the March 2017 VA examiner’s opinion great probative value. The examiner considered the Veteran’s entire relevant medical history in forming her opinion, and provided a thorough rationale with supporting data, as well as well reasoned medical explanations. There is no competent opinion to the contrary. To the extent that the Veteran and his wife assert that his restless leg syndrome is the result of his active duty service, the Board finds that they are not competent to do so, as the determination as to the etiology of such a disorder is a complex medical question that is beyond the ken of a layperson. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). (Continued on the next page)   Accordingly, for reasons outlined above, the preponderance of the evidence is against the claim of entitlement to service connection for restless leg syndrome on a direct and secondary basis. As such, the benefit of the doubt doctrine is not for application, and service connection must be denied. STEVEN D. REISS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S.S. Mahoney, Associate Counsel