Citation Nr: 19190865 Decision Date: 12/03/19 Archive Date: 12/03/19 DOCKET NO. 16-11 133A DATE: December 3, 2019 ORDER Service connection for peripheral neuropathy of the right upper extremity, claimed is secondary to service-connected diabetes mellitus, is denied. Service connection for peripheral neuropathy of the left upper extremity, claimed is secondary to service-connected diabetes mellitus, is denied. Service connection for peripheral neuropathy of the right lower extremity, claimed is secondary to service-connected diabetes mellitus, is denied. Service connection for peripheral neuropathy of the left lower extremity, claimed is secondary to service-connected diabetes mellitus, is denied. FINDINGS OF FACT 1. Peripheral neuropathy of the right upper extremity was not demonstrated inservice, was not disabling within a year of the Veteran’s separation from active duty, and is not secondary to a service-connected disability. 2. Peripheral neuropathy of the left upper extremity was not demonstrated inservice was not disabling within a year of the Veteran’s separation from active duty, and is not secondary to a service-connected disability. 3. Peripheral neuropathy of the right lower extremity was not demonstrated inservice was not disabling within a year of the Veteran’s separation from active duty, and is not secondary to a service-connected disability. 4. Peripheral neuropathy of the left lower extremity was not demonstrated inservice was not disabling within a year of the Veteran’s separation from active duty, and is not secondary to a service-connected disability. CONCLUSIONS OF LAW 1. Peripheral neuropathy of the right upper extremity was not incurred or aggravated by active military service. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. 2. Peripheral neuropathy of the left upper extremity was not incurred or aggravated by active military service 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. 3. Peripheral neuropathy of the right lower extremity was not incurred or aggravated by active military service 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. 4. Peripheral neuropathy of the left lower extremity was not incurred or aggravated by active military service. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran performed active duty service May 1970 to December 1971. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a February 2014 decision by a Department of Veterans Affairs (VA) Regional Office (RO). Service Connection 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). To establish entitlement to service-connected compensation benefits, 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. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010). Congress specifically limits entitlement for service-connected disease or injury to cases where those incidents have resulted in a disability. In the absence of proof of a present disability there can be no valid claim. Brammer v. Brown, 3 Vet. App. 223 (1992). Service connection may be granted secondary to a disability that is proximately due to a service-connected condition. 38 C.F.R. § 3.310 (a). Further, service connection is possible when a service-connected condition has aggravated a claimed condition, but compensation is only payable for the degree of additional disability attributable to the aggravation. Allen v. Brown, 7 Vet. App. 439 (1995). Service connection for peripheral neuropathy of the bilateral upper and lower extremities is denied. The Veteran contends he has peripheral neuropathy of the bilateral upper and lower extremities which is due to his active military service. Specifically, he contends that he experiences peripheral neuropathy of the bilateral upper and lower extremities secondary to his service-connected diabetes mellitus. Service treatment records show complaints regarding the left shoulder but reveal no complaints, findings, or diagnosis of peripheral neuropathy of the extremities. Post service treatment records reveal that the Veteran complained of numbness and tingling as early as the mid 1980s. In June 2008, the Veteran complained of upper numbness of the tips of the index and middle fingers, but he was negative for neurological deficiencies. In October 2009, the Veteran had neurological and cardiovascular problems. In March 2011, the Veteran stated that he saw a neurosurgeon in the mid 1980s when he had his left shoulder operation. He denied being seen by a neurologist or PM&R (physical medicine and rehabilitation) and never had injections, other than the cortisone injections in 1970. He also denied every having physical therapy or being seen by a chiropractor. In March 2013, the Veteran had normal muscle bulk and tone throughout (no thenar or foot wasting). The muscle strength was 5/5 in the upper and lower extremities both proximally and distally, and there was no pronator drift. In December 2014, the Veteran was evaluated by Dr. R.A.G. for possible neuropathy. At that time, the Veteran reported that his upper extremity symptoms began in the 1970s following a neck injury in service. His lower extremity symptoms began in the 1990s. Dr. R.A.G. determined the most likely diagnosis was cervical/lumbosacral polyradiculopathy: however, she could not exclude superimposed peripheral polyneuropathy. She reported the most common causes of polyradiculopathy are disk herniation and degenerative changes. She also stated the most common cause of polyneuropathy in the Veteran’s case is diabetes and/or Agent Orange exposure. A VA peripheral neuropathy examination was conducted in August 2016. Significantly, this examination report is negative for a diagnosis of diabetic peripheral neuropathy. The examiner noted the Veteran’s report that symptoms of upper and lower extremity pain, numbness, and tingling began approximately 13 years before he was diagnosed with diabetes mellitus (DM) and opined that it was more likely that his symptoms were due to his documented cervical and lumbar radiculopathy and not to diabetes. Significantly, there was no objective evidence confirming a diagnosis of superimposed peripheral neuropathy on neurology notes in CPRS dated in March 2013 and a neurology note from Dr. R.A.G. dated in December 2014 notes a need to review magnetic resonance imaging (MRI) and electromyography (EMG) to determine etiology of the Veteran’s symptoms, but this was never done. There was no objective evidence confirming a diagnosis of diabetic peripheral neuropathy. The Veteran was sent a notification letter in March 2017 to provide all outstanding private treatment records, particularly those from Dr. R.A.G. However, the Veteran did not respond to this request. In this case, service connection for peripheral neuropathy of the extremities is not warranted. Service treatment records are silent of any complaints, findings, and diagnoses. Post-service treatment records reveal complaints of a neurological disorder but a preponderance of the medical evidence suggests that the Veteran is experiencing cervical and lumbar radiculopathy and service connection is not currently in effect for either cervical and/or lumbar spine disabilities. In addition, the Veteran has failed to provide the necessary private records for a diagnosis to be determined, and there is no other medical evidence diagnosing or linking the claimed conditions to his military service. Without a link to service, service connection cannot be granted. While the appellant may sincerely believe that his peripheral neuropathy of the upper and lower extremities is related to his military service, as a lay person untrained in the field of medicine he is not competent to offer a medical opinion linking that disorder to service. See, e.g., Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Accordingly, the Board finds that the preponderance of the evidence is against the claim, and that it should be denied. APRIL MADDOX Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Anthony L. Hines, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.