Citation Nr: 20007390 Decision Date: 01/30/20 Archive Date: 01/29/20 DOCKET NO. 11-27 398 DATE: January 30, 2020 ORDER Entitlement to service connection for peripheral neuropathy of the left lower extremity is denied. Entitlement to service connection for peripheral neuropathy of the right lower extremity is denied. FINDING OF FACT The preponderance of the evidence fails to establish that the Veteran’s peripheral neuropathy of the bilateral lower extremities is etiologically related to or aggravated by his service-connected diabetes mellitus type II. CONCLUSION OF LAW The criteria for service connection for peripheral neuropathy of the bilateral lower extremities have not been met. 38 U.S.C. § § 1110, 5107; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from March 1970 to November 1971, and from September 1972 to February 1977. This matter is on appeal to the Board of Veterans’ Appeals (Board) from a June 2010 rating decision of a regional office (RO) of the Department of Veterans Affairs (VA) where service connection was denied for peripheral neuropathy of the bilateral upper and lower extremities. The Veteran specifically limited his appeal to the issues of service connection on a secondary basis for peripheral neuropathy of the bilateral lower extremities. See Notice of Disagreement dated December 2010 and VA Form 9 dated October 2011. In September 2017, the Veteran withdrew his request for a Board hearing. In January 2018, the Board remanded the matter for additional evidentiary development. Service Connection 1. Entitlement to service connection for peripheral neuropathy of the left lower extremity. 2. Entitlement to service connection for peripheral neuropathy of the right lower extremity. For the reasons explained below, the Board finds service connection for the Veteran’s peripheral neuropathy of the bilateral lower extremities is not warranted. While the Board acknowledges that the Veteran’s treatment records reflect a history of peripheral neuropathy and diabetes mellitus type II, the Board observes that there is no medical evidence of record to support a finding that the Veteran’s claimed peripheral neuropathy of the lower extremities is due to the result of or is aggravated by his service-connected diabetes mellitus type II. Meaning, there is no probative evidence to show a medical link between the current claimed disability to a service-connected disability. In this regard and to specifically address this complex medical question, the Board remanded the matter in January 2018 to obtain an adequate medical opinion. In compliance with the Board’s remand, a VA medical opinion was obtained in June 2019, which the Board finds constitutes the most probative medical evidence of record. In fact, the June 2019 VA examiner, a neurologist, indicated that “this record is complex and required 3 hours of time to review and assimilate the pertinent information per the Board’s lengthy set of questions.” The examiner also indicated that his medical opinion was based on a “detailed and explicit chart review which includes the analysis of medical opinions” previously rendered (VA opinions from April 2010, March 2013, September 2015 and June 2017). See June 2019 VA Medical Opinion Disability Benefits Questionnaire (DBQ). The June 2019 VA neurologist opined that the Veteran’s peripheral neuropathy of the bilateral lower extremities is less likely than not due to or the result of the Veteran’s service-connected diabetes mellitus type II. The neurologist also rendered an opinion on aggravation by a service-connection disability finding, Veteran’s peripheral neuropathy of the bilateral lower extremities is less likely as not aggravated, beyond the natural progression of the disease, by the Veteran’s service-connected diabetes. In the rationale, the examiner explained that, “the diagnosis of diabetes mellitus did not occur until 2007 and the patient’s complaints of peripheral neuropathy in the lower extremities started a full 5 years prior (in 2002), therefore it is not possible for the condition of diabetes mellitus to have caused or aggravated any of these symptoms since he less likely than not possessed this condition until it was in fact, diagnosed in 2007.” Id. The examiner further explained that the Veteran’s records are “silent for any complaints of a medical nature having to do with paresthesias in the lower extremities until the year 2002 which is more likely than not the proximate result or consequence of his fulminant and well documented substance abuse history which could not be stopped or corrected for decades.” In particular, the examiner noted that the Veteran’s “history of both alcohol and substance abuse which was treated at least 19 times in rehabilitation centers and facilities and since it is known that such substance abuse is clear and present risk factor to development of paresthesias…” The examiner indicated that “any appearance of paresthesias in the latter part of 2002 as a result of herbicide exposure (more than three decades earlier) would be impossible to identify among the symptoms of peripheral neuropathy already present as a consequence to [the Veteran’s] history of substance abuse or positive Hepatitis status which are known to cause and precipitate such symptoms. Therefore, any nexus of paresthesias in the lower extremities to herbicidal agent exposure is purely speculative.” Id. Moreover, in addressing the conflicting VA opinion of record, the June 2019 VA neurologist indicated that the March 2013 medical examiner “failed to mention any of the relevant information regarding this patient’s substance abuse history nor the fact that symptoms in the lower extremities (known to be those of his peripheral neuropathy) had been documented as far back as 2002 at which time he was evaluated by EMG and found to have bilateral [carpal tunnel syndrome] in the upper extremities but refused the lower extremity examination. Therefore, the conclusions drawn as to the direct or unequivocal nexus between the patient’s peripheral neuropathy appeared or was appreciated is imprecise and cannot be supported by the medical facts in this case.” Id. Finally, as to whether any current neuropathy qualifies as an early-onset peripheral neuropathy, the examiner indicated that the record reflects the Veteran having symptoms of peripheral neuropathy (numbness, tingling, pain in the lower extremities) as of the year 2002, consequently, any claimed current neuropathy does not qualify as early onset as per the Veteran’s recollection. In view of the above, the Board assigns significant probative value to the June 2019 VA medical opinion. There is simply no competent medical evidence of record to support a finding that the Veteran’s current peripheral neuropathy of the bilateral lower extremities are related to his service-connected diabetes or otherwise etiologically related to service. The Board further observes that the June 2019 VA medical opinion is based on a comprehensive review of the Veteran’s claims file, including prior VA opinions from April 2010, March 2013, September 2015 and June 2017, consideration of lay evidence of record, and provide sufficient rationale to support the examiner’s conclusion. The opinion provides substantial reasoning and explanation as to why the Veteran’s peripheral neuropathy of the lower extremities is not related to or aggravated by his diabetes. The opinion is sufficient to satisfy the statutory requirements of producing an adequate statement of reasons and bases where the expert has fairly considered material evidence which appears to support the Veteran’s position. Wray v. Brown, 7 Vet. App. 488, at 492-93 (1995). Accordingly, the Board finds great probative value in the June 2019 VA medical opinion. Further, the Board recognizes the Veteran’s personal assertions that his peripheral neuropathy of the lower extremities is related to his diabetes. While the Veteran is certainly capable of describing the medical history and competent to report symptoms observable to a layperson, he is not competent to independently opine as to the specific etiology of a claimed condition to a service-connected disability or to render a medical diagnosis of a disability manifested by such symptoms, as such requires medical expertise. Davidson v. Shinseki, 581 F.3d 1313 (2009). For this purpose, the Veteran’s statements are not competent medical evidence. Therefore, his assertions, standing alone, have little probative value and the Board assigns more weight to the medical opinions provided by the VA examiners. The Board has also considered whether the presumption of service connection has been established under 38 C.F.R. § 3.309(e). However, there is no persuasive medical or lay evidence of record that shows that symptoms manifested to a compensable degree within one year following the Veteran’s discharge from service. As indicated above, the June 2019 examiner found the current neuropathy does not qualify as early-onset peripheral neuropathy as the Veteran reported onset on or around 2002, approximately 25 years after discharge from service. Accordingly, service connection for peripheral neuropathy of the lower extremities on a presumptive basis has not been shown and therefore, not warranted. See 38 C.F.R. §§ 3.303(b), 3.309. After weighing all the evidence of record, the Board observes that the June 2019 VA medical opinion stands uncontradicted by any other evidence found in the record and is significantly probative in determining whether the Veteran has substantiated the claim for service connection. Based on a review of the foregoing evidence and the applicable laws and regulations, the Board finds that the preponderance of the evidence is against the Veteran’s claim for service connection for peripheral neuropathy of the bilateral lower extremities. In reaching these conclusions, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the claims, that doctrine is not helpful to this claimant. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Service connection has not been established and the claims must be denied. KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. An, 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.