Citation Nr: 20020171 Decision Date: 03/18/20 Archive Date: 03/18/20 DOCKET NO. 15-40 161 DATE: March 18, 2020 ORDER Entitlement to service connection for left upper extremity neuropathy is denied. Entitlement to service connection for right upper extremity neuropathy is denied. REMANDED Entitlement to service connection for a skin disorder of the groin is remanded. Entitlement to service connection for hypertension is remanded. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran has left or right upper extremity neuropathy due to a disease or injury in service. CONCLUSIONS OF LAW 1. The criteria for service connection for left upper extremity neuropathy have not been satisfied. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. 2. The criteria for service connection for right upper extremity neuropathy have not been satisfied. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSIONS The Veteran served on active duty in the United States Army from April 1971 to April 1973, to include service in the Republic of Vietnam. He has additional service in the Air Force Reserve. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a March 2013 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In April 2019, the Veteran testified at a Travel Board hearing before the undersigned Veterans Law Judge. A transcript of that hearing is of record. Service Connection for Upper Extremity Neuropathy Generally, to establish service connection, a claimant must show: (1) a present disability; (2) an 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, the so-called “nexus” requirement. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). A disability that is proximately due to, the result of, or aggravated by a service-connected disease or injury shall be service connected. 38 C.F.R. § 3.310. The Veteran contends that he has bilateral upper extremity neuropathy related to active duty service, or a service-connected disability. See August 2013 Statement in Support of Claim, April 2019 Hearing Tr. at 2. The Board concludes that the Veteran does not have a current bilateral upper extremity neuropathy disability or functional impairment associated with the upper extremity and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Service connection is therefore not warranted. 38 C.F.R. § 3.303(a), (d); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); see also Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). A review of the Veteran’s service treatment records (STRs) reflects an absence of complaints regarding any upper extremity neuropathy. There was no treatment rendered nor was any diagnosis provided. A review of the VA medical records indicate that the Veteran has complained of numbness and tingling of his lower extremities, particularly his feet and toes, but not the upper extremities. The record shows that the last time the Veteran reported tingling in his left arm was in November 2004. In October 2015, the Veteran reported tingling on his neck. The Veteran presented for a VA examination in February 2014, at which time he was interviewed by the examiner who also reviewed the pertinent medical history and performed an examination. The Veteran reported that he has occasional pins and needles sensation in both feet for the last year or so, lasting for a few seconds/minutes, but did not report pain or numbness. The examiner opined that the Veteran does not have a diagnosis of diabetic peripheral neuropathy. In support of this conclusion, the examiner explained that a review of the Veteran’s symptoms does not show symptoms attributable to diabetic peripheral neuropathy. Notably, the examiner found that there was no functional impact pertaining to the Veteran’s reported peripheral neuropathy. After conducting appropriate testing, the examiner was unable to diagnose the Veteran with diabetic peripheral neuropathy based on the lack of physical findings on examination, and the findings of sensation to monofilament noted as normal. The examiner also noted that sensation was reported normal on the Veteran’s physical examination by a primary care clinic in January 2014. The Board finds this opinion highly probative as it was made by a medical professional with consideration of the specific facts in this case, a review of the record, and after examination of the Veteran. There is no additional medical evidence in significant conflict with the opinion of the VA examiner. For the above reasons, the preponderance of the evidence is against the claim and service connection is denied. The Board acknowledges the Veteran’s reports of numbness and tingling and notes the holding in Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018) that pain with functional loss can constitute a disability. The February 2014 examiner found that the Veteran’s reported symptoms are not attributable to upper extremity peripheral neuropathy and specifically found that there was no functional impact associated with the Veteran’s reported symptoms. As with all claims for service-connection under direct and secondary basis, in the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Service connection is therefore not warranted. 38 C.F.R. § 3.303. REASONS FOR REMAND 1. Skin Disorder of the Groin Remand is necessary for a medical opinion. The Veteran testified that he has had skin problems in the groin area episodically since service. See April 2019 Hearing Tr. at 2-3. Treatment records show symptoms at least as early as February 1980, when it was noted that the Veteran was “in again with groin itching.” A May 2014 VA examiner diagnosed tinea cruris but did not offer an opinion specific to the tinea cruris. 2. Hypertension Remand is necessary for a medical opinion. The Veteran asserts that his hypertension is secondary to his service-connected diabetes or due to his exposure to herbicide agents in Vietnam. See April 2019 Hearing Tr. at 2, November 2015 Statement of Accredited Representative in Appealed Case. The Veteran’s treatment records show that he was diagnosed with hypertension in 2011. The matters are REMANDED for the following action: 1. Ask the Veteran to identify all outstanding treatment records relevant to his skin problem and hypertension. All identified VA records should be added to the claims file. All other properly identified records should be obtained if the necessary authorization to obtain the records is provided by the Veteran. If any records are not available, or the Veteran identifies sources of treatment but does not provide authorization to obtain records, appropriate action should be taken (see 38 C.F.R. § 3.159(c)-(e)), to include notifying the Veteran of the unavailability of the records. 2. After records development is completed, the claims file should be sent to an appropriate examiner to offer an opinion as to whether it is at least as likely as not (50 percent probability or greater) that a current skin disorder of the groin onset during service or is otherwise related to an in-service injury, event, or disease, to include the Veteran’s testimony that he has had skin problems in the groin area episodically since service. The examiner’s attention is drawn to medical records received by VA on September 7, 2012 showing treatment for related complaints dating back to at least 1980. The need for an examination is left to the discretion of the examiner. A rationale for all opinions offered is requested as the Board is precluded from making any medical findings. 3. After records development is completed, the claims file should be sent to an appropriate examiner to offer an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the current hypertension is related to an in-service injury, event, or disease, to include exposure to herbicide agents while serving in Vietnam. The examiner should also address whether hypertension is at least as likely as not (a) caused by, or (b) aggravated by (worsened beyond natural progression) service-connected diabetes mellitus type II. The need for an examination is left to the discretion of the examiner. A rationale for all opinions offered is requested as the Board is precluded from making any medical findings. Nathan Kroes Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Mathew 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.