Citation Nr: 20021784 Decision Date: 03/27/20 Archive Date: 03/27/20 DOCKET NO. 17-44 494 DATE: March 27, 2020 ORDER Entitlement to service connection for peripheral neuropathy of the right upper extremity is granted. Entitlement to service connection for peripheral neuropathy of the left upper extremity is granted. Entitlement to service connection for peripheral neuropathy of the right lower extremity is granted. Entitlement to service connection for peripheral neuropathy of the left lower extremity is granted. FINDINGS OF FACT 1. The Veteran’s right and left upper extremity peripheral neuropathy is as likely as not related to service to include in-service herbicide exposure. 2. The Veteran’s right and left lower extremity peripheral neuropathy is as likely as not related to service to include in-service herbicide exposure. CONCLUSIONS OF LAW 1. The criteria for service connection for peripheral neuropathy of the right upper extremity have been met. 38 U.S.C. §§ 1110, 1112, 1113, 1116, 5107 (2012); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309 (2019). 2. The criteria for service connection for peripheral neuropathy of the left upper extremity have been met. 38 U.S.C. §§ 1110, 1112, 1113, 1116, 5107 (2012); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309 (2019). 3. The criteria for service connection for peripheral neuropathy of the right lower extremity have been met. 38 U.S.C. §§ 1110, 1112, 1113, 1116, 5107 (2012); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309 (2019). 4. The criteria for service connection for peripheral neuropathy of the left lower extremity have been met. 38 U.S.C. §§ 1110, 1112, 1113, 1116, 5107 (2012); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1968 to March 1972, to include service in the Republic of Vietnam. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran argues that his peripheral neuropathy of the bilateral upper and lower extremities is due to herbicide exposure during service. As the Veteran served in Vietnam, herbicide exposure is conceded. 38 U.S.C. § 1116 (f) (2012) and 38 C.F.R. § 3.307 (a)(6)(iii) (2019). Further, the medical evidence of record demonstrates that he has a diagnosis of peripheral neuropathy of the bilateral lower and upper extremities. However, the presumption of service connection for early onset peripheral neuropathy is only applicable if it manifested to a degree of 10 percent or more within one year of service discharge. 38 U.S.C. § 1116 (2012); 38 C.F.R. §§ 3.307, 3.309 (2019). The Veteran asserts that he demonstrated symptoms of peripheral neuropathy within one year of his service discharge. He specified that he presented to a VAMC in 1973 complaining of numbness and tingling in both legs. He was diagnosed with restless leg syndrome, and no other testing was completed. The Board notes that VA was unable to locate any records verifying this visit. Nevertheless, the Veteran may still establish his entitlement to service connection with proof of actual direct causation, i.e., with probative evidence directly linking his peripheral neuropathy to exposure to Agent Orange during his service. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). The medical evidence of record indicates that the Veteran complained of muscle jerking at night in September 2003. The examiner noted that the Veteran previously saw a neurologist at another VAMC and that he was prescribed Carbidopa (used for shakiness, stiffness, and difficulty moving). A May 2004 VA treatment record noted restless leg syndrome. The Veteran was later diagnosed with bilateral peripheral neuropathy in April 2013. In July 2017, a Board-certified neurologist provided an independent medical opinion that supports a nexus between the Veteran’s peripheral neuropathy and his exposure to herbicides. The examiner noted that the Veteran was diagnosed with a form of sensory polyneuropathy, and that studies have revealed that while some subjects develop neuropathic symptoms shortly after exposure, others develop symptoms years later. The examiner noted that the final opinion recently published by the National Academy of Sciences stated that the VA’s position on the timing of onset of neuropathic symptoms related to herbicide exposure should be clarified. The examiner found that the Veteran demonstrated symptoms of peripheral neuropathy, but was never provided with even a cursory neurologic examination by his treating healthcare providers (until 2013). Consequently, the examiner opined that it is as likely as not that the Veteran’s peripheral neuropathy was related to herbicide exposure. Based on the foregoing, the Board finds in favor of the claims for service connection. Although the Veteran’s disabilities were not formally diagnosed in service or for years thereafter, positive evidence has been submitted showing a link between the Veteran’s service and his peripheral neuropathy of the lower and upper extremities. Moreover, the Veteran has presented credible evidence of symptoms of peripheral neuropathy since service. In sum, the Board finds that the credible lay statements of record in conjunction with the medical opinion from the independent neurologist place the evidence at least in equipoise. In resolving reasonable doubt in his favor, service connection for peripheral neuropathy of the bilateral upper and lower extremities is granted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. Kristin Haddock Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Roya Bahrami, 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.