Citation Nr: 20032955 Decision Date: 05/12/20 Archive Date: 05/12/20 DOCKET NO. 20-14 075 DATE: May 12, 2020 ORDER Entitlement to service connection for peripheral neuropathy of the right upper extremity is denied. REMANDED Entitlement to service connection for myelofibrosis, to include as due to herbicide agent exposure is remanded. Entitlement to service connection for hypertension, to include as due to herbicide agent exposure or service-connected DM II is remanded. FINDING OF FACT The preponderance of the evidence of record is against finding that the Veteran has had peripheral neuropathy of the right upper extremity at any time during or approximate to the pendency of the claim. CONCLUSION OF LAW The criteria for entitlement to service connection for peripheral neuropathy of the right upper extremity have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from May 1967 to February 1971. These matters come before the Board of Veterans’ Appeals (Board) on appeal from an October 2018 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). Entitlement to service connection for peripheral neuropathy of the right upper extremity. The Veteran contends he is entitled to service connection for his peripheral neuropathy of the right upper extremity secondary to his exposure to herbicide agents. Alternatively, he contends that his peripheral neuropathy of the right upper extremity is secondary to his service-connected DM II. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current diagnosis of peripheral neuropathy of the right upper extremity and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The February 2020 VA examiner evaluated the Veteran and determined that he did not have a diagnosis of right upper extremity peripheral neuropathy. Further, despite consistent treatment from 2009 to 2019, VA treatment records do not contain a diagnosis of peripheral neuropathy of the right upper extremity. VA treatment records during this time frame consistently note the Veteran’s diagnoses of peripheral neuropathy of the bilateral lower extremities and left upper extremity however, these records are silent to a diagnosis or complaints of pain concerning the right upper extremity. Additionally, the Veteran asserted at the February 2020 VA peripheral neuropathy examination that he experienced neuropathic symptoms in his left upper extremity and bilateral lower extremities and did not indicate any neuropathic symptoms in the right upper extremity which is consistent with the pertinent medical evidence of record. While the Veteran believes he has a current diagnosis of peripheral neuropathy of the right upper extremity, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence and the claim is denied. REASONS FOR REMAND 1. Entitlement to service connection for myelofibrosis, to include as due to herbicide agent exposure is remanded. Here, the Veteran has a current diagnosis of myelofibrosis which he contends was caused by his exposure to herbicide agents during service. The record reflects that VA has conceded the Veteran’s exposure to herbicide agents. Additionally, the record contains an August 2018 medical opinion from the Veteran’s treating oncologist which indicates the Veteran’s myelofibrosis is most likely secondary to Agent Orange exposure. The examiner did not provide any rationale for the opinion rendered as myelofibrosis is not one of the presumptive diseases associated with exposure to herbicide agents. Thus, the Board finds remand is necessary to determine the nature and etiology of the Veteran myelofibrosis as there is no opinion of record that adequately addresses the issue. 2. Entitlement to service connection for hypertension, to include as due to service-connected DM II is remanded. During the pendency of the appeal, the Veteran was granted service connection for DM II. The Veteran has asserted his hypertension is due to his DM II or in the alternative due to his herbicide agent exposure. There is currently no opinion of record that addresses the nature and etiology of the Veteran’s hypertension. Thus, the Board finds remand necessary to obtain a medical opinion. The matters are REMANDED for the following action: 1. Obtain an addendum opinion by an appropriate clinician to determine the nature and etiology of any myelofibrosis and hypertension. In regard to the Veteran’s myelofibrosis, the examiner must opine whether it is at least as likely as not related to in-service herbicide agent exposure. In regard to the Veteran’s hypertension, the examiner must opine whether it is at least as likely as not related to in-service herbicide agent exposure. OR Whether it is at least as likely as not (1) proximately due to service-connected disability, or (2) aggravated beyond its natural progression by service-connected disability. All opinions provided must be thoroughly explained, and a complete and detailed rationale for any conclusions reached should be provided (a bare conclusory statement will be deemed inadequate). The examiner is reminded that the term “as likely as not” does not mean within the realm of possibility,” but rather that the evidence of record is so evenly divided that, in the examiner’s expert opinion, it is as medically sound to find in favor of the proposition as it is to find against it. It is not sufficient to base an opinion on a mere lack of documentation of complaints in the service or post-service treatment records. 2. After completing the requested actions, and any additional development deemed warranted, readjudicate the claims in light of all pertinent evidence and legal authority. If the benefits sought remain denied, furnish to the Veteran a Supplemental Statement of the Case and afford them the appropriate time period for response before the claims file is returned to the Board for further appellate consideration. C. TRUEBA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. McDuffie, 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.