Citation Nr: A20008735 Decision Date: 05/15/20 Archive Date: 05/15/20 DOCKET NO. 200123-63310 DATE: May 15, 2020 ORDER Service connection for loss of use of creative organ secondary to diabetes mellitus type II is granted. Service connection for peripheral neuropathy of the left lower extremity secondary to diabetes mellitus type II is granted. Service connection for peripheral neuropathy of the right lower extremity secondary to diabetes mellitus type II is granted. REMANDED Service connection for chronic cough is remanded. Service connection for peripheral neuropathy of the left upper extremity is remanded. Service connection for peripheral neuropathy of the right upper extremity is remanded. FINDINGS OF FACT 1. The Veteran is service-connected for diabetes mellitus type II. 2. The Veteran’s loss of use of creative organ and his peripheral neuropathy of the bilateral lower extremities are proximately due to or the result of his service-connected diabetes. CONCLUSIONS OF LAW 1. The criteria for service connection for loss of use of creative organ secondary to diabetes mellitus type II have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 2. The criteria for service connection for peripheral neuropathy of the left lower extremity secondary to diabetes mellitus type II have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 3. The criteria for service connection for peripheral neuropathy of the left lower extremity secondary to diabetes mellitus type II have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had honorable active duty service in the United States Army from January 1967 through April 1969. For his meritorious service, the Veteran was awarded (among other decorations) the Vietnam Service and Campaign Medals. The matter comes to the Board of Veterans Appeals (Board) on direct appeal from a December 2019 Rating Decision. In the Veteran’s January 2020 VA Form 10182, the Veteran elected the evidence submission lane; he submitted relevant evidence in April 2020. Service Connection To establish direct service connection, there must be competent evidence showing: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the in-service injury incurred or aggravated during service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303; Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for any disability that is proximately due to or aggravated by a service-connected disease or injury. 38 C.F.R. § 3.310. Generally, a claimant has the responsibility to present and support a claim for benefits. All information, lay evidence and medical evidence in a case is to be considered by the Board in deciding the claim. When there is an approximate balance of positive and negative evidence regarding any material issue, the claimant is to be given the benefit of the doubt. 38 U.S.C. § 5107; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. Lay evidence, if competent and credible, may serve to establish a nexus in certain circumstances. See Davidson v. Shinseki, 581 F.3d 1313 (2009) (noting that lay evidence is not incompetent merely for lack of contemporaneous medical evidence). When considering whether lay evidence may be competent, the Board must determine, on a case by case basis, whether the Veteran’s particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (holding that “[w]hether lay evidence is competent and sufficient in a particular case is a factual issue.”). The Board has an obligation to provide reasons and bases supporting its decision, but there is no need to discuss, in detail, every piece of evidence of record. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). The Board’s analysis is to focus specifically on what the evidence shows, or fails to show, on the claim. See Timberlake v. Gober, 14 Vet. App. 122, 129 (2000) (noting that the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant). 1. Service connection for loss of use of creative organ secondary to diabetes mellitus type II is granted. The Veteran seeks service connection for loss of use of his creative organ secondary to his service-connected diabetes mellitus type II. The Veteran is service-connected for diabetes mellitus type II. Medical records confirm erectile dysfunction, with an onset somewhere between 1997 to 2012. See August 2017 Private Treatment Record (noting a 5 to 10 year prior onset of erectile dysfunction). The evidence in favor of the claim consists of a June 2019 Diabetes DBQ completed by Dr. D. H., Endocrinologist, noted the Veteran had erectile dysfunction that was at least as likely as not due to his diabetic condition. Also, a January 2020 Male Reproductive Organ Conditions DBQ completed by W. T., MD, Urologist, noted “severe erectile dysfunction due to diabetes mellitus.” These opinions are competent and credible and are given significant weight. To the extent that there is a contrary opinion offered by a VA examiner, the Board finds that opinion outweighed by the positive opinions of record. Thus, with the preponderance of evidence in favor of the claim, the Veteran has more than met his burden. Service connection for loss of use of a creative organ secondary to diabetes is therefore granted. 2. Service connection for peripheral neuropathy left lower extremity secondary to diabetes mellitus type II is granted. 3. Service connection for peripheral neuropathy right lower extremity secondary to diabetes mellitus type II is granted. The Veteran seeks service connection for peripheral neuropathy of the bilateral lower extremities. He contends that the VA examination he was afforded was inadequate. See January 2020 Statement in Support of Claim. It appears that at there was no diagnosis of neuropathy in the records associated with the file at the time of the December 2019 VA medical examination and opinion. No neuropathy condition was confirmed on examination, and as such, a nexus opinion was not given. On appeal, the Veteran submitted a printout of VA medical records from the Lyons-VA New Jersey HCS that show the Veteran was assessed in July 2019 with neuropathy, was advised to continue Gabapentin and to follow up with non-VA podiatry. A January 2020 Diabetic Sensory-Motor Peripheral Neuropathy DBQ completed by J. M., Podiatrist noted a January 2015 diagnosis of bilateral lower extremity diabetic neuropathy. The diagnoses are accepted as having been given by a competent clinician, and as the diagnosis itself speaks to causation, the claims of service connection for diabetic peripheral neuropathy of the left lower extremity and right lower extremity as secondary to diabetes mellitus type II are proven and are accordingly granted. 38 C.F.R. § 3.310. REASONS FOR REMAND 1. Service connection for chronic cough is remanded. 2. Service connection for peripheral neuropathy left upper extremity is remanded. 3. Service connection for peripheral neuropathy right upper extremity is remanded. The Veteran seeks service connection for bilateral upper extremity neuropathy, and a chronic cough. There is insufficient evidence of record to grant the benefit sought with regards to these claims. There is not currently any medical evidence that diagnoses the Veteran with upper extremity diabetic neuropathy. Moreover, “chronic cough” is not a presumptive service-connected condition associated with herbicide exposure (see 38 C.F.R. § 3.309), and the Veteran’s identified date of onset of such symptoms in 1994—a quarter-century after his separation from active service—does not generally suggest any relationship to service. See September 2019 Fully Developed Claim. Notwithstanding, the evidence presented on appeal by the Veteran shows that there are outstanding VA records, and suggests there may be additional outstanding private treatment records. The outstanding VA records at the time of the adjudication of these claims shows a pre-decisional duty to assist error was made, and a remand is required to allow VA to obtain these records. The Veteran is reminded that while efforts will be made to secure outstanding medical evidence, he bears the burden of proof on his claims, and is encouraged to obtain and submit or identify any other evidence he may have in support of these claims. The matters are REMANDED for the following action: Obtain the Veteran’s outstanding VA treatment records, to include those from Lyons-New Jersey. Evan M. Deichert Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. C. King, 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.