Citation Nr: 20041612 Decision Date: 06/18/20 Archive Date: 06/18/20 DOCKET NO. 15-23 250A DATE: June 18, 2020 ORDER Entitlement to service connection for gout is denied. Entitlement to service connection for peripheral vascular disease of the left upper extremity is denied. Entitlement to service connection for peripheral vascular disease of the right upper extremity is denied. Entitlement to service connection for peripheral vascular disease of the left lower extremity is denied. Entitlement to service connection for peripheral vascular disease of the right lower extremity is denied. Entitlement to service connection for peripheral neuropathy of the left upper extremity is denied. Entitlement to service connection for peripheral neuropathy of the right upper extremity is denied. 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. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that the Veteran’s gout began during active service, or is otherwise related to an in-service injury or disease. 2. The preponderance of the evidence is against finding that the Veteran’s peripheral vascular disease of the left upper extremity began during active service, or is otherwise related to an in-service injury or disease. 3. The preponderance of the evidence is against finding that the Veteran’s peripheral vascular disease of the right upper extremity began during active service, or is otherwise related to an in-service injury or disease. 4. The preponderance of the evidence is against finding that the Veteran’s peripheral vascular disease of the left lower extremity began during active service, or is otherwise related to an in-service injury or disease. 5. The preponderance of the evidence is against finding that the Veteran’s peripheral vascular disease of the right lower extremity began during active service, or is otherwise related to an in-service injury or disease. 6. The preponderance of the evidence is against finding that the Veteran’s peripheral neuropathy of the left upper extremity began during active service, or is otherwise related to an in-service injury or disease. 7. The preponderance of the evidence is against finding that the Veteran’s peripheral neuropathy of the right upper extremity began during active service, or is otherwise related to an in-service injury or disease. 8. The preponderance of the evidence is against finding that the Veteran’s peripheral neuropathy of the left lower extremity began during active service, or is otherwise related to an in-service injury or disease. 9. The preponderance of the evidence is against finding that the Veteran’s peripheral neuropathy of the right lower extremity began during active service, or is otherwise related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for gout are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for peripheral vascular disease of the left upper extremity are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for peripheral vascular disease of the right upper extremity are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for service connection for peripheral vascular disease of the left lower extremity are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 5. The criteria for service connection for peripheral vascular disease of the right lower extremity are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 6. The criteria for service connection for peripheral neuropathy of the left upper extremity are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 7. The criteria for service connection for peripheral neuropathy of the right upper extremity are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 8. The criteria for service connection for peripheral neuropathy of the left lower extremity are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 9. The criteria for service connection for peripheral neuropathy of the right lower extremity are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1980 to February 1983 with additional Reserve service. The appeal was most recently before the Board in August 2018 when it was remanded for additional development. The Board finds there has been substantial compliance with the remand directives for the claims decided herein. Stegall v. West, 11 Vet. App. 268 (1998). Service Connection The Veteran seeks service connection for gout, peripheral vascular disease of his bilateral upper and lower extremities, and peripheral neuropathy of his bilateral upper and lower extremities. 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 Veteran initially asserted that his gout, peripheral vascular disease, and peripheral neuropathy were each secondary to diabetes. However, service connection for diabetes has not been established. See August 2018 Board Decision. Accordingly, the Board will only address each disability as directly related to service. Gout The Veteran seeks service connection for gout. 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, while the Veteran has a current diagnosis of gout, the preponderance of the evidence weighs against finding that the diagnosed gout began during service or is otherwise related to an in-service injury, event, or disease. The Veteran has not asserted how his gout is related to service, and there is no competent evidence suggesting that he had complaints, treatment, or diagnoses related to gout in service. Further, the August 2019 VA examiner opined that the Veteran’s gout was not at least as likely as not related to an in-service injury, event, or disease. The rationale was that the record was silent for any complaints, treatment, or diagnosis of gout while in service, and that the Veteran was not diagnosed with gout until 2006, 23 years after his separation from service. The examiner’s opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Accordingly, a nexus to the Veteran’s active duty service cannot be established and service connection for gout is denied. Peripheral vascular disease of the bilateral upper extremities and bilateral lower extremities The Board concludes that, while the Veteran has a current diagnosis of peripheral vascular disease of all extremities, the preponderance of the evidence weighs against finding that any of the disabilities began during service or is otherwise related to an in-service injury, event, or disease. The Veteran has not asserted how his peripheral vascular disease is related to service, and there is no competent evidence suggesting that he had complaints, treatment, or diagnoses related to peripheral vascular disease in service. Further, the August 2019 VA examiner opined that the Veteran’s peripheral vascular disease of each extremity were not at least as likely as not related to an in-service injury, event, or disease. The rationale was that the record was silent for any complaints, treatment, or diagnosis of peripheral vascular disease of any of his upper extremities or lower extremities while in service, and that the Veteran was not diagnosed with peripheral vascular disease in all his extremities until 2012, 29 years after his separation from service. The examiner’s opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez, 22 Vet. App. at 304. Accordingly, a nexus to the Veteran’s active duty service cannot be established and service connection for peripheral vascular disease of the bilateral upper extremities and bilateral lower extremities are denied. Peripheral neuropathy of the left upper extremity The Board concludes that, while the Veteran has a current diagnosis of peripheral neuropathy of the left upper extremity, the preponderance of the evidence weighs against finding that it began during service or is otherwise related to an in-service injury, event, or disease. The Veteran has not asserted how his peripheral neuropathy of the left upper extremity is related to service, and there is no other evidence suggesting that he had complaints, treatment, or diagnoses related to peripheral neuropathy in service. Further, the August 2019 VA examiner opined that the Veteran’s peripheral neuropathy of the left upper extremity was not at least as likely as not related to an in-service injury, event, or disease. The examiner noted that on examination, the Veteran denied any neurological symptoms of his left upper extremity, during the course of the appeal, a May 2013 EMG identified right medial neuropathy of the right C5 vertebrae greater than the left C5 vertebrae. The examiner’s rationale was that the record was silent for any diagnosis of peripheral neuropathy of the left upper extremity while in service, and that the Veteran’s neuropathy of the left upper extremity was not noted until May 2013, which is 30 years after his separation from service. The examiner’s opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez, 22 Vet. App. at 304. Accordingly, a nexus to the Veteran’s active duty service cannot be established and service connection for peripheral neuropathy of the left upper extremity is denied. Peripheral neuropathy of the right upper extremity The Board concludes that, while the Veteran has a current diagnosis of peripheral neuropathy of the right upper extremity, the preponderance of the evidence weighs against finding that it began during service or is otherwise related to an in-service injury, event, or disease. The Veteran has not asserted how his peripheral neuropathy of the right upper extremity is related to service, and there is no other evidence suggesting that he had complaints, treatment, or diagnoses related to peripheral neuropathy of the right upper extremity in service. Further, the August 2019 VA examiner opined that the Veteran’s peripheral neuropathy of the right upper extremity was not at least as likely as not related to an in-service injury, event, or disease. The rationale was that the record was silent for any diagnosis of peripheral neuropathy of the right upper extremity while in service, and that the Veteran was not diagnosed with peripheral neuropathy of the right upper extremity until 2001, 18 years after his separation from service. The examiner’s opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez, 22 Vet. App. at 304. Accordingly, a nexus to the Veteran’s active duty service cannot be established and service connection for peripheral neuropathy of the right upper extremity is denied. Peripheral neuropathy of the left lower extremity The Board concludes that, while the Veteran has a current diagnosis of peripheral neuropathy of the left lower extremity, the preponderance of the evidence weighs against finding that it began during service or is otherwise related to an in-service injury, event, or disease. The Veteran has not asserted how his peripheral neuropathy of the left lower extremity is related to service, and there is no other evidence suggesting that he had complaints, treatment, or diagnoses related to peripheral neuropathy of the left lower extremity in service. Further, the August 2019 VA examiner opined that the Veteran’s peripheral neuropathy of the left lower extremity was not at least as likely as not related to an in-service injury, event, or disease. The rationale was that the record was silent for any diagnosis of peripheral neuropathy of the left lower extremity while in service, and that the Veteran was not diagnosed with peripheral neuropathy of the left lower extremity until 2015, 32 years after his separation from service. The examiner’s opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez, 22 Vet. App. at 304. Accordingly, a nexus to the Veteran’s active duty service cannot be established and service connection for peripheral neuropathy of the left lower extremity is denied. Peripheral neuropathy of the right lower extremity The Board concludes that, while the Veteran has a current diagnosis of peripheral neuropathy of the left lower extremity, the preponderance of the evidence weighs against finding that it began during service or is otherwise related to an in-service injury, event, or disease. The Veteran has not asserted how his peripheral neuropathy of the left lower extremity is related to service, and there is no other evidence suggesting that he had complaints, treatment, or diagnoses related to peripheral neuropathy of the left lower extremity in service. Further, the August 2019 VA examiner opined that the Veteran’s peripheral neuropathy of the left lower extremity was not at least as likely as not related to an in-service injury, event, or disease. The rationale was that the record was silent for any diagnosis of peripheral neuropathy of the left lower extremity while in service, and that the Veteran was not diagnosed with peripheral neuropathy of the left lower extremity until 2015, 32 years after his separation from service. The examiner’s opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez, 22 Vet. App. at 304. Accordingly, a nexus to the Veteran’s active duty service cannot be established and service connection for peripheral neuropathy of the left lower extremity is denied. M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Eric Struening 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.