Citation Nr: 20042324 Decision Date: 06/22/20 Archive Date: 06/22/20 DOCKET NO. 09-44 878 DATE: June 22, 2020 ORDER Service connection for peripheral neuropathy of the upper and lower extremities is denied. FINDING OF FACT The weight of the evidence is against a finding that the Veteran’s peripheral neuropathy is related to his in-service beating; or was caused or aggravated by his service-connected diabetes mellitus, type II. CONCLUSION OF LAW The criteria for service connection for peripheral neuropathy of the upper and lower extremities have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from December 1967 to October 1969 and from October 1969 to March 1972. The Veteran testified before the undersigned Veterans Law Judge in February 2018. A transcript of the hearing is of record. Service Connection Service connection requires competent evidence showing: (1) the existence of a present disability; (2) 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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310 (a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). If a Veteran was exposed to a herbicide agent during active military service, peripheral neuropathy is an enumerated disease that is presumed to have been incurred in service if manifest to a compensable degree within specified periods, even if there is no record of such disease during service. However, the peripheral neuropathy must manifest within a year of the last exposure to herbicides. 38 U.S.C. § 1116 (a)(2); 38 C.F.R. §§ 3.307 (a)(6), 3.309(e). Here, the Veteran has given various statements as to when the onset of his peripheral neuropathy. At the February 2018 hearing, he testified that he first became aware of his neuropathy in September 1998, about 26 years after his separation from the miliary. Further, the Board notes that there is no medical evidence that the Veteran’s neuropathy manifested within a year of service. As such, the Veteran is not entitled presumptive service connection based on exposure to herbicides. The Veteran asserts that his peripheral neuropathy is aggravated by his service-connected diabetes mellitus. The Board notes that the Veteran initially claimed service connection for his peripheral neuropathy, which he was the resulted of being physically assaulted in service. The Veteran’s service treatment records (STRs) document the in-service assault. The Veteran was afforded a VA examination in March 2013. After a review of the Veteran’s claims file, the examiner opined that the claimed neuropathy was less likely as not the result of the in-service assault. The hospital records show multiple abrasions and contusions, with no further abnormalities detected. The examiner noted that there was no evidence of injury to the neck or back, or any internal organs. The examiner explained that medical literature stated that polyneuropathy had a variety of causes, to include diabetes, which the Veteran was diagnosed, but was not service-connected for. The Veteran credibly testified at the February 2018 Board hearing that he has limited sensations in his hands and feet. He testified that he is able to walk in the snow, without feeling discomfort. He stated that he was diagnosed with diabetes in 2013, and that his neuropathy symptoms pre-dated the diabetic symptoms by about 10-15 years. This issue was previously before the Board in May 2018. The Board acknowledged the negative nexus opinion, as to direct service connection in related to the in-service assault. The Board noted that the March 2013 examiner stated that diabetes could cause peripheral neuropathy, but did not opine whether the two conditions were related. The issue was remanded to address whether the Veteran’s peripheral neuropathy was caused or aggravated by his service-connected diabetes. The Veteran was afforded a VA examination in March 2020, which addressed the Veteran’s theory of secondary service connection. As such, the Board finds that there has been substantial compliance with the November 2017 Board remand directives.  See Stegall v. West, 11 Vet. App. 268, 271 (1998).   The Veteran was afforded a VA examination in March 2020. After a review of the Veteran’s claims file, the examiner stated that it was less likely as not that the Veteran’s peripheral neuropathy was either caused or aggravated by his service-connected diabetes mellitus. The examiner explained that the Veteran separated from the military in 1972 and that he was diagnosed with diabetes in 2013. The Veteran’s diabetes is well-controlled with diet management, so it was very unlikely that his claimed peripheral neuropathy was secondary to his diabetes, which did not exist during his active service. Neither the Veteran nor his representative have objected to the findings of this examination, and neither has offered any medical opinion that would call the examiner’s conclusions into question. Moreover, at his Board hearing, the Veteran specifically denied having been told by a medical professional that his diabetes mellitus had caused or aggravated his peripheral neuropathy. The Board acknowledges the Veteran’s complaints of peripheral neuropathy symptoms. However, the evidence of record does not support the grant of service connection on a presumptive basis, a direct basis, or a secondary basis. Here, the Veteran’s peripheral neuropathy did not manifest within a year of his separation from the military. 38 U.S.C. § 1116 (a)(2); 38 C.F.R. §§ 3.307 (a)(6), 3.309(e). He acknowledged at the February 2018 Board hearing that the onset of his peripheral neuropathy symptoms was in the late 1980s for subacute peripheral neuropathy and then later in the 1990s for peripheral neuropathy. Regardless, it is clear that the onset was decades after service, but well-before diabetes mellitus was diagnosed. The March 2013 VA examiner provided a negative nexus opinion in regard to direct service connection and the March 2020 examiner provided a negative nexus opinion in regard to secondary service connection. To the extent that he believes that his peripheral neuropathy is the result of, or is aggravated by his diabetes mellitus, or due to his military service, such a medical opinion requires medical expertise, and that determination cannot simply be made by lay observation alone; and the Veteran is not considered competent (meaning medically qualified by training or experience) to provide a medical opinion. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Here, VA provided the Veteran with examinations to address both direct and secondary service connection theories, but the respective examiners unfortunately provided negative nexus opinions. The Veteran has not offered any medical evidence that would undermine either of the VA examiner’s medical opinions in regard to direct or secondary service connection. Here, the Veteran’s diabetes mellitus clearly onset years after service, but also years before the onset of his diabetes mellitus. Moreover, there is no medical evidence showing that the Veteran’s diabetes mellitus worsened his peripheral neuropathy in any way. Accordingly, service connection for peripheral neuropathy of the upper and lower extremities is denied. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Fu, 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.