Citation Nr: 20049865 Decision Date: 07/27/20 Archive Date: 07/27/20 DOCKET NO. 17-60 904 DATE: July 27, 2020 ORDER Entitlement to service connection for peripheral neuropathy of the right upper 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 lower extremity is denied. Entitlement to service connection for peripheral neuropathy of the left lower extremity is denied. FINDING OF FACT The probative evidence of record does not show the Veteran’s peripheral neuropathy of the bilateral upper and lower extremities is related to his active duty service. CONCLUSIONS OF LAW 1. The criteria for service connection for peripheral neuropathy of the right upper extremity have not been met. 38 U.S.C. §§ 101, 1131; 38 C.F.R. §§ 3.6, 3.303, 3.304, 3.307, 3.309. 2. The criteria for service connection for peripheral neuropathy of the left upper extremity have not been met. 38 U.S.C. §§ 101, 1131; 38 C.F.R. §§ 3.6, 3.303, 3.304, 3.307, 3.309. 3. The criteria for service connection for peripheral neuropathy of the right lower extremity have not been met. 38 U.S.C. §§ 101, 1131; 38 C.F.R. §§ 3.6, 3.303, 3.304, 3.307, 3.309. 4. The criteria for service connection for peripheral neuropathy of the left lower extremity have not been met. 38 U.S.C. §§ 101, 1131; 38 C.F.R. §§ 3.6, 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from December 1952 to November 1954. The claims were brought before the Board in January 2018 and May 2019 and were remanded for further development. Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). In order to establish service connection, the record must show competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d, 1362, 1366 (Fed. Cir. 2009). When considering such a claim for service connection, the Board must consider on a case-by-case basis, the competence and sufficiency of lay evidence offered to support a finding of service connection. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (quoting Jandreau v. Nicholson, 492 F.3d 1372, 1377 Fed. Cir. 2007)). The mere conclusory or generalized lay statements that a service event or illness caused a current disability are insufficient. Waters v. Shinseki, 601 F.3d 1274, 1278 (2010). For the chronic diseases listed in 38 C.F.R. § 3.309(a), including peripheral neuropathy (as organic diseases of the nervous system), service connection may alternatively be established with evidence of chronicity of the disease during service or during a presumptive period following service separation, or by showing a continuity of symptoms after service. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2012); see Fountain v. McDonald, 27 Vet. App. 258 (2015). When chronicity or continuity is established, subsequent manifestations of the same chronic disease at any later date, no matter how remote in time from the period of service, will be service connected unless clearly attributable to causes unrelated to service (“intercurrent” causes). 38 C.F.R. § 3.303(b). Entitlement to Service Connection: Peripheral Neuropathy The Veteran contends that his peripheral neuropathy of the bilateral upper and lower extremities is related to his active duty service, to include possible cold injury while stationed in Korea. As an initial matter, the Board acknowledges that the Veteran has been diagnosed with peripheral neuropathy of the bilateral lower and upper extremities. Further, his records confirm that he was stationed in Korea during his service, and exposure to cold weather would be consistent with the circumstances of his service. Thus, the issue turns upon whether there is evidence of a nexus between the claimed in-service event and the present disabilities. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The Board finds there is not. In February 2018, the Veteran was provided a VA examination. The examiner found that the Veteran’s current bilateral upper and lower extremity peripheral neuropathy was characterized as diabetic neuropathy. The examiner then opined that the current condition of bilateral upper and lower extremity diabetic peripheral neuropathy was less likely than not incurred in or caused by his active duty service. The examiner rationalized that though the Veteran claimed he suffered from extreme cold weather, the Veteran’s service treatment records show no documentation for frostbite or cold injuries. The examiner further provided that there is no documentation of chronicity of cold injuries or diagnosis of peripheral neuropathy for several years. The examiner provided that private examinations in 2004 and 2003 denied any sign of peripheral neuropathy, and the Veteran’s peripheral neuropathy was noted as most likely related to his diabetes by his private physician in 2010. The examiner then provided that high glucose levels were a known major risk factor for the development of diabetic neuropathy in patients with type 1 or type 2 diabetes. VA treatment records show consistent treatment for peripheral neuropathy and complaints of numbness and pain. However, the Veteran’s peripheral neuropathy of the bilateral upper and lower extremities has consistently been noted and diagnosed as diabetic peripheral neuropathy. His records show no notations relating the Veteran’s conditions to cold injury nor has the Veteran provided any records showing such. Further, the Veteran’s service treatment records show no complaints or notations of cold injury, numbness, or a diagnosis of peripheral neuropathy. The Board notes that following the Board’s January 2018 remand, the Regional Office requested the Veteran submit any additional records, to include private treatment records, and the Veteran did not respond. Therefore, the Board finds the February 2018 VA opinion to be of significant probative value in determining that the Veteran’s peripheral neuropathy of the bilateral upper and lower extremities are not related to his active service. The Board notes that the probative value of medical opinion evidence is based on the medical experts’ personal examination of the patient, their knowledge, and skill in analyzing the data, and their medical conclusion. As is true with any piece of evidence, the credibility and weight to be attached to these opinions are within the province of the adjudicator. Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). Whether a physician provides a basis for his or her medical opinion goes to the weight or credibility of the evidence in the adjudication of the merits. See Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998). Here, the reviewing physician’s opinion was based on review of the Veteran’s lay contentions, his reported medical history, and review of the medical evidence of record. Further, a complete and thorough rationale was provided for the opinion rendered and is consistent with the medical evidence of record. The Board acknowledges the Veteran’s assertions that his peripheral neuropathy is related to his active duty service. The Board also recognizes that lay persons are competent to provide medical opinions on some medical issues. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). However, although the Veteran is competent to report his symptoms, any opinion regarding whether any peripheral neuropathy is related to his service requires medical expertise that the Veteran has not demonstrated since peripheral neuropathy can have many causes. See Jandreau v. Nicholson, 492 F.3d 1372, 1376 (2007). Further, as provided above, the Veteran’s peripheral neuropathy has been found as due to his diabetes, diagnosed as diabetic peripheral neuropathy, for which the Board notes the Veteran is not service-connected. The Board has also considered whether service connection for peripheral neuropathy is warranted on a presumptive basis, but the record contains no evidence that the Veteran had peripheral neuropathy to a compensable degree within one year after discharge from service. The evidence of record does not show any mentioning of possible peripheral neuropathy until 2004, and no official diagnosis of peripheral neuropathy until 2010, over 50 years after his active duty service. Therefore, to the extent that the Veteran contends he has experienced peripheral neuropathy continuously since his active duty service, these statements are not credible, as they are inconsistent with the medical and other lay evidence of record. In light of the foregoing, the Board concludes that the preponderance of evidence is against the claims and the benefit of the doubt doctrine is not for application. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F.3d 1361 (Fed Cir. 2001). JENNIFER HWA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Negron, 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.