Citation Nr: 21002737 Decision Date: 01/14/21 Archive Date: 01/14/21 DOCKET NO. 14-04 014 DATE: January 14, 2021 ORDER Service connection for neuropathy is denied. FINDING OF FACT Neuropathy was not incurred in and is not otherwise etiologically related to active service, including in-service herbicide exposure. CONCLUSION OF LAW The criteria for service connection for neuropathy are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service in the United States Air Force from April 1968 to March 1984, including service in the Republic of Vietnam. This appeal comes to the Board of Veterans’ Appeals (Board) from a September 2012 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Jackson, Mississippi. The Veteran offered testimony on this matter during a July 2016 videoconference hearing. A transcript of this proceeding has been associated with the record. In November 2020, he was informed that the Veterans Law Judge (VLJ) who presided over his hearing was no longer with the Board, and offered a hearing before a different VLJ. As the Veteran did not request a new hearing within 30 days of this notice, the Board may proceed with its review of the matter on appeal. 38 U.S.C. § 7107(c); 38 C.F.R. § 20.707. Additionally, this appeal was remanded by the Board in August 2018 for further development; specifically, to obtain additional medical records and a new VA examination. Following the Board’s remand, additional medical records were obtained and the Veteran underwent VA examination in August 2019. Therefore, the Board is satisfied as to substantial compliance with the instructions from the August 2018 remand. Stegall v. West, 11 Vet. App. 268 (1998). Service connection for neuropathy The Veteran is currently seeking service connection for neuropathy on a direct basis only. The Board will limit its analysis accordingly. Service connection may be granted directly as a result of disease or injury incurred in service based on nexus using a three-element test: (1) The existence of 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 disease or injury incurred in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Here, it is well-established that the Veteran has a current disability. He was diagnosed with peripheral sensory neuropathy following August 2019 VA examination, and his history of neuropathy is noted throughout VA treatment records. Thus, the first element of direct service connection is met. As to the second element, the Veteran maintains that his neuropathy onset during active duty following his in-service exposure to Agent Orange. His service personnel records document service in Vietnam from approximately 1968 to 1969, such that his in-service exposure to herbicide agents is presumed. 38 U.S.C. § 1116(a); 38 C.F.R. §§ 3.307, 3.309. Presumptive service connection due to in-service herbicide exposure is available for multiple disorders, including early-onset peripheral neuropathy. Id. However, the August 2019 VA examiner clearly indicated that the Veteran was not diagnosed with his neuropathy until April 2011, “when his symptoms first occurred.” Such reporting is supported by the Board’s contemporaneous review of the claims file, which contains no evidence of a relevant diagnosis, symptoms, or treatment until 2011, some 30 years following the Veteran’s military separation. Thus, a diagnosis of early-onset peripheral neuropathy was explicitly denied by the examiner, and there is no competent medical evidence to contradict such a finding. Accordingly, the Veteran does not demonstrate such a diagnosis as to warrant presumptive service connection on this basis. Similarly, presumptive service connection as based upon chronicity is available for tumors of the peripheral nerves. However, there is no evidence that the Veteran has had tumors of the peripheral nerves at any time. Accordingly, service connection based upon chronicity is also inapplicable. 38 U.S.C. § 1116(a); 38 C.F.R. §§ 3.307, 3.309. Nonetheless, this appeal may still be granted upon a finding that the Veteran’s current disability is etiologically related to his military service, including presumed herbicide exposure. 38 C.F.R. §§ 3.303(d), 3.309(e); see also Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). There are two opinions of record for consideration. First, in October 2014, Dr. G.P. noted the Veteran’s reports of herbicide exposure during service and current diagnosis of a possible small fiber polyneuropathy. In doing so, the physician noted his belief that it “is possible if [the Veteran] indeed had exposure to [herbicides] that this could be the cause of his neuropathy.” No more definitive opinion was provided, nor did the physician offer any supporting rationale. Thus, Dr. G.P.’s opinion is too vague and equivocal to be probative in this instance. Next, a VA examination was conducted in August 2019. At that time, the examiner opined that it was less likely than not that the Veteran’s current neuropathy onset during service or was otherwise related to service, to include in-service exposure to herbicide agents. In doing so, the examiner noted that the Veteran was not diagnosed with neuropathy until 2011, many years after his discharge from service. Moreover, the Veteran’s service treatment records (STRs) do not indicate that he was diagnosed with neuropathy during service, or demonstrated neuropathic symptoms. Instead, his in-service examinations yielded normal results. Further, evidence-based literature reports that there are many causes of peripheral neuropathy; although in some cases, known as “idiopathic neuropathy,” the causes are unknown. Additionally, literature states that research conducted over the past two decades concludes that the evidence is insufficient to conclude or confirm a connection between herbicide exposure and peripheral neuropathy. As such, a nexus was not asserted at that time. The above opinion is probative evidence against the claim. Notably, the examiner offered a definitive nexus opinion as based upon direct contemplation of the Veteran’s military and medical histories, including in-service exposure to herbicide agents and the onset of his current neuropathy. Said opinion was supported by the examiner’s reference to medical literature on the matter. See Prejean v. West, 13 Vet. App. 444, 448-49 (2000); see also Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008) (holding that the probative value of a medical opinion comes from the “factually accurate, fully articulated, sound reasoning for the conclusion”). There is no indication that the August 2019 examiner was not fully aware of the Veteran’s past medical history or misstated any relevant fact in formulating the negative nexus opinion. Moreover, the examiner possesses the requisite expertise to render a medical opinion regarding the etiology of the claimed disorder and had sufficient facts and data on which to base her conclusions. In contrast, the Veteran asserts that a nexus is present in this case. Although he is competent to describe what he has personally observed or experienced, Layno v. Brown, 6 Vet. App. 465, 469 (1994), he lacks the requisite training and expertise to offer competent opinions as to complex medical matters, including the etiology of a disability. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Rather, greater probative value is afforded to the medical evidence, which supports the conclusion that a nexus is not present in this case. Briefly, the Board acknowledges the Veteran’s hearing testimony that his symptoms onset during service, but that he did not seek treatment at that time upon his superiors’ representation that “there was nothing they could do.” July 2016 hearing transcript, p. 5. However, this argument is insufficient upon which to grant this appeal. Critically, the Veteran lacks the medical expertise to attribute his reported symptoms to a specific disorder. In direct contradiction to his testimony, the competent and objective medical records do not document related symptoms until approximately 2011, several decades after military separation. Thus, the probative evidence does not establish that the Veteran’s symptoms onset during service. Accordingly, the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application, and service connection for neuropathy is not warranted. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Of final note, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board’s consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Kate E. Kovarovic Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Andrew Ledman II 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.