Citation Nr: 21004121 Decision Date: 01/26/21 Archive Date: 01/26/21 DOCKET NO. 15-22 804A DATE: January 26, 2021 ORDER Service connection for peripheral neuropathy of the right upper extremity is denied. Service connection for peripheral neuropathy of the left upper extremity is denied. An initial rating in excess of 10 percent for PTSD is denied. FINDINGS OF FACT 1. The preponderance of the evidence of record is against finding that the Veteran has had peripheral neuropathy of the right upper extremity at any time during or approximate to the pendency of the claim. 2. The preponderance of the evidence of record is against finding that the Veteran has had peripheral neuropathy of the left upper extremity at any time during or approximate to the pendency of the claim. 3. The severity, frequency, and duration of the Veteran’s PTSD symptoms did not more closely approximate occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. 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. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 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. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 3. The criteria for a rating in excess of 10 percent for PTSD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9411. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran, who is the appellant in this case, had service from September 1967 to September 1969, which included service in the Republic of Vietnam. He received the Combat Infantry Badge and Bronze Star Medal. In August 2018, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge (VLJ); a transcript of the hearing is associated with the claims file. The Board previously considered this appeal in April 2019 and remanded these issues for additional development. After the development was completed, the case returned to the Board for further appellate review. 1. Service connection for peripheral neuropathy of the right upper extremity. 2. Service connection for peripheral neuropathy of the left upper extremity. The Veteran contends that he has peripheral neuropathy of the bilateral upper extremities that is related to service, to include as secondary to service-connected diabetes mellitus, type 2. 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). Service connection may also be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310. 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 or related to a service-connected disability. The Board concludes that the Veteran does not have a current diagnosis of peripheral neuropathy of the bilateral upper extremities and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The January 2020 VA examiner evaluated the Veteran and determined that, while he experienced subjective symptoms of pain in the bilateral upper extremities, he did not have a diagnosis of peripheral neuropathy the bilateral upper extremities. Further, despite treatment from 2012 to the present, VA and private treatment records do not contain a diagnosis of peripheral neuropathy of the bilateral upper extremities. While private treatment records show assessments for polyneuropathy, these do not clearly indicate that the condition pertains to the upper extremities. As outlined above, physical examinations and diagnostic tests do not confirm the presence of peripheral neuropathy in the bilateral upper extremities. Consequently, the Board gives more probative weight to the January 2020 VA examiner’s findings. While the Veteran believes he has a current diagnosis of peripheral neuropathy of the bilateral upper extremities, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education, knowledge of the interaction between multiple systems in the body, and the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. 3. An initial rating in excess of 10 percent for PTSD. The Veteran generally asserts that his PTSD warrants a higher rating. Under the General Formula for Mental Disorders (General Formula), the Board must conduct a “holistic analysis” that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013). The issue in this appeal is whether the Veteran’s associated symptoms caused the level of impairment required for a disability rating of 30 percent or higher. The Board concludes that the Veteran’s symptoms did not cause the level of impairment required for a disability rating of 30 percent or higher. The Veteran’s symptoms more closely approximated the symptoms associated with a 10 percent rating, and resulted in a level of impairment that most closely approximated the level of impairment associated with a 10 percent rating. A 10 percent rating is assigned when mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of occasional stress, or symptoms controlled by medication cause occupational and social impairment. A 30 percent rating is assigned when symptoms such as depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, or mild memory loss (such as forgetting names, directions, or recent events), cause occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and normal conversation). A 50 percent rating is assigned when symptoms such as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; or difficulty in establishing and maintaining effective work and social relationships cause occupational and social impairment with reduced reliability and productivity. A 70 percent rating is assigned when symptoms such as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); or inability to establish and maintain effective relationships cause occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. A 100 percent rating is assigned for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation or own name. VA treatment records, the November 2005, October 2012, April 2016, and January 2020 VA examinations, and the Veteran’s lay statements show that the Veteran’s PTSD was manifested primarily by mild, transient symptoms and/or symptoms controlled by continuous medication. He also had symptoms that are not listed with a specific rating, such as hypervigilance, and exaggerated startle response. The Board finds the severity, frequency, and duration of the Veteran’s unlisted symptoms more closely approximate the symptoms contemplated by a 10 percent rating, which are less severe, less frequent, and shorter in duration than those contemplated by a 30 percent rating. See 38 C.F.R. § 4.126. The Veteran reported that these symptoms were not present daily, but would increase in severity when attending public events with crowds. Further, hypervigilance and exaggerated startle response when attending public events is similar to having transient symptoms only during periods of significant stress, which are contemplated by the assigned 10 percent rating. The Board also finds the level of impairment caused by the Veteran’s symptoms more closely approximates the level associated with a 10 percent rating. The Veteran experienced occupational and social impairment in the form of mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication. Mental status examinations in VA treatment records and the November 2005, October 2012, April 2016, and January 2020 VA examinations also support a 10 percent rating for the Veteran’s occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication. While the Veteran did experience symptoms contemplated by a 30 percent rating—anxiety, depression, and some forgetfulness—the evidence overall does not demonstrate the level of impairment associated with a 30 percent rating. As noted above, the Veteran’s other remaining symptoms were either contemplated by or more consistent with a 10 percent rating. Further, while VA treatment records show the Veteran reported perceived memory loss, anxiety, depression, and panic feelings, prior and subsequent treatment records contain reports that the Veteran was generally performing well at work. In fact, during the 2016 examination he indicated he got along okay with coworkers. While he reported some problems they were from dealing with middle school children and he denied any disciplinary actions or excessive absences. During the January 2020 VA examination, the Veteran denied any trouble at work and still attended church twice per week. Similarly, the record generally reflects he did not manifest with social impairment resulting in decreased efficiency or inability to intermittently complete tasks. In fact, the 2005 examination noted he socializes with co-workers and still goes out with his wife at times and the examiner “cannot find evidence that symptoms of mood dysphoria limit his ability to socialize or relate interpersonally.” The 2012 examination reflected he lived with his wife, retained some relationship with his children, occasionally spent time with friends and cousins and people from church. He had some hobbies and attended family reunions and church. During the 2016 examination he continued to describe a decent relationship with his wife and reported some contact with siblings and children but indicated there were some children who he had more distant relationships with than others. He described socializing with some friends from work and meeting some friends in the morning for breakfast and talking to other veterans in group sessions. In short, the preponderance of the evidence weighs against finding that the severity, frequency, and duration of the Veteran’s symptoms resulted in the level of impairment required for a 30 percent rating. The criteria for a 30 percent or higher rating are not met and the appeal must be denied. (Continued on the next page)   Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366 (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). H. SEESEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Connally, 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.