Citation Nr: 21004916 Decision Date: 01/28/21 Archive Date: 01/28/21 DOCKET NO. 17-14 864 DATE: January 28, 2021 ORDER Entitlement to service connection for heart disability, to include congestive heart failure and atrial fibrillation, is denied. Entitlement to service connection for diabetes mellitus is denied. Entitlement to service connection of peripheral neuropathy of left upper extremity is denied. Entitlement to service connection for peripheral neuropathy of right upper extremity is denied. FINDINGS OF FACT 1. The Veteran’s heart disability, to include congestive heart failure and atrial fibrillation, is not etiologically related to service or secondary to service-connected PTSD or cold injury of the lower extremities. 2. The Veteran’s diabetes mellitus is not etiologically related to service or secondary to service-connected PTSD or cold injury of the lower extremities. 3. The Veteran’s peripheral neuropathy of the left upper extremity is not etiologically related to service or secondary to service-connected PTSD or cold injury of the lower extremities. 4. The Veteran’s peripheral neuropathy of the right upper extremity is not etiologically related to service or secondary to service-connected PTSD or cold injury of the lower extremities. CONCLUSIONS OF LAW 1. The criteria for service connection for heart disability, to include congestive heart failure and atrial fibrillation, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. 2. The criteria for service connection for diabetes mellitus have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. 3. The criteria for service connection of peripheral neuropathy of left upper extremity have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. 4. The criteria for service connection for peripheral neuropathy of right upper extremity have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from July 1952 to April 1954, to include combat service. The Veteran had service in Korea. These matters come before the Board of Veterans’ Appeals (Board) on appeal from an April 2013 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In November 2020, the Board remanded the claims to obtain addendum medical opinions for heart disability and diabetes that address secondary service connection to cold injury peripheral neuropathy of the lower extremities. Service Connection Service connection is granted for any current disability that is the result of a disease contracted or an injury sustained while on active duty service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for a disease diagnosed after discharge, where all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38C.F.R. § 3.303(d). 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 is permissible, as well, on a secondary basis for disability that is proximately due to, the result of, or chronically aggravated by a service-connected condition. See 38 C.F.R. § 3.310 (a) and (b). See also Allen v. Brown, 7 Vet. App. 439, 448 (1995). In order to establish entitlement to service connection on this alternative secondary basis, there must be: (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a nexus (i.e., link) between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). VA regulations provide that a veteran who served between September 1, 1967, and August 31, 1971, in a unit that, as determined by the DoD, operated in or near the Korean DMZ in an area in which herbicides are known to have been applied during that period, shall be presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service. 38 C.F.R. § 3.307 (a)(6)(iv). 1. Entitlement to service connection for heart disability, to include congestive heart failure and atrial fibrillation. The Veteran contends that his heart disability is related to service, to include in-service occurrence of frostbite and/or exposure to Agent Orange or, alternatively, secondary to PTSD or cold injuries of the bilateral lower extremities. Military personnel records indicate that the Veteran had active service between July 1952 to April 1954, with service in Korea. His period of service is outside the applicable period for presumptive herbicide exposure based on service in Korea. The record does not otherwise substantiate exposure to herbicides in service. The Veteran has not been shown to posses the expertise to identify herbicide agents. The Board finds that the official service department determinations regarding the dates and storage of herbicide agents to be more probative regarding the issue of exposure. In a July 2013 Statement in Support of the Claim, the Veteran asserted that his heart disability is due to frost bite incurred during service. The first evidence of a heart disability is shown in 1990 medical treatment record noting diagnosis of atrial fibrillation (AFib) and 2004 medical treatment record noting a diagnosis of congestive heart failure (CHF). The Veteran was afforded a VA examination in September 2019, which noted the above diagnoses. The examiner opined the Veteran’s CHF and Afib are less likely as not caused or aggravated by his service or his service-connected posttraumatic stress disorder (PTSD). The examiner stated that the records indicate that the Veteran did not have service in Vietnam nor at a location in Korea subject to agent orange exposure and the STRs are silent for any heart symptoms or diagnoses. The examiner explained that the current medical literature does not yet support a cause and effect relationship between PTSD and the development of Afib and or CHF. Upon remand, a VA addendum opinion was obtained in December 2020. The examiner opined that the Veteran’s heart disability, to include ischemic heart disease and/or atrial fibrillation is less likely as proximately due to or aggravated beyond its natural progression by his service-connected lower extremity frostbite injury. The examiner reasoned that frostbite injury due to cold injuries are associated with health problems, but heart conditions are not one of them. Further, the examiner explained that the literature does not support a causal relationship or aggravation of a heart condition by a cold injury such as frostbite to the lower extremity. After careful review of the claim, the Board concludes that the evidence of record weighs against finding that the Veteran’s heart disability is related to service, to include as caused by or aggravated by residuals of cold injury or PTSD. The examiner opined that the Veteran’s heart disability is less likely than not caused by or incurred in service, or proximately due to or aggravated by a service-connected PTSD or cold injuries of the lower extremities. The examiner reviewed medical literature addressing the Veteran’s contentions that there may be a link between cold injuries of the lower extremities and a heart disability or between PTSD and a heart disability. Following review of the medical resources and the Veteran’s history, no such link was established. 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 based on the evidentiary record. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Veteran maintains that his heart disability is related to service, to include secondary to cold injury residuals of the lower extremities and PTSD. Although the Veteran is credible as to his testimony regarding date of onset, symptoms and the environmental conditions of his military service, there is no indication that he has the training or expertise to competently opine on the etiology of his heart disability. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372, 1376-77 (Fed. Cir. 2007). Service connection is also not warranted for heart disability as a chronic disability under 38 C.F.R. § 3.307(a), as the competent medical evidence of record does not demonstrate that the Veteran’s heart disability was noted as chronic in service or manifested to a compensable degree in service or within the one year presumptive period. The record does not show a diagnosis of heart disability until 1990, approximately 37 years post service. See 38 C.F.R. §§ 3.307(a)(3), 3.309(a). Accordingly, as the preponderance of the evidence weighs against service connection, this claim must be denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 2. Entitlement to service connection for diabetes mellitus. The Veteran contends that his diabetes mellitus is related to service, to include an in-service occurrence of frostbite and/or exposure to Agent Orange or, alternatively, secondary to PTSD or cold injury residuals of the lower extremities. Military personnel records indicate that the Veteran had active service between July 1952 to April 1954, with service in Korea. His period of service is outside the applicable period for presumptive herbicide exposure based on service in Korea. The record does not otherwise substantiate exposure to herbicides in service. The Veteran has not been shown to posses the expertise to identify herbicide agents. The Board finds that the official service department determinations regarding the dates and storage of herbicide agents to be more probative regarding the issue of exposure. In a July 2013 Statement in Support of the Claim, the Veteran asserted that his diabetes is due to frost bite incurred during service. The first evidence of diabetes is shown in 1990 medical treatment record. The Veteran was afforded diabetes VA examinations in September 2019, which noted the 1990 diagnosis of diabetes mellitus, type II. Regarding direct service connection, the examiner concluded there was no evidence of exposure to Agent Orange; accordingly, the condition could not be related to service on that basis. The examiner further stated that service treatment record is silent for any diabetes symptoms or diagnoses. Regarding secondary service-connection, the examiner opined the Veteran’s diabetes is less likely as not caused or aggravated by his service or his service-connected posttraumatic stress disorder (PTSD). The examiner reasoned that there is no current objective evidence that the Veteran’s Diabetes is caused or aggravated to any degree by his military service, or his service-connected PTSD. Upon remand, a VA addendum opinion was obtained in December 2020. The examiner opined that the Veteran’s Diabetes is less likely as not proximately due to or aggravated by lower extremity frostbite injury. The examiner reasoned that frostbite injury due to cold injuries are associated with health problems, but diabetes is not one of them. Further, the examiner stated that the literature does not support a causal relationship or aggravation of diabetes by a cold injury such as frostbite to the lower extremity. After careful review of the claim, the Board concludes that the evidence of record weighs against finding that the Veteran’s diabetes is related to service, to include in-service frostbite or secondary to PTSD or cold injuries of the lower extremities. The examiner opined that the Veteran’s diabetes is less likely than not caused by or incurred in service, or proximately due to or aggravated by service-connected PTSD or cold injury residuals of the lower extremities. The examiner reviewed medical literature addressing the Veteran’s contentions that there may be a link between cold injuries and diabetes. Following review of the medical resources and the Veteran’s history, no such link was established. 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 based on the evidentiary record. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Veteran maintains that his diabetes is related to in-service frostbite or, alternatively, secondary to PTSD or cold injury/peripheral neuropathy of the lower extremities. Although the Veteran is credible as to his reports regarding date of onset, symptoms and the environmental conditions of his military service, there is no indication that he has the training or expertise to competently opine on the etiology of his diabetes. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372, 1376-77 (Fed. Cir. 2007). Service connection is also not warranted for diabetes as a chronic disability under 38 C.F.R. § 3.307(a), as the competent medical evidence of record does not demonstrate that the Veteran’s diabetes was noted as chronic in service or manifested to a compensable degree in service or within the one year presumptive period. The record does not show a diagnosis of diabetes until 1990, approximately 37 years post service. See 38 C.F.R. §§ 3.307(a)(3), 3.309(a). Accordingly, as the preponderance of the evidence weighs against service connection, this claim must be denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 3. Entitlement to service connection of peripheral neuropathy of the left upper extremity. 4. Entitlement to service connection for peripheral neuropathy of right upper extremity. The Veteran contends that peripheral neuropathy of his bilateral upper extremities is related to service, to include in-service frostbite or, in the alternative, secondary to diabetes mellitus. See July 2013 Statement in Support of the Claim. The first evidence of such is shown in 2015 medical treatment record, which notes a diagnosis of diabetic peripheral neuropathy of the bilateral upper extremities. September 2019 VA examination noted the above diagnosis. The Veteran reported that he was diagnosed with bilateral upper extremity peripheral neuropathy symptoms following his diabetes. He reported that he has also had tingling, pain and numbness of both feet since his frostbite during service; he reported that only his feet were frostbitten and that his hands were okay. Based on the above and the evidentiary record, the examiner opined that the Veteran’s peripheral neuropathy of the bilateral upper extremities is at least as likely as not the result of his diabetes. After careful review of the claim, the Board concludes that the evidence of record weighs against finding that the Veteran’s peripheral neuropathy of the upper extremities is related to service, to include in-service frostbite or secondary to diabetes. The examiner noted that the Veteran did not report a frostbite injury to his upper extremities, despite reporting such for his lower extremities. Accordingly, the examiner related the Veteran’s upper extremity peripheral neuropathy to his diabetes. However, as service connection is not in effect for diabetes and determined as unwarranted, service-connection cannot be granted on this secondary basis and this aspect of the claim is denied as a matter of law. The Veteran also contends that there may be a link between in-service frostbite and peripheral neuropathy of the upper extremities. However, based on the Veteran’s reports that in-service frostbite applied only to his lower extremity, and lack of other evidence of in-service injury to his upper extremity, no such link was established. Instead, the examiner described the peripheral neuropathy of the upper extremities as sensory in nature and related it to the Veteran’s diabetes. 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 based on the record. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Veteran maintains that his peripheral neuropathy of the upper extremities is related to service, to include in-service frostbite or, alternatively, secondary to diabetes. Although the Veteran is credible as to his reports regarding date of onset, symptoms and the environmental conditions of his military service, there is no indication that he has the training or expertise to competently opine on the etiology of his peripheral neuropathy of the upper extremities. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372, 1376-77 (Fed. Cir. 2007). Service connection is also not warranted for peripheral neuropathy as a chronic disability under 38 C.F.R. § 3.307(a), as the competent medical evidence of record does not demonstrate that it was noted as chronic in service or manifested to a compensable degree in service or within the one year presumptive period. The record does not show a diagnosis until 2015, approximately 61 years post service. See 38 C.F.R. §§ 3.307(a)(3), 3.309(a).   Accordingly, as the preponderance of the evidence weighs against service connection, this claim must be denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Wilson, 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.