Citation Nr: 21005242 Decision Date: 01/29/21 Archive Date: 01/29/21 DOCKET NO. 14-37 884 DATE: January 29, 2021 ORDER Entitlement to service connection for diabetes mellitus 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. FINDINGS OF FACT 1. The Veteran is not presumed to have been exposed to herbicide agents during his assignment at Fort McClellan, Alabama; actual exposure also has not been established. 2. The Veteran’s diabetes mellitus type II did not manifest in service or within one year of separation from service and is not otherwise shown to be related to the Veteran’s active service by the preponderance of the evidence. 3. The preponderance of the evidence does not support that the Veteran’s peripheral neuropathy of the bilateral lower extremities is etiologically linked to his active duty service. CONCLUSIONS OF LAW 1. The criteria for to service connection for diabetes mellitus have not been met. 38 U.S.C. §§ 1101, 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for service connection for peripheral neuropathy of right lower extremity have not been met. 38 U.S.C. §§ 1101, 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for to service connection for peripheral neuropathy of left lower extremity have not been met. 38 U.S.C. §§ 1101, 1110, 5107; 38 C.F.R. §§ 3.102, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from November 1979 to May 1985 and from October 1986 to June 1993. This matter initially came before the Board of Veterans’ Appeals (Board) on appeal from a July 2013 rating decision issued by the Agency of Original Jurisdiction (AOJ). The appeal was remanded in May 2018 for to obtain an adequate medical opinion as to the nature and etiology of the Veteran’s diabetes mellitus and peripheral neuropathy. Additionally, the AOJ was instructed to obtain any missing VA treatment records and military personnel records to include an VA Forms DD 1141. The Veteran was afforded VA examinations in August 2020. The Board finds that the medical opinions issued in connection with the Veteran’s claims for service connection for diabetes mellitus and bilateral peripheral neuropathy are supported by sufficient rationale. Moreover, all available military personnel records were associated with the file in November 2018. Finally, updated VA treatment records were associated with the file in August 2020. Thus, the Board determines that there has been substantial compliance with the July 2019 remand directives. Therefore, further remand is not required. See Stegall v. West, 11 Vet. App. 268 (1998) (holding that remand not required where there was substantial compliance with remand directives). Entitlement to service connection for diabetes mellitus and peripheral neuropathy of the bilateral lower extremities Service connection may be granted for current disability arising from disease or injury incurred or aggravated by active service. 38 U.S.C. § 1110. Service connection may be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). Service connection may also be established on a secondary basis for a disability which is shown to be proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show that a current disability exists and that the current disability was either caused by or aggravated by a service-connected disability. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439 (1995). In deciding an appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material evidence favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). When considering whether lay evidence is competent, the Board must determine, on a case-by-case basis, whether a veteran’s disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). The Board has the discretion to make credibility determinations and otherwise weigh the evidence submitted, including lay evidence. Buchanan v. Nicholson, 451 F.3d 1331, 1335 (Fed. Cir. 2006). The Veteran believes that he suffers from diabetes mellitus and peripheral neuropathy as a result of exposure to chemical warfare agents and radiation during assignments at Fort McClellan, Alabama and in Germany. Specifically, the Veteran alleges he was exposed to Polychlorinated biphenyls (PCBs), contaminated water, radiation rods, sarin gas, mustard gas, and nerve agents. VA treatment records indicate the Veteran has been diagnosed with diabetes mellitus and peripheral neuropathy of the bilateral lower extremities. Thus, the evidence is sufficient to show a current disability. The issue that remains disputed is whether the Veteran’s conditions had their onset in service or are otherwise related to his active service. Service treatment records are silent for complaints of or treatment for symptoms related to diabetes or peripheral neuropathy. Furthermore, the Veteran’s service treatment records do not show that the Veteran was diagnosed with either of these conditions during either period of active service. The Veteran’s post service treatment records are similarly silent for a diagnosis of diabetes until February 2010, nearly 17 years after the Veteran separated from service. Thus, in service incurrence is not established based on onset of in service. The Veteran’s personnel records do not contain a DD 1141 or any evidence detailing exposure to radiation during the Veteran’s active service. However, the Veteran has competently and credibly testified that he came into contact with chemical warfare agents on at least one occasion during his service in Germany. Resolving all reasonable doubt in the Veteran’s favor, the second element of direct service connection, an in-service event, has been established. Nevertheless, the claims must fail for lack of a nexus. The Veteran was afforded VA examinations in August 2020. The examiner found that the Veteran’s diabetes was less likely than not related to his active duty service. The examiner acknowledged the Veteran’s contentions including documents submitted which discussed radioactive components, chemical warfare agents and airborne PCBs. The examiner explained that PCB and radiation exposure was associated typically with cancer, leukemia and myeloma rather than diabetes. The examiner found that the Veteran’s diabetes was likely due to cellular resistance to insulin and the pancreas’ inability to make enough insulin to overcome buildup of sugar in the blood stream. The examiner noted that the Veteran’s medical records first revealed elevated glucose and A1c in February 2010, 17 years post service. Therefore, the examiner found the condition was less likely than not incurred or caused by exposure to chemical warfare agents, airborne PCBs or any possible exposure to radiation during service. For the same reasons, the examiner found that the Veteran’s peripheral neuropathy was not related to any harmful exposure during service. Rather, the examiner found, the Veteran’s peripheral neuropathy which developed after his diabetes mellitus was directly linked to that condition. The Board finds the VA examiner’s opinions adequate and probative. The examiner possessed the necessary education, training, and expertise to provide the requested opinions. See Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). In addition, the VA examiner provided a detailed rationale for the opinions, which was based on an examination and interview of the Veteran, a review of the service treatment records, post-service treatment records, and the lay statements of the Veteran. The opinion considered an accurate history, were definitive and supported by a detailed rationale that considered the lay and medical evidence. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Significantly, the Veteran has not presented or identified any contrary medical opinion that supports the claim for service connection. VA adjudicators are not free to ignore or disregard the medical conclusions of a VA physician, and are not permitted to substitute their own judgment on a medical matter. Colvin v. Derwinski, 1 Vet. App. 171 (1991); Willis v. Derwinski, 1 Vet. App. 66 (1991). The Board has also considered the Veteran’s assertions that his diabetes and peripheral neuropathy are related to radiation and environmental toxins in service. The Veteran’s statement is the only evidence suggesting his current disabilities are related to service, and the Veteran is not competent to provide an opinion on issues requiring medical expertise. Jandreau, 492 F.3d at 1376-77. The Board finds that the probative value of the Veteran’s general lay assertions of a relationship between his exposure to contaminants and his current disabilities are outweighed by the specific, reasoned opinions provided in the VA examination reports and the clinical evidence of record. Likewise, while the articles submitted by the Veteran are somewhat probative, the opinions of the medical providers are more probative as they apply the general findings within the articles to the Veteran’s specific case. The preponderance of the evidence shows that the Veteran’s diabetes and peripheral neuropathy of the bilateral lower extremities are not related to service. Service connection for diabetes and peripheral neuropathy of the bilateral lower extremities is denied. GAYLE STROMMEN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Sherman 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.