Citation Nr: 21061731 Decision Date: 10/05/21 Archive Date: 10/05/21 DOCKET NO. 17-32 688 DATE: October 5, 2021 ORDER Service connection for peripheral neuropathy of the bilateral upper extremities is denied. REMANDED Entitlement to service connection for a disorder of the digestive system (previously claimed as enteropathy/bowel problem), to include as secondary to diabetes mellitus, type II, is remanded. Entitlement to service connection for melanoma is remanded. FINDING OF FACT The preponderance of the evidence of record is against finding that the Veteran had peripheral neuropathy of the bilateral upper extremities at any time during or approximate to the pendency of the claim. CONCLUSION OF LAW The criteria for service connection for peripheral neuropathy of the bilateral upper extremities have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Navy from June 1955 to June 1958 and in the United States Coast Guard from January 1959 to December 1975. The Veteran died in March 2019. The appellant filed this case as the surviving spouse. In January 2020, the appellant was deemed to be a valid substitute claimant for the purposes of processing the Veteran's appeal to completion. The Veteran requested a video conference hearing before the Board, which was scheduled for April 2019. The request to withdraw his hearing request was received in March 2019. In April 2020, the Board remanded the claims of service connection for a heart disability, diabetes, prostate cancer, melanoma, hypertension, erectile dysfunction, peripheral neuropathy of the bilateral lower extremities, peripheral neuropathy of the bilateral upper extremities, disorder of the digestive system, disorder of the genitourinary system, a bilateral eye disorder, and Special Monthly Compensation for loss of use of a creative organ. An October 2020 rating decision granted service connection for a heart disability, diabetes, prostate cancer, erectile dysfunction, peripheral neuropathy of the bilateral lower extremities, a bilateral eye disorder, and Special Monthly Compensation for loss of use of a creative organ. A March 2021 rating decision granted service connection for hypertension and a disorder of the genitourinary system. Accordingly, these claims are no longer in appellate status. 1. Peripheral neuropathy of the bilateral upper extremities The Veteran sought service connection for peripheral neuropathy. The Board concludes that the Veteran did not have a current diagnosis of peripheral neuropathy of the bilateral upper extremities, and did not have 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 existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C. §§ 1110, 1131; Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (in the absence of proof of a present disability there can be no valid claim). A current disability means a disability shown by competent and credible (i.e., probative) evidence to exist. Chelte v. Brown, 10 Vet. App. 268 (1997). A September 2020 VA examiner conducted a file review. She provided that there was no documented diagnosis or complaint of peripheral neuropathy of the upper extremities. The Board finds the opinion of the VA examiner is adequate as the examiner based her medical opinion on an accurate medical history as post-service medical treatment records are absent for peripheral neuropathy of the upper extremities. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Review of medical treatment records do not indicate the presence of peripheral neuropathy of the upper extremities. Rather, the medical treatment evidence indicated neuropathy in the feet, toes, thighs, and legs. To the extent the Veteran had a diagnosis of peripheral neuropathy, the Board notes that the Veteran had been compensated for service connection for peripheral neuropathy of the bilateral lower extremities. In sum, the preponderance of evidence is against the presence of a current disability as to the upper extremities. While the Veteran had presumed herbicide exposure, there is no probative evidence to support that peripheral neuropathy of the bilateral upper extremities manifested a year after service. 38 C.F.R. § 3.309. Again, the preponderance of evidence is against the presence of a current disability as to the upper extremities. While the Veteran believed he had peripheral neuropathy of the bilateral upper extremities, he was not competent to provide a medical opinion in this case as he did not have the requisite training or credentials needed to render a competent opinion as to a current diagnosis. 38 C.F.R. § 3.159(a)(2); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). As such, his lay opinions during the appeal do not constitute competent medical evidence and lacks probative value. Nerve disorders are medically complex disorders that require specialized training for a determination as to diagnosis and causation. Consequently, the Board gives more probative weight to the competent post-service medical treatment records reflecting no presence of peripheral neuropathy of the bilateral upper extremities and the opinion of the September 2020 VA examiner who confirmed there was no current disability. The Board therefore finds that service connection for peripheral neuropathy of the upper extremities is not warranted as there was no diagnosis or showing of impairment in earning capacity due to pain. See Saunders v. Wilkie, 886 F.3d 1356, 1364-65 (Fed. Cir. 2018). The preponderance of the evidence is against this service connection claim, and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. REASONS FOR REMAND 2. Digestive disorder The Veteran sought service connection for an "enteropathy/bowel problem." The April 2020 Board remand recharacterized this claim as a disorder of the digestive system. Clemons v. Shinseki, 23 Vet. App. 1, 5-6, 8 (2009). The Board had previously noted that service treatment records (STRS) showed hemorrhoids documented in February 1968, with later diagnosed hemorrhoids and hemorrhoidectomy in February 2012. A March 2021 VA examiner only discussed diverticulitis, and in doing so did not specifically address the notation in the STRS regarding hemorrhoids. Thus, it cannot be said that the medical opinion provided is complete. Another remand is required. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007); see also Stegall v. West, 11 Vet. App. 268, 271 (1998) (Board remand confers a right on a claimant to compliance with the remand order). 3. Melanoma The Board cannot make a fully informed decision on the issue of melanoma because no VA examiner has opined whether it is due to herbicide exposure. The Board notes that while melanoma is not listed or contemplated among the diseases associated with certain herbicide agents under 38 C.F.R. § 3.309(e), direct service connection remains available. Combee v. Brown, 34 F.3d 1039 (Fed Cir. 1994). The matters are REMANDED for the following actions: 1. Obtain an addendum opinion from an appropriate clinician on the Veteran's disorders of the digestive system, to include any residuals from the stapled hemorrhoidectomy in February 2012 or hemorrhoids. The examiner is asked to opine: a) Whether a disorder of the digestive system, to include diverticulitis, was at least as likely as not (50 percent probability or greater) related to service, to include herbicide exposure therein. The examiner must address the February 1968 STR notation of hemorrhoids. b) Whether a disorder of the digestive system is at least as likely as not (50 percent probability or greater) proximately due to or aggravated service-connected diabetes mellitus. The VA examiner must provide separate findings and rationales relating to causation and aggravation. The examiner is advised aggravation under 38 C.F.R. § 3.310 (b) does not require that there be "permanent" worsening of the nonservice connected disability. A complete rationale must be provided for all opinions rendered. 2. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's melanoma was at least as likely as not (50 percent probability or greater) related to service, to include herbicide exposure therein. A complete rationale must be provided for all opinions rendered. L. Chu Veterans Law Judge Board of Veterans' Appeals Attorney for the Board AD 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.