Citation Nr: 21065857 Decision Date: 10/27/21 Archive Date: 10/27/21 DOCKET NO. 14-09 230A DATE: October 27, 2021 ORDER Entitlement to service connection for bilateral lower limb polyneuropathy is granted. FINDING OF FACT Resolving all reasonable doubt in favor of the Veteran, his bilateral lower limb polyneuropathy began during active service. CONCLUSION OF LAW The criteria for service connection for bilateral lower limb polyneuropathy are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1982 to September 1985 and January 1992 to February 1998. He died in February 2015. The appellant, the Veteran's surviving spouse, has been substituted for the Veteran. This matter comes to the Board of Veterans' Appeals (Board) on appeal from an October 2012 rating decision by a Regional Office (RO) of the Department of Veterans Affairs (VA). The Board remanded the claim in October 2020, January 2021, and April 2021. 1. Entitlement to service connection for bilateral lower limb polyneuropathy is granted. The Veteran contended that his bilateral lower limb polyneuropathy had its onset in service. Alternatively, he contended that his bilateral lower limb polyneuropathy was due to jet fuel exposure in service. Service connection may be granted for current disability arising from disease or injury incurred or aggravated by active service. 38 U.S.C. §§ 1110, 1131. 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). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Service treatment records reflect the Veteran's reports of pain that radiated into his left leg in April 1994 as well as complaints of radicular symptoms in May 1995. An undated initial Medical Board report indicates that the Veteran presented with low back pain that radiated down the left leg in April 1994, that he awoke in December 1994 with left leg pain described as a like a toothache or needle in the bottom of his left heel and up the leg, that a magnetic resonance imaging (MRI) scan revealed L5-S1 left paracentral disc herniation with lateral displacement of the left S1 nerve root and that he continued to have significant sensory of the neuropathy of the L4-5 distribution. A September 1997 service discharge examination found that the left leg was positive for straight leg raise. Post-service treatment records include a September 2010 VA treatment record which show the Veteran had severe sensorimotor peripheral polyneuropathy with features of mixed demyelination and axonal loss.. A May 2010 VA treatment note reflects an impression of lumbar foraminal stenosis with likely bilateral radiculopathy but rule-out comorbid sensorimotor neuropathy. A January 2011 VA treatment note indicates that nerve conduction studies found severe generalized sensorimotor neuropathy that was worse in the lower extremities. Turning to the question of whether there is an etiological relationship between the Veteran's service and his diagnosed bilateral lower limb polyneuropathy, the Board notes that the record contains several etiology opinions which must be considered and weighed. See Hayes v. Brown, 5 Vet. App. 60, 69-70 (1993). When faced with conflicting medical opinions, the Board may favor one medical opinion over the other. See Evans v. West, 12 Vet. App. 22, 30 (1998). The Board will consider each of these opinions below. The evidence against the claim includes a September 2012 VA examination which indicated that the Veteran's polyneuropathy was not due to degenerative disc disease of the lumbar spine, the November 2020 VA examination which noted the Veteran had not shown a diagnosis of polyneuropathy while on active duty, and the November 2020 addendum opinion indicating there is no objective medical evidence showing a link between the current diagnosis of peripheral polyneuropathy and the Veteran's time in military service. However, previous Board remands have found that these opinions are inadequate as they did not clarify whether the Veteran had a lower extremity nerve condition in addition to the already service-connected left lower extremity radiculopathy; did not adequately address the fact that the Veteran had frequently reported leg pain, numbness, tingling, and cramps, during service; did not address the Veteran or his mother-in-law's statements including that he was repeatedly soaked in aircraft hydraulic fluid from just above his waist to his feet for 8 to 12 hours during service. The evidence in favor of the claim includes a July 2021 VA examination in which the examiner found the Veteran's claimed condition was at least as likely as not (50 percent or greater probability) incurred in or caused by the claimed in-service injury, event, or illness. The examiner noted that the Veteran's service treatment records demonstrate related complaints during service and that symptoms have been present continuously since that point, therefore, current condition likely represents a continuation of the same disease process. The examiner based their conclusions on a review of the record, to include an interview with the Veteran and a full examination. Moreover, such opinion offered clear conclusions with supporting data as well as reasoned medical explanations connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion ... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). There is no contrary probative opinion of record. Further, the Board finds there is no sufficient basis for the Board to reject this supportive opinion and to further develop the claim. Cf. Mariano v. Principi, 17 Vet. App. 305, 312 (2003) (holding that, because it is not permissible for VA to undertake additional development to obtain evidence against an appellant's case, VA must provide an adequate statement of reasons or bases for its decision to pursue such development where such development could be reasonably construed as obtaining additional evidence for that purpose). (Continued on the next page) Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran's bilateral lower limb polyneuropathy arose in service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for bilateral lower limb polyneuropathy is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. KRISTY L. ZADORA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. M. Donahue Boushehri, 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.