Citation Nr: 21071511 Decision Date: 11/30/21 Archive Date: 11/30/21 DOCKET NO. 15-11 899 DATE: November 30, 2021 ORDER Service connection for peripheral neuropathy left arm, to include as due to chemical exposure, is denied. Service connection for peripheral neuropathy right arm, to include as due to chemical exposure, is denied. Service connection for peripheral neuropathy left leg, to include as due to chemical exposure, is denied. Service connection for peripheral neuropathy right leg, to include as due to chemical exposure, is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that left arm peripheral neuropathy began during active service or within one year of service, or is otherwise related to an in-service injury, event, or disease, to include as due to chemical exposure. 2. The preponderance of the evidence is against finding that right arm peripheral neuropathy began during active service or within one year of service, or is otherwise related to an in-service injury, event, or disease, to include as due to chemical exposure. 3. The preponderance of the evidence is against finding that left leg peripheral neuropathy began during active service or within one year of service, or is otherwise related to an in-service injury, event, or disease, to include as due to chemical exposure. 4. The preponderance of the evidence is against finding that right leg peripheral neuropathy began during active service or within one year of service, or is otherwise related to an in-service injury, event, or disease, to include as due to chemical exposure. CONCLUSIONS OF LAW 1. The criteria for service connection for left arm extremity peripheral neuropathy are not met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 2. The criteria for service connection for right arm extremity peripheral neuropathy are not met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 3. The criteria for service connection for left leg extremity peripheral neuropathy are not met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 4. The criteria for service connection for right leg extremity peripheral neuropathy are not met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served honorably in the U.S. Army from March 1963 to February 1965. 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. In April 2021, the Board remanded the issues of service connection for bilateral upper peripheral neuropathy and bilateral lower peripheral neuropathy to obtain an addendum VA medical opinion and examination. In July 2021 the Veteran was afforded a VA addendum medical opinion and examination for the issues on appeal. Therefore, the Board finds there has been substantial compliance with the remand directives. See D'Aries v. Peake, 22 Vet. App. 97, 105 (2008); see also Stegall v. West, 11 Vet. App. 268 (1998). SERVICE CONNECTION 1. Service connection for peripheral neuropathy left arm, to include as due to chemical exposure. 2. Service connection for peripheral neuropathy right arm, to include as due to chemical exposure. 3. Service connection for peripheral neuropathy left leg, to include as due to chemical exposure. 4. Service connection for peripheral neuropathy right leg, to include as due to chemical exposure. To prevail on a direct service connection claim, there must be competent evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). A disability may be service connected on a secondary basis if it is proximately due to or the result of a service-connected disease or injury; or, if it is aggravated beyond its natural progress by a service-connected disease or injury. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.310(a), (b). Presumptive service connection is available for specific diseases associated with exposure to herbicide agents listed under 38 C.F.R. § 3.309(e) if the disease becomes manifest to a degree of 10 percent or more at any time after service. 38 C.F.R. § 3.307 (2018). The Board notes that the Veteran served honorably in the U.S. Army from March 1963 to February 1965. Service treatment records (STRs) indicate that the Veteran did not serve in the Republic of Vietnam. A Veteran who served in or near the Demilitarized Zone (DMZ) in the Republic of Korea from September 1, 1967 to August 31, 1971 is presumed to have been exposed to certain designated herbicide agents (e.g., Agent Orange) during such service, absent affirmative evidence to the contrary. 38 U.S.C. § 1116B(a)(2). In the case of such a veteran, service connection based on herbicide agent exposure will be presumed for certain specified diseases that become manifest to a compensable degree. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307(a)(6), 3.309(e). As the Veteran served from 1963 to 1965, he was not exposed to herbicide agents in the DMZ, as herbicide exposure is found to have occurred from 1967 to 1971, years after the Veteran separated from service. Therefore, presumptive service connection based on herbicide exposure is not warranted, as the Veteran did not serve in any theater that would qualify him for presumptive exposure to herbicides. 38 U.S.C. § 1116(a)(1); 38 C.F.R. § 3.307(a)(6). However, a claimant is not precluded from establishing service connection with proof of actual causation. Combee v. Brown,34 F.3d 1039, 1042 (Fed. Cir. 1994). The Veteran claims entitlement to service connection for bilateral upper and bilateral lower extremity peripheral neuropathy as a result of chemical exposure during the performance of his in-service duties. Specifically, the Veteran contends that in-service exposure to carbon tetrachloride, not herbicides, caused the current peripheral neuropathy. The Board notes that STRs are silent for any complaints, treatments, or diagnosis of peripheral neuropathy. In November 2000, private treatment records show that an EMG report indicated that the Veteran's lower extremities were normal. In November 2002, VA treatment records show a normal neurological examination. In April 2012, the Veteran submitted an article which suggested a causal relationship between exposure to carbon tetrachloride and peripheral neuropathies. In April 2012, the Veteran also submitted a statement that while he was in the Army he filled fire-extinguishers and cleaned rifles using carbon tetrachloride. The Veteran also indicated in the statement that he did not start to experience any pain until approximately 1999 when he first started to notice numbness in his big toes. In November 2012, the Veteran had a VA examination for his bilateral upper peripheral neuropathy. However, the VA examiner did not give a medical opinion because they could not resolve the issue without resorting to mere speculation. The VA examiner indicated that the claims file was incomplete because it did not contain private medical records. The VA examiner did state that the evidence of record shows there is no evidence of peripheral neuropathy in STRs. Additionally, the VA examiner stated that there were no records to support a claim that the Veteran had peripheral neuropathy within one year of service. In June 2015, VA treatment records indicate that the Veteran continues to have decreased sensation in his feet that has not improved. In April 2018, VA treatment records show a treatment note from Dr. K.M.T. commenting on the Veteran's peripheral neuropathy. The note stated, "there are multiple causes of neuropathy; medication induced, infectious causes, deficient nutritional status, medical illness, natural aging of the spine and also potential chemicals. At the time there has not been any identifiable correctable cause of neuropathy." In an August 2018 Board hearing, the Veteran testified that he stated having problems with his arms and legs beginning in 1999. The Veteran stated that the pain began in his toes and eventually went all the way up his legs. He also asserted that he does not have as much pain in his arms but mainly in the fingertips. Notably, the Veteran testified that he did not have any complaints in service about pain in his arms or legs. In October 2019, VA treatment records indicate that the Veteran endorsed a long history of neuropathy in his legs bilaterally, which he believed started due to his exposure to carbon tetrachloride while in the military. The Veteran also stated that he maintains function in his legs bilaterally, however he cannot stand for extended periods of time. In February 2020, the Veteran underwent a VA examination. The VA examiner opined that the Veteran's right and left arm peripheral neuropathy and right and left leg peripheral neuropathy were less likely than not related to service. The VA examiner stated that the Veteran did not have a diagnosis for upper or lower peripheral neuropathy. Their rationale provided a detailed review of STRs, post service medical records and statements from the Veteran, including from the August 2018 Board hearing. The VA examiner also commented on the April 2012 internet article the Veteran submitted and stated that, after a review of STRs, there is no objective evidence of exposure to chemicals or treatment for exposure to the chemicals. Additionally, the VA examiner discussed that there were no post service medical records of complaints for peripheral neuropathy until 35 years after service. In September 2020, private treatment records indicate that an EMG report was performed and a finding of moderately severe neuropathy (axonal) was determined. In a January 2021 VA addendum medical opinion, the VA examiner indicated that a September 2020 EMG report showed left upper extremity and left lower extremity peripheral neuropathy only. The VA examiner opined that the Veteran's peripheral neuropathy of the left lower extremity and left upper extremity were less likely than not related to service, to include due to carbon tetrachloride. The rationale provided was that "[t]here are no STRs found to show complaints consistent with or treatment or diagnosis of neuropathy. Separation history and physical is silent for neuropathy. Review of the mainstream medical literature does not cite neuropathy as a result of carbon tetrachloride use." In July 2021, a VA addendum medical opinion was provided and the VA examiner concluded that both the Veteran's peripheral neuropathy of the bilateral upper extremity and bilateral lower extremity were less likely than related to active service. A diagnosis of right and left arm peripheral neuropathy and right and left leg peripheral neuropathy were provided at this examination. The VA examiner provided the findings from the September 2020 electromyography report and stated that the Veteran suffers from peripheral neuropathy of the bilateral upper extremity and bilateral lower extremity. The VA examiner indicated that the onset of these symptoms were 35 years after leaving service. Further, the VA examiner noted that there are no identifiable records related to the peripheral neuropathy of the bilateral upper extremities and the bilateral lower extremities. Additionally, the VA examiner reviewed and commented on both the April 2012 internet article and the April 2018 letter from Dr. K.M.T. Regarding the April 2012 internet article, the VA examiner deferred to the neurologist's opinion and noted the 35 year time gap between exposure and onset of symptoms. Concerning the April 2018 letter from Dr. K.M.T., the VA examiner stated that Dr. K.M.T. did not provide a definitive opinion. The Board must assess the credibility and weight of all evidence, including the medical evidence, to determine its probative value, accounting for evidence that it finds to be persuasive or unpersuasive. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Equal weight is not accorded to each piece of evidence contained in the record; not every item of evidence has the same probative value. First, the Board affords the April 2018 VA opinion letter from Dr. K.M.T. low probative value. The Board notes that no rationale for the opinion was provided. Additionally, Dr. KM.T. did not indicate whether they reviewed the Veteran's claim file, to include STRs, post-service medical records or the Veteran's lay statements, when forming their opinion. See Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993) (noting that the credibility and weight to be attached to medical opinions are within the province of the Board). Furthermore, the opinion of Dr. K.M.T. was speculative and listed exposure to chemicals as one of several possible causes of neuropathy. See Swann v. Brown, 5 Vet. App. 229, 232 (1993) (noting that the weight of a medical opinion is diminished where that opinion is ambivalent, based on an inaccurate factual premise, based on an examination of limited scope, or where the basis for the opinion is not stated); see Tirpak v. Derwinski, 2 Vet. App. 609, 611 (1992) (a letter from a physician indicating that Veteran's death "may or may not" have been averted if medical personnel could have effectively intubated the Veteran held to be speculative). Next, the Board finds both the February 2020 and July 2021 VA medical opinions to be competent and credible, and as such, are entitled to significant probative weight. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994). The opinion was rendered after reviewing the Veteran's claims file, which included STRs, post-service treatment records, and consideration of the Veteran's lay statements. See Prejean v. West, 13 Vet. App. 444 (2000) (factors for assessing the probative value of a medical opinion include the examiner's access to the claims folder and the Veteran's history, and the thoroughness and detail of the opinion). Specifically, the February 2020 VA examiner provided an opinion after a review of STRs, post service medical records and statements from the Veteran, including from the August 2018 Board hearing. Notably, the February 2020 VA examiner also commented on the April 2012 internet article and opined that there is no objective evidence of exposure to chemicals or treatment for exposure to the chemicals in service. The July 2021 VA examiner based their opinion on reviewed of STRs, post-service treatment records and provided a detailed rationale for their opinion. Notably, the July 2021 VA examiner correctly addressed the April 2021 Board remand directives, including reviewing and commenting on both the April 2012 internet article and the April 2018 letter from Dr. K.M.T. Further, both the February 2020 and July 2021 VA examiners noted that the Veteran did not have any complaints or treatment for his disability in service and also no treatment or complaints until over 30 years after service. As such, the Board finds the February 2020 and July 2021 VA examiner's opinions to be adequate and are given great probative value. Significantly, there is no conflicting medical evidence that states the Veteran's bilateral upper and lower peripheral neuropathy is related to service. The Veteran has made a general assertion that his bilateral upper and lower peripheral neuropathy is related active service, to include chemical exposure. The Board, however, cannot rely on the Veteran's general assertions as to a medical nexus to service because although he is competent to pain in his arms and legs, he is not shown to possess the type of medical expertise that would be necessary to opine regarding the etiology of peripheral neuropathy. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). The Board has considered the Veteran's lay contentions, specifically those provided during the August 2018 Board hearing, and those provided throughout the period on appeal, that his bilateral upper and lower peripheral neuropathy is related to chemical exposure during active service. However, there is no evidence that the Veteran has the medical education and training required to make competent clinical diagnosis to specific events or injuries. The Veteran's statements are outweighed by more contemporaneous medical evidence of record, which includes the probative February 2020 and July 2021 VA medical opinions. Moreover, there is no adequate medical opinion to contradict the conclusions from the February 2020 and July 2021 VA examiners. As such, the Board finds the Veteran's statements probative with regard to establishing his current symptoms, but finds little probative value with regard to establishing service connection. There can be no doubt that the Veteran rendered honorable and faithful service for which the Board is grateful, and that he is sincere in his belief that he has a diagnosis of peripheral neuropathy that is related to his active military service and specifically his exposure to chemicals. However, the Board has carefully reviewed the record in depth and has been unable to identify a basis upon which service connection may be granted. Therefore, a preponderance of the evidence of record is against the Veteran's claim for service connection for bilateral upper peripheral neuropathy and bilateral lower peripheral neuropathy. The benefit-of-doubt rule does not apply when the Board finds that a preponderance of the evidence is against the claim. Ortiz v. Principi, 274 F.3d 1361, 1365 (Fed. Cir. 2001). H. SEESEL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Dourmashkin 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.