Citation Nr: A21018993 Decision Date: 11/30/21 Archive Date: 11/30/21 DOCKET NO. 210721-173497 DATE: November 30, 2021 ORDER Entitlement to service connection for peripheral neuropathy of the upper left extremity, to include as due to exposure to contaminated water at Camp Lejeune or as secondary to irritable bowel syndrome (IBS), is denied. Entitlement to service connection for peripheral neuropathy of the upper right extremity, to include as due to exposure to contaminated water at Camp Lejeune or as secondary to IBS, is denied. Entitlement to service connection for peripheral neuropathy of the lower left extremity, to include as due to exposure to contaminated water at Camp Lejeune or as secondary to IBS, is denied. Entitlement to service connection for peripheral neuropathy of the lower right extremity, to include as due to exposure to contaminated water at Camp Lejeune or as secondary to IBS, is denied. FINDINGS OF FACT 1. The Veteran served at Camp Lejeune for at least thirty days between August 1, 1953 and December 31, 1987 and, thus he is presumed to have been exposed to contaminated water. 2. Bilateral upper and lower extremity peripheral neuropathy is not shown to be causally or etiologically related to any disease, injury, or incident during service, to include exposure to contaminated water at Camp Lejeune, did not manifest within one year of service discharge, and is not caused or aggravated by a service-connected disability. CONCLUSIONS OF LAW 1. The criteria for service connection for peripheral neuropathy of the left upper extremity, to include as due to exposure to contaminated water at Camp Lejeune or as secondary to IBS, have not been met. 38 U.S.C. §§ 1110, 1112, 1117, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. 2. The criteria for service connection for peripheral neuropathy of the right upper extremity, to include as due to exposure to contaminated water at Camp Lejeune or as secondary to IBS, have not been met. 38 U.S.C. §§ 1110, 1112, 1117, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. 3. The criteria for service connection for peripheral neuropathy of the left lower extremity, to include as due to exposure to contaminated water at Camp Lejeune or as secondary to IBS, have not been met. 38 U.S.C. §§ 1110, 1112, 1117, 1131, 1137, 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 the right lower extremity, to include as due to exposure to contaminated water at Camp Lejeune or as secondary to IBS, have not been met. 38 U.S.C. §§ 1110, 1112, 1117, 1131, 1137, 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 Marine Corps from October 1961 to February 1966. The Board notes that the rating decision on appeal was issued in December 2019. In February 2020, the Veteran filed a notice of disagreement and requested Evidence Submission Reviewed by a Veterans Law Judge under the Appeals Modernization Act (AMA). In June 2020, the Board remanded the claims on appeal for further development and adjudication. The Board finds that there was substantial compliance with its June 2020 remand directives. A remand by the Board confers upon the claimant, as a matter of law, the right to compliance with the remand order. Stegall v. West, 11 Vet. App. 268 (1998). Nonetheless, it is only substantial compliance, rather than strict compliance, with the terms of a remand that is required. See D'Aries v. Peake, 22 Vet. App. 97, 104 (2008) (finding substantial compliance where an opinion was provided by a neurologist as opposed to an internal medicine specialist requested by the Board); Dyment v. West, 13 Vet. App. 141 (1999). Entitlement to service connection for peripheral neuropathy of the upper left and right extremities and the lower left and right extremities is denied. The Veteran contends that he suffers from bilateral upper and lower extremity neuropathy as a result of his active-duty service. Specifically, he alleges that he was exposed to contaminated water while stationed at Camp Lejeune and that such exposure resulted in his current neuropathy. In the alternative, the Veteran contends that his IBS has caused or aggravated his current neuropathy. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996) [(table)]. Where a Veteran served for at least 90 days during a period of war or after December 31, 1946, and manifests certain chronic diseases to a degree of 10 percent within one year, from the date of termination of such service, such disease shall be presumed to have been incurred or aggravated in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1137; 38 C.F.R. §§ 3.307, 3.309. Alternatively, when a disease at 38 C.F.R. § 3.309 (a) is not shown to be chronic during service or the one-year presumptive period, service connection may also be established by showing continuity of symptomatology after service. See 38 C.F.R. § 3.303 (b). However, the use of continuity of symptoms to establish service connection is limited only to those diseases listed at 38 C.F.R. § 3.309 (a) and does not apply to other disabilities which might be considered chronic from a medical standpoint. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Service connection may also be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310 (a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Furthermore, service connection may not be awarded on the basis of aggravation without establishing a pre-aggravation baseline level of disability and comparing it to the current level of disability. 38 C.F.R. § 3.310 (b). Furthermore, VA acknowledges that persons residing or working at the U.S. Marine Corps Base Camp Lejeune from August 1, 1953, through December 31, 1987, were potentially exposed to drinking contaminated water with volatile organic compounds. See Veterans Benefits Administration Fast Letter 11-03 (January 11, 2011). In this regard, VA has established a presumption of service connection for certain diseases for veterans, former reservists, and former National Guard members who were exposed to contaminants in the water supply while serving at Camp Lejeune for no less than 30 days (either consecutive or nonconsecutive) from August 1, 1953, to December 31, 1987. See 38 U.S.C. §§ 1101, 1112, 1137; 38 C.F.R. §§ 3.307, 3.309. Specifically, there is a presumption of service connection for kidney cancer, liver cancer, Non-Hodgkin's lymphoma, adult leukemia, multiple myeloma, Parkinson's disease, aplastic anemia and other myelodysplastic syndromes, and bladder cancer, which have become manifest to a degree of 10 percent or more at any time after service if the veteran was stationed at Camp Lejeune between August 1, 1953, and December 31, 1987. Notwithstanding the foregoing presumption, a veteran is not precluded from establishing service connection with proof of direct causation. 38 U.S.C. § 1113 (b); Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). As an initial matter, the Board observes that the Veteran was diagnosed with bilateral upper and lower extremity neuropathy in approximately 1990. See May 2021 VA Peripheral Nerves Examinations. However, the evidence does not show, and the Veteran has not contended, that such had its onset during service, manifested within one year of service, or is otherwise directly related to service. In fact, the Veteran's service treatment records are silent for any complaints, treatment, or diagnosis of bilateral upper or lower extremity neuropathy or related symptoms, and such was not diagnosed for many years after service. See Robinson v. Shinseki, 557 F.3d 1355, 1361 (2008). Therefore, presumptive service connection and service connection based on continuity of symptomatology is not warranted. Rather, the Veteran alleges that his bilateral upper extremity and lower extremity neuropathy is presumptively related to his alleged in-service exposure to contaminated water at Camp Lejeune or is secondary to his IBS. In regard to presumptive service connection based on contaminated water exposure, as previously noted the Veteran contends that he was exposed to such while stationed at Camp Lejeune. The Board notes that the Veteran served for at least 30 days between August 1, 1953 and December 31, 1987 at Camp Lejeune. Therefore, he is presumed to have been exposed to contaminated water. The Board notes however, that while the Veteran is presumed to have been exposed to contaminated water at Camp Lejeune during his service, peripheral neuropathy is not one of the presumed conditions that VA has acknowledged as related to contaminants in the water supply at Camp Lejeune. Therefore, presumptive service connection based on contaminated water exposure is not warranted. While presumptive service connection is not warranted, the Veteran is not barred from direct service connection. See Combee, 34 F.3d at 1042. However, the March and May 2021 VA examiners found that the Veteran's bilateral upper and lower extremity peripheral neuropathy was not caused by or related to any event or injury in service, to include any contaminated water exposure at Camp Lejeune. The March 2021 VA examiner specifically found that the Veteran was stationed at Camp Lejeune for two months between January and March 1962 and did not experience any acute symptoms of peripheral neuropathy while he was in the service nor did he experience any symptoms immediately post service or for the next 48 years. The examiner further noted that the medical literature and research does not support latent onset of peripheral neuropathy with solvent exposure. In addition, the examiner noted that while some studies have shown that high levels of solvent exposure over a lifetime may cause neuropathy, low doses for short periods have not been shown to produce peripheral neuropathy symptoms. Finally, the examiner noted that the Veteran had many personal risk factors that likely contributed to his peripheral neuropathy (vitamin B12 deficiency, pre-diabetes, history of alcohol use, and post-service herbicide exposure). The May 2021 VA examiner also found that as the Veteran had no documented complaints or symptoms of peripheral neuropathy in service or for many years thereafter, that it was less likely than not that his peripheral neuropathy was due to service, to include exposure to contaminated water therein. As the examiners supported their conclusions with adequate reasoning and rationale, the Board finds them probative. 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"). Finally, the Board notes that there are no contrary opinions of record. Therefore, as an essential element of direct service connection, a nexus, is missing, direct service connection is not warranted. As for secondary service connection, the Board notes that the Veteran is not currently service connected for IBS. As such, the Board finds that under the law, the Veteran lacks legal grounds to establish entitlement to service connection for bilateral upper and lower extremity peripheral neuropathy on a secondary basis. See Sabonis v. Brown, 6 Vet. App. 426 (1994). In Sabonis, the Court held that in cases in which the law and not the evidence is dispositive, a claim for entitlement to VA benefits should be denied or the appeal to the Board terminated because of the absence of legal merit or the lack of entitlement under the law. Insofar as service connection is not in effect for the disability claimed by the Veteran to have proximally caused his bilateral upper and lower extremity peripheral neuropathy, service connection on a secondary basis is not applicable under the law. Furthermore, the Board notes that there is no medical evidence of record to support the contention that the Veteran's current neuropathy is due to IBS. Rather the Veteran's treatment records as well as VA medical opinions indicate that the Veteran's neuropathy is likely due to a vitamin deficiency or idiopathic. However, as previously noted the Veteran is not service connected for IBS and therefore, secondary service connection based on such is barred by law. Therefore, secondary service connection is not warranted. The Board has considered the Veteran's statements that his peripheral neuropathy is related to his contaminated water exposure and/or IBS. In this regard, a layperson is competent to report on that of which he or she has personal knowledge. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). A lay person may speak to etiology in some limited circumstances in which nexus is obvious merely through observation, such as a fall leading to a broken leg. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). However, the question of causation or aggravation of peripheral neuropathy involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship. In this regard, such an opinion requires specialized knowledge of several internal bodily systems. There is no indication that the Veteran possesses such specialized knowledge. As such, the question of etiology in this case may not be competently addressed by lay evidence, and the Veteran's opinion regarding the etiology of his peripheral neuropathy is non-probative evidence. See Jandreau, supra; Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Moreover, the Veteran has offered only conclusory statements regarding the relationship between his peripheral neuropathy and contaminant exposure and/or IBS. In contrast, the VA examiners took into consideration all the relevant facts in providing their opinions. Therefore, the Board accords greater probative weight to the VA examiners' opinions and medical evidence of record. The Board finds that the Veteran's bilateral upper and lower extremity peripheral neuropathy is not shown to be causally or etiologically related to any disease, injury, or incident during service, to include any contaminated water exposure at Camp Lejeune, did not manifest within one year of service discharge, and is not caused or aggravated by any of the Veteran's service-connected disabilities. Therefore, service connection for such disorders is not warranted. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran's claims of entitlement to service connection for bilateral upper and lower extremity peripheral neuropathy. As such, that doctrine is not applicable in the instant appeal, and his claims must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra. L. M. BARNARD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Unger, 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.