Citation Nr: 21072821 Decision Date: 12/06/21 Archive Date: 12/06/21 DOCKET NO. 16-56 695 DATE: December 6, 2021 ORDER Entitlement to service connection for left lower extremity peripheral neuropathy is granted. Entitlement to service connection for right lower extremity peripheral neuropathy is granted. FINDINGS OF FACT 1. Resolving all reasonable doubt in favor of the Veteran, his currently diagnosed left lower extremity peripheral neuropathy is secondary to service-connected diabetes mellitus, type II. 2. Resolving all reasonable doubt in favor of the Veteran, his currently diagnosed right lower extremity peripheral neuropathy is secondary to service-connected diabetes mellitus, type II. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for left lower extremity peripheral neuropathy have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.304, 3.310. 2. The criteria for entitlement to service connection for right lower extremity peripheral neuropathy have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.304, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from September 1967 to September 1970, including service in the Republic of Vietnam from December 1968 to December 1969. These matters come before the Board of Veterans' Appeals (Board) on appeal from a September 2015 rating decision issued by Department of Veterans Affairs (VA) Regional Office (RO). In August 2021, the Veteran testified via tele-hearing before the undersigned Veterans Law Judge (VLJ); a transcript is of record. Service Connection Service connection on a direct basis requires evidence of three elements: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship or nexus between the current disability and the disease or injury incurred or aggravated during active service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection may also be established on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disability. 38 C.F.R. § 3.310(a). Service connection on a secondary basis may also be established for a disorder which is aggravated by a service-connected disability; compensation may be provided for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310(b); Allen v. Brown, 8 Vet. App. 374 (1995). In order to prevail on the issue of secondary service connection, the record must show: (1) a current disability; (2) a service-connected disability; and (3) a nexus between the current disability and the service-connected disability. See Wallin v. West, 11 Vet. App. 509 (1998); Allen v. Brown, supra. 1. Peripheral neuropathy, left lower extremity 2. Peripheral neuropathy, right lower extremity The Veteran contends that his current peripheral neuropathy of the bilateral lower extremities is secondary to his service-connected diabetes mellitus, type II. See e.g., NOD received October 12, 2015. The Veteran is currently service connected for diabetes mellitus. As set forth below, the record also contains current diagnoses of peripheral neuropathy of the lower extremities. As to the final element of nexus, the record contains conflicting medical evidence as to the etiology of the Veteran's diagnosed bilateral lower extremity peripheral neuropathy. It is the Board's responsibility to weigh the conflicting medical evidence to reach a conclusion as to the ultimate grant of service connection. Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). The Board may favor the opinion of one competent medical expert over another if its statement of reasons and bases is adequate to support that decision. Owens v. Brown, 7 Vet. App. 429, 433 (1995). Stated another way, the Board decides, in the first instance, which of the competing medical opinions or examination reports is more probative of the medical question at issue. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 300 (2008). In July 2015, the Veteran underwent a VA examination. The Veteran reported that he had symptoms of numbness and tingling in his lower extremities that began seven to eight years prior. He denied injury to his feet or back. He also denied a B12 deficiency or alcohol use. He started Gabapentin the previous month. The examiner reported the Veteran had never been diagnosed with diabetic peripheral neuropathy and did not have any symptoms attributable to diabetic peripheral neuropathy. The examiner noted the Veteran underwent an EMG of the bilateral lower extremities in May 2015 which was normal. The examiner opined that the Veteran's bilateral lower extremity peripheral neuropathy was less likely than not proximately due to or the result of his service-connected diabetes mellitus, type II. She did not, however, comment on the etiology of the Veteran's disabilities. In support of his claim, the Veteran submitted a letter dated July 2015 from his private neurologist, Dr. J.R.C., who noted that the Veteran had undergone a nerve conduction study (NCS) and Somatosensory Evoked Potential (SSEP) of both lower extremities which was interpreted as showing findings consistent with a lumbosacral polyradiculopathy secondary to lumbar spinal stenosis and/or spondylosis. Dr. J.R.C., however, explained that the Veteran had undergone a lumbosacral MRI which was essentially normal, with no report of any lumbar spinal stenosis or spondylosis. In view of these findings, along with the borderline abnormalities noted on NCS and the Veteran's symptomatology, Dr. J.R.C. indicated it appeared most likely that the Veteran has a small fiber peripheral polyneuropathy. (Continued on the next page) Also of record are VA treatment records which support a finding that the Veteran's bilateral lower extremity neuropathy is secondary to service-connected diabetes mellitus, type II. In May 2015, the Veteran's VA primary care physician telephoned the Veteran to inform him that the results of the 2015 EMG were normal but that he "remains clinically with DN [diabetic neuropathy]." Subsequent VA treatment records also include multiple entries of diabetic neuropathy and indicate that the Veteran has been treated with Gabapentin and Nortriptyline. After evaluating the evidence of record, the Board finds it to be in equipoise on the question of nexus. In other words, the evidence indicates that it is at least as likely as not that the Veteran's diagnosed bilateral lower extremity peripheral neuropathy is secondary to his service-connected diabetes mellitus. Therefore, the Veteran's service connection claims for left and right lower extremity peripheral neuropathy is granted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). K. Conner Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A.N., 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.