Citation Nr: 21073908 Decision Date: 12/13/21 Archive Date: 12/13/21 DOCKET NO. 19-22 498 DATE: December 13, 2021 ORDER Entitlement to service connection for left upper extremity peripheral neuropathy, to include as due to in-service herbicide exposure, is granted. Entitlement to service connection for right upper extremity peripheral neuropathy, to include as due to in-service herbicide exposure, is granted. FINDINGS OF FACT 1. Probative evidence of record showed left upper extremity peripheral neuropathy was causally related to presumed in-service herbicide exposure. 2. Probative evidence of record showed right upper extremity peripheral neuropathy was causally related to presumed in-service herbicide exposure. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for left upper extremity peripheral neuropathy, to include as due to in-service herbicide exposure, have been met. 38 U.S.C. §§ 1110, 1131, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2021). 2. The criteria for entitlement to service connection for right upper extremity peripheral neuropathy, to include as due to in-service herbicide exposure, have been met. 38 U.S.C. §§ 1110, 1131, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2021). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from May 1968 to May 1971. These matters come before the Board of Veterans' Appeals (Board) on appeal from rating decisions rendered in August 2018 and September 2018. In October 2021, the Veteran testified at a Board videoconference hearing before the undersigned Veterans Law Judge (VLJ). A transcript of that hearing is of record. 1. Entitlement to service connection for left upper extremity peripheral neuropathy, to include as due to in-service herbicide exposure 2. Entitlement to service connection for right upper extremity peripheral neuropathy, to include as due to in-service herbicide exposure In written statements of record and during his October 2021 Board hearing, the Veteran asserted that his current left and right upper extremity peripheral neuropathy was related to herbicide exposure during active service. He further indicated that he had suffered from pain, tingling, and numbness in his upper extremities since 1970. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110 (2012); 38 C.F.R. § 3.303 (2021). Service connection may be established for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes the disease was incurred in service. 38 C.F.R. § 3.303(d) (2021). The Veteran's service personnel records established that he had served in Vietnam from November 1968 to November 1969. A veteran who served in Vietnam is presumed to have been exposed to herbicides during that service. 38 C.F.R. § 3.307(a)(6)(iii) (2021). If a veteran was exposed to an herbicide agent during active service, certain diseases, including early-onset peripheral neuropathy, are deemed service-connected. Early onset peripheral neuropathy is listed as a presumptive disorder but is subject to a requirement that it had been manifest to a compensable degree within a year of the last exposure to herbicides. This does not, however, preclude a claimant from establishing service connection for the claimed disorder on direct basis, to include as due to exposure to herbicides. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). Post-service VA and private treatment records dated from 2008 revealed findings of neuropathy, peripheral neuropathy, advanced peripheral autonomic sympathetic neuropathy, bilateral median mononeuropathies, idiopathic progressive neuropathy, polyneuropathy, and mononeuropathy. In a September 2017 private physician statement, A. G. M., D. O., identified himself as the Veteran's treating neurologist. The physician indicated that the Veteran had been diagnosed with peripheral neuropathy for several years. Based on his examination and medical history, the physician did not have an etiology for the cause of the neuropathy. For that reason, he opined that the Veteran's neuropathy was as likely as not (50 percent or greater probability) due to in-service herbicide exposure. In an August 2018 VA examination report/medical opinion, the examiner indicated that the Veteran had a diagnosis of bilateral upper extremity peripheral autonomic sympathetic neuropathy with no certain etiology. It was noted that the Veteran had no issues related to the claimed disorders prior to military service, that onset of the condition was during service as documented in service records, and that there was evidence of current, chronic, and continuous treatment. The examiner then highlighted that the Veteran had a history of in-service herbicide exposure and concluded it was more than 50 percent likely than not that the current upper extremity neuropathy was related to his Agent Orange exposure. In view of the totality of the evidence, including the Veteran's presumed in-service herbicide exposure while in Vietnam during active duty; the findings of right and left upper extremity peripheral neuropathy during the appeal period; the probative medical opinion in the September 2017 private physician statement; the findings in the August 2018 VA examination report/medical opinion; and the competent and credible lay assertions of record, the Board finds that the Veteran's right and left upper extremity peripheral neuropathy cannot be reasonably disassociated from events during his military service, specifically presumed herbicide exposure. The Board finds that the evidence is at least in equipoise and, therefore, applying the benefit-of-the-doubt doctrine, service connection for right and left upper extremity peripheral neuropathy is warranted. 38 U.S.C. § 5107(b) (2012); 38 C.F.R. § 3.102 (2021); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). MICHAEL MARTIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. D. Deane, 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.