Citation Nr: 21074996 Decision Date: 12/17/21 Archive Date: 12/17/21 DOCKET NO. 17-52 057 DATE: December 17, 2021 ORDER Entitlement to service connection for bilateral lower extremity disability, to include neuropathy, is denied. FINDING OF FACT The preponderance of the evidence is against finding that any left or right lower extremity disability, including neuropathy, began during the Veteran's active military service, within a year of her discharge, or is otherwise related or attributable to her service. CONCLUSION OF LAW The criteria are not met for entitlement to service connection for a bilateral lower extremity disability, including neuropathy. 38 U.S.C. §§ 1101, 1112, 1113, 1116, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from October 1977 to February 1978. This appeal to the Board of Veterans' Appeals (Board) is from a November 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In April 2019, the Board remanded this claim back to the RO, so back to the Agency of Original Jurisdiction (AOJ), for further development and consideration including to obtain any outstanding treatment records relevant to this claim and then to have the Veteran examined to determine any neurological disability affecting her lower extremities and its etiology, particularly in terms of whether related or attributable to her military service. Those remand instructions since have been completed, as directed. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding that a remand by the Board confers upon the Veteran, as a matter of law, the right to compliance with the remand instructions); but see also D'Aries v. Peake, 22 Vet. App. 97, 105 (2008) (holding that only "substantial" rather than strict or exact compliance with the Board's remand directives is required under Stegall); accord Dyment v. West, 13 Vet. 141, 146-47 (1999). Other claims that also were remanded for service connection for headaches and a gastrointestinal disability, specifically, Irritable Bowel Syndrome (IBS), were granted in a July 2020 rating decision since issued, on remand. Thus, those other claims are no longer on appeal. The Veteran must separately appeal the ratings and effective date assigned for these now service-connected disabilities. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997) (indicating she must separately appeal these "downstream" issues). Entitlement to service connection for a bilateral lower extremity disability, including neuropathy The Veteran contends that she has a current bilateral lower extremity disability that is the result of her exposure to hazardous chemicals during her service at Fort McClellan. However, the Board concludes that, while the Veteran has a current diagnosis of right thigh meralgia paresthetica, the preponderance of the evidence weighs against finding that any neurological disability involving her lower extremities, including this one especially, began during her service, within a year of her discharge, or is otherwise related or attributable to her service. At the outset, the Board acknowledges the Veteran's contention that she was exposed to hazardous chemicals while stationed at Fort McClellan in Alabama. But presumptive service connection for a lower extremity disability, including neuropathy, is not available in this instance. Concerning exposure to herbicides (the dioxin in Agent Orange), the evidence of record does not suggest that she was stationed in Vietnam or any other area where it would be presumed that she was exposed to any herbicide agents. She has only alleged that she was exposed to "hazardous chemicals" in a more general sense Further, she did not serve during the Vietnam Era, which ended on May 7, 1975, as her dates of service were from October 1977 to February 1978. See 38 U.S.C. § 1116; 38 C.F.R. § 3.307. Finally, there is no indication that sh has ever had a diagnosis of "early-onset" peripheral neuropathy, specifically within one year of her February 1978 separation from service. Hence, service connection for a bilateral lower extremity disability, including neuropathy, on a presumptive basis is not warranted. See 38 U.S.C. § 1116(f); 38 C.F.R. § 3.307(a)(6)(ii), 3.309(e). Service connection may be granted on a direct basis for disability resulting from disease or injury directly incurred in or aggravated by active military service in the line of duty. 38 U.S.C. §§ 1131; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or an injury; and (3) a causal relationship ("nexus") between the current disability and the disease or injury in service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). But, concerning this other theory of entitlement based on direct service connection, the Board similarly finds that the preponderance of the evidence is against the claim, so this additional theory also is unavailing. A November 2008 private treatment record shows that, upon examination, the Veteran's lower extremities were normal, and there was no sign of joint or limb tenderness to palpation and no edema present. She also had "sensation intact to light touch in extremities" and a normal gait. With submission of her claim in June 2015, the Veteran also submitted a written statement asserting that she has had "several issues for over 30 years...", so dating back to around 1985, seven years after her separation from service. A September 2015 private treatment record shows the Veteran denied any neurologic symptoms, including limb pain, gait abnormality, and paresthesia. On her November 2015 VA Form 21-0958, Notice of Disagreement (NOD), the Veteran stated that her feet and legs had started bothering her during her service and that, when she reported to medical, she was told her boots were causing foot problems. She also indicated that she since has had foot surgery. A June 2019 private treatment record shows the Veteran's medical history included neuropathy, and that she was diagnosed with neuralgia and meralgia paresthetica, right side. Notably, this record was associated with the claims file after the Veteran's November 2019 VA examination, so that examiner did not have opportunity to consider this evidence. During that November 2019 VA peripheral nerves examination, the examiner found no diagnosis referable to the Veteran's lower left extremity but confirmed she had a diagnosis of right lower extremity sciatica. However, regarding its origins, this examiner determined the Veteran's right lower extremity sciatica was not at least as likely as not related to her service including to exposure to hazardous chemicals, rather, was more likely caused by her nonservice-connected lumbar radiculopathy. Nevertheless, because, as mentioned, the June 2019 private treatment record was associated with the file after that November 2019 examination and opinion, the Veteran underwent an additional examination in October 2020. During this additional October 2020 VA peripheral nerves examination, the Veteran stated that she had an onset of symptoms just five to six years earlier, so in around 2014 at the earliest. Notably, that was 36 years after her separation from service. Moreover, the October 2020 examiner provided diagnosed meralgia paresthetica with neuralgia of the right thigh that had onset even more recently, in 2018. The Veteran had no other peripheral nerve disorders, and she reported symptoms only in her right lower extremity. The examiner opined that it is less likely than not the Veteran's right lower extremity peripheral nerve disability was incurred during or caused by her service, including by any exposure to hazardous chemicals. In explanation, that October 2020 VA examiner noted that there was no objective evidence of any meralgia paresthetica in the Veteran's service treatment records (STRs), and there is no current left lower extremity disability. Concerning the other diagnoses rendered during the pendency of this appeal, this most recent examiner surmised that the 2019 VA examiner's diagnosis of right lower extremity sciatica was in error since private and VA treatment records show the Veteran had no symptoms of sciatica and examinations were normal. Further, during the examination, which was pointed out to have lasted for one hour, the Veteran did not mention any concerns that her disability was potentially due to hazardous chemical exposure during her service. This examiner further explained that medical literature explains that meralgia paresthetica is associated with compression of the lateral femoral cutaneous nerve. While meralgia paresthetica mostly arises spontaneously, accepted risk factors include obesity, diabetes mellitus, and older age, with the median age at presentation being 50 years old. Additional risk factors include body habitus, pregnancy, tight clothing, groin trauma, and long-distance physical movement, among others. This examiner concluded the most likely etiology of the Veteran's meralgia paresthetica is her body habitus, not any incurrence in or related to her military service. This VA examiner's opinion is probative because it is based on an accurate medical history and provides an explanation containing clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). In May 2021, apparently in response, the Veteran submitted a letter from a private doctor at Texas Institute for Neurological Disorders. In this letter, the commenting doctor explained that the Veteran has a history of peripheral neuropathy and has a neuritis/neuralgia of her right lower extremity. Regarding etiology, this doctor indicated "[t]hese are of an idiopathic nature and is more likely than not that these are related to her previous chemical exposure as a contractor during her employment." However, the Board gives this letter less probative weight since there is no indication this doctor is relating any current peripheral nerve disability to the Veteran's active military service, specifically. Moreover, the letter does not specify which hazardous chemicals cause peripheral nerve disability or impairment and, in any event, does not provide any rationale for the opinion in terms of attributing any of the Veteran's current impairment to her military service. Aside from that, "idiopathic" is a term doctors use to acknowledge there is no known explanation for the cause of the disorder. Since the October 2020 VA examiner did not find any nexus between the Veteran's current right lower extremity disability and her service, and instead found that it is more likely due to her body habitus, the preponderance of the evidence is against this claim. Because the Veteran is a layman, she does not have the competence to give a probative opinion concerning the diagnosis and etiology of any peripheral nerve disorder. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Thus, the VA medical examiner's opinion against this claim is more probative and, in fact, determinative of the ultimate disposition. See King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2012) (indicating lay evidence must demonstrate some competence and affirming the Court's conclusion that the Board did not improperly discount the weight of a lay opinion in finding a medical expert's opinion more probative on the issue of medical causation). Accordingly, the preponderance of the probative evidence is against this claim of entitlement to service connection for a bilateral lower extremity disability, including neuropathy. In reaching this conclusion, the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the claim, this doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). KEITH W. ALLEN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Pak 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.