Citation Nr: A21020295 Decision Date: 12/21/21 Archive Date: 12/21/21 DOCKET NO. 200317-76831 DATE: December 21, 2021 ORDER Entitlement to service connection for peripheral neuropathy, right lower extremity, is granted. Entitlement to service connection for peripheral neuropathy, right upper extremity, is granted. Entitlement to service connection for peripheral neuropathy, left lower extremity, is granted. Entitlement to service connection for peripheral neuropathy, left upper extremity, is granted. FINDINGS OF FACT 1. Resolving reasonable doubt in the Veteran's favor, his peripheral neuropathy, right lower extremity, was incurred due to in-service herbicide agent exposure. 2. Resolving reasonable doubt in the Veteran's favor, his peripheral neuropathy, right upper extremity, was incurred due to in-service herbicide agent exposure. 3. Resolving reasonable doubt in the Veteran's favor, his peripheral neuropathy, left lower extremity, was incurred due to in-service herbicide agent exposure. 4. Resolving reasonable doubt in the Veteran's favor, his peripheral neuropathy, left upper extremity, was incurred due to in-service herbicide agent exposure. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for peripheral neuropathy, right lower extremity, have been met. 38 U.S.C. §§ 1110, 1116, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for entitlement to service connection for peripheral neuropathy, right upper extremity, have been met. 38 U.S.C. §§ 1110, 1116, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 3. The criteria for entitlement to service connection for peripheral neuropathy, left lower extremity, have been met. 38 U.S.C. §§ 1110, 1116, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 4. The criteria for entitlement to service connection for peripheral neuropathy, left upper extremity, have been met. 38 U.S.C. §§ 1110, 1116, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1966 to April 1969. A rating decision was issued under the legacy system in November 2012. In August 2018, the Veteran opted into the modernized review system, also known as the Appeals Modernization Act (AMA), by submitting a Rapid Appeals Modernization Program (RAMP) election form and selecting the higher-level review (HLR) lane. The agency of original jurisdiction (AOJ) issued a RAMP HLR decision in March 2019. Subsequently, the Veteran filed multiple supplemental claims and the AOJ issued rating decisions in August 2019, November 2019, February 2020 and March 2020, which is the decision on appeal. In the March 2020 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Hearing docket. In August 2021, the Veteran withdrew the hearing request. Therefore, the Board may only consider the evidence of record at the time of the AOJ decision on appeal, as well as any evidence submitted by the Veteran or his representative within 90 days following receipt of the withdrawal. 38 C.F.R. § 20.302(b). The record shows that neither the Veteran nor his representative submitted evidence during this period. The March 2020 rating decision on appeal notes that new and relevant evidence was received with respect to all four claims on appeal. The Board adopts this favorable finding. 1. Entitlement to service connection for peripheral neuropathy, right lower extremity 2. Entitlement to service connection for peripheral neuropathy, right upper extremity 3. Entitlement to service connection for peripheral neuropathy, left lower extremity 4. Entitlement to service connection for peripheral neuropathy, left upper extremity Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 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 injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). If a Veteran was exposed to an herbicide agent during active military, naval, or air service, certain diseases, including early onset peripheral neuropathy, may be service connected if the requirements of 38 U.S.C. § 1116 and 38 C.F.R. § 3.307(a)(6)(iii) are met, even though there is no record of such disease during service. 38 C.F.R. §§ 3.307(d), 3.309(e). Veterans who, during active military, naval, or air service, served in the Republic of Vietnam from February 28, 1961 to May 7, 1975, shall be presumed to have been exposed to an herbicide agent, including Agent Orange, unless there is affirmative evidence to establish that the Veteran was not exposed to any such agent during that service. 38 C.F.R. § 3.307(a)(6)(iii). Here, the record shows that the Veteran served in Vietnam from January 25, 1967, to January 4, 1968. See military personnel records received by VA in November 2011; see also May 2014 statement of the case (SOC). Exposure to herbicide agents is therefore presumed. The Veteran's medical records reflect that he was diagnosed with peripheral neuropathy of the right and left upper and lower extremities. See private medical treatment records received by VA in April 2013; and VA examinations dated March 2019 and July 2019. Thus, the first and second elements for establishing service connection, a current disability and in-service event, have been met. The question becomes whether the Veteran's condition is related to service. Early-onset peripheral neuropathy is listed among the conditions presumed to be service connected in veterans that have been exposed to certain herbicidal agents. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307(a)(6)(iii), 3.309(e). The Veteran's medical treatment records indicate a diagnosis of peripheral neuropathy; however, they do not indicate a diagnosis of early-onset peripheral neuropathy. See private medical treatment records received by VA in April 2013; and VA examinations dated March 2019 and July 2019. Service connection for peripheral neuropathy may still be granted on a direct basis. Having considered the evidence of record, and after affording the Veteran the benefit of the doubt, the Board finds that it is at least as likely as not that the Veteran's peripheral neuropathy of the right and left upper and lower extremities was incurred due to in-service herbicide agent exposure. The Veteran underwent a VA examination in July 2019. The Veteran reported that he began noticing a severe burning sensation in his feet in approximately 1972-73 and subsequently began having soreness and sensitivity in his arms. The examiner opined in favor of service connection, stating that the claims file indicates herbicide agent exposure during service in the Republic of Vietnam. The examiner stated that the Veteran reported signs and symptoms consistent with those associated with peripheral neuropathy, such as pain, burning and numbness in the extremities. The examiner noted that, though early-onset peripheral neuropathy is a presumptive condition if it manifests within one year of separation, in the present case, it did not manifest until approximately 1972. The examiner noted that the Veteran stated that he began having vague symptoms of the condition prior to 1972, but he dismissed them until realizing they warranted further medical evaluation. The examiner also noted that the Veteran does not have other common risk factors for peripheral neuropathy. The Board finds that the VA examiner's opinion is probative because it is based on the accurate pertinent medical history and it provides explanations that contain clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Furthermore, a private medical treatment record by Dr. H.W. notes that the Veteran has a history of neuropathy secondary to Agent Orange exposure. See private medical treatment records received by VA in January 2020. The Veteran also testified in the January 2017 Board legacy hearing that he began experiencing symptoms, specifically, a burning sensation in his feet, in the early 1970s but that these complaints were dismissed by medical providers. While the Veteran is not competent to provide a diagnosis, as the issue is medically complex and he lacks the requisite credentials to make such a determination, he is competent to report readily observable symptoms, such as the presence of pain or a burning sensation. Accordingly, the Board finds that the Veteran's lay statements further support to an award of service connection. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); Layno v. Brown, 6 Vet. App. 465, 469 (1994). In conclusion, the Board finds that the evidence shows that the Veteran's bilateral upper and lower peripheral neuropathy was incurred due to in-service herbicide agent exposure. Accordingly, the Board finds that service connection is warranted for peripheral neuropathy of the right and left upper and lower extremities. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Mike Sobiecki Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Minaya, 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.