Citation Nr: 21006631 Decision Date: 02/04/21 Archive Date: 02/04/21 DOCKET NO. 18-43 575 DATE: February 4, 2021 ORDER Entitlement to service connection for bilateral upper extremity peripheral neuropathy, to include as due to herbicide agent exposure is denied. Entitlement to service connection for bilateral lower extremity peripheral neuropathy, to include as due to herbicide agent exposure is denied. FINDINGS OF FACT 1. The Veteran has a current diagnosis of bilateral carpal tunnel syndrome and ulnar neuropathy, which could represent poly neuropathy of the upper extremities; and distal length-dependent polyneuropathy of the lower extremities, 2. The Veteran’s current disabilities were not shown in service and did not manifest to a compensable degree within the applicable presumptive period following his service discharge; moreover, continuity of symptomatology since his service is not established and these disabilities are not otherwise shown to be etiologically related to an in-service injury, disease, or event, including presumed exposure to herbicide agents such as Agent Orange. CONCLUSION OF LAW The criteria for service connection for bilateral upper and lower extremity peripheral neuropathy, to include as due to herbicide agent exposure have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from July 1957 to May 1960 and August 1960 to July 1969. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran appeared at a Board hearing before the undersigned Veterans Law Judge in December 2020. A transcript of the hearing is in the Veteran’s file. Service Connection 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). Certain diseases, including organic disease of the nervous system may be presumed to have been incurred in service if they manifested to a compensable degree (generally meaning to at least 10-percent disabling) within a year after the Veteran’s separation from service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309(a). Additionally, a veteran who had active service in the Republic of Vietnam during the period beginning on January 9, 1962 and ending on May 7, 1975 (Vietnam era) will be presumed to have been exposed to an herbicide agent during such service unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service. See 38 U.S.C. § 1116(f); 38 C.F.R. § 3.307(a)(6)(iii). Early onset peripheral neuropathy is presumed service connected if manifested to a degree of 10 percent or more following the last exposure to herbicide agent in service. 38 C.F.R. § 3.307. A review of the Veteran’s records shows that he had qualifying service in Vietnam and is presumed to have been exposed to an herbicide agent, to include Agent Orange. Furthermore, in determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of matter, the benefit of the doubt will be given to the Veteran. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. Entitlement to service connection for bilateral peripheral neuropathy of the upper and lower extremities, to include as due to herbicide agent exposure The Veteran contends that his neuropathy of the bilateral upper and lower extremities is due to his military service, including as a chronic disease or due to his presumed Agent Orange exposure. The Veteran has a current diagnosis of bilateral carpal tunnel syndrome and ulnar neuropathy, which could represent poly neuropathy of the upper extremities; and distal length-dependent polyneuropathy of the lower extremities, as confirmed by March 2016 private treatment records. Thus, he has a current disability. However, his disability was not shown as chronic, or otherwise in service, did not manifest to a compensable degree within a presumptive period, and continuity of symptomatology since service was not established. In a March 2016 written statement to VA, the Veteran stated that he began to experience symptoms of peripheral neuropathy in 1975 but was unable to diagnose it due to lack of information on the problem. In a June 2016 written statement, he stated the symptoms began in 1970/1971 for his hands and 1978/1979 for his toes. He stated he mentioned this to various doctors, but they told him there was no treatment that would be effective to cure it. The record does not show a medical diagnosis of neuropathy until March 2016. In his Notice of Disagreement, the Veteran stated that he noticed the onset of peripheral neuropathy when he left Vietnam in about September 1967. He claims he did not know nerve pain had anything to do with Agent Orange. At the December 2020 Board hearing, the Veteran testified that in 1974, his wife complained his hands and feet were cold and to seek medical attention. A local doctor told him that hands and feet get cold off and on, so the Veteran left it alone. The Veteran did not say he was diagnosed with neuropathy at that time. He also stated his symptoms progressed and by the time he filed the claim, he had considerable pain in his fingers and feet. The Veteran also testified that his feet pain may have been due to the military providing the wrong size shoes that he wore for 12 years. The Board finds the Veteran did not establish continuity of symptomatology of the claimed condition. No probative evidence has been submitted showing that the various symptoms claimed to have been present for decades are symptoms associated with the current disability. In addition, while the Veteran apparently consulted a physician decades ago about his complaints, those whom he consulted did not diagnose his claimed condition. In addition, the Board finds the Veteran is not credible in this regard, as he has provided inconsistent statements as to the onset of his symptoms. He claimed an onset of symptoms ranging in service to several years after service for both his upper and lower extremities. In these circumstances the greater weight of the evidence is against finding that the Veteran experienced a continuity of symptoms of his currently diagnosed disabilities. Concerning the Veteran’s claim that his neuropathy is due to his presumed Agent Orange exposure, as above, the evidence of record does not include a diagnosis of early onset peripheral neuropathy, nor does the record support the onset of peripheral neuropathy within one year of the Veteran’s 1969 separation from active service. The claimed disability is not shown in the service treatment records, the Veteran is not competent to diagnose the condition, he has been inconsistent as to when the symptoms began, and any physician whom he saw from the 1970’s apparently did not find peripheral neuropathy. Thus, presumptive service connection for peripheral neuropathy of the bilateral upper and lower extremities based on exposure to Agent Orange is not warranted. Service connection for peripheral neuropathy on a direct basis also is not warranted. No relevant complaints or findings are shown in the service treatment records; no probative evidence has been submitted that the symptoms the Veteran reports he experienced nearest in time to service are associated with his claimed disabilities; and no probative evidence associates the Veteran’s current disabilities with service. While the Veteran believes his current disability is related to an in-service injury, event, or disease, including exposure to Agent Orange he is not competent to provide any probative nexus opinion. This issue is medically complex, as it requires specialized medical education and knowledge of the interaction between multiple systems in the body. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). In reaching this decision to deny the appeal, the Board notes that a VA medical opinion regarding a nexus between the Veteran’s current diagnosis and service has not been obtained. However, the Board finds that obtaining a VA medical opinion is not necessary to make a decision on this claim since there is no probative evidence of any in-service injury, disease or event associated with the Veteran’s current diagnoses. The only evidence linking the Veteran’s claimed disability with service is the Veteran’s lay contentions. Thus, the need for a medical opinion is not triggered. See 38 U.S.C. § 5103A. Under the circumstances described above, the Board finds that entitlement to service connection on a direct or presumptive basis for neuropathy of the bilateral upper and bilateral lower extremities is not warranted. MICHAEL KILCOYNE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Jaigirdar, 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.