Citation Nr: 21007024 Decision Date: 02/08/21 Archive Date: 02/08/21 DOCKET NO. 13-23 871 DATE: February 8, 2021 ORDER Entitlement to service connection for left upper extremity peripheral neuropathy, to include as secondary to service-connected thoracic spine disability, is denied. Entitlement to service connection for right upper extremity peripheral neuropathy, to include as secondary to service-connected thoracic spine disability, is denied. FINDINGS OF FACT 1. Peripheral neuropathy of the left upper extremity was not manifest during the Veteran’s active duty service; and, the most probative evidence of record fails to establish that the Veteran’s left upper extremity peripheral neuropathy is etiologically related to service, or proximately due to, or aggravated by, service-connected thoracic spine disability. 2. Peripheral neuropathy of the right upper extremity was not manifest during the Veteran’s active duty service; and, the most probative evidence of record fails to establish that the Veteran’s right upper extremity peripheral neuropathy is etiologically related to service, or proximately due to, or aggravated by, service-connected thoracic spine disability. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for left upper extremity peripheral neuropathy, to include as secondary to service-connected thoracic spine disability, have not been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.310. 2. The criteria for entitlement to service connection for right upper extremity peripheral neuropathy, to include as secondary to service-connected thoracic spine disability, have not been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 1980 to July 1980 and from July 1985 to August 1985 with additional service in the Army National Guard and Army Reserves. These matters come before the Board of Veterans’ Affairs (Board) on appeal from an October 2018 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Board last remanded the issues on appeal in September 2020 to obtain an addendum medical opinion. An addendum medical opinion was associated with the claims file in October 2020. As such, a review of the record shows substantial compliance with the Board’s remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The case has been returned to the Board for review. The Board notes that the issue of entitlement to service connection for peripheral neuropathy of the bilateral lower extremities, to include as secondary to service-connected thoracic spine disability was previously denied by the Board in the September 2020 decision. Board decisions are final when issued. See 38 U.S.C. § 7104; 38 C.F.R. § 20.1100. Therefore, the Board’s September 2020 denial of the Veteran’s claim for entitlement to service connection for peripheral neuropathy of the bilateral lower extremities, to include as secondary to service-connected thoracic spine disability is final and no longer part of the appeal. Service Connection Entitlement to service connection for left upper extremity peripheral neuropathy, to include as secondary to service-connected thoracic spine disability. Entitlement to service connection for right upper extremity peripheral neuropathy, to include as secondary to service-connected thoracic spine disability. The Veteran seeks service connection for bilateral upper extremity peripheral neuropathy. See August 2018 VA Form 21-526. Specifically, the Veteran, through his representative, asserts he is entitlement to service connection on a direct basis, or secondary to his service-connected degenerative disc disease of the thoracic spine. See October 2019 Notice of Disagreement (NOD). Generally, service connection may be established for a disability resulting from a disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. To establish direct-incurrence service connection for a disability, the Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Secondary service connection is granted where a service-connected disability causes or aggravates a nonservice-connected disability. See 38 C.F.R. § 3.310; see also Allen v. Brown, 7 Vet. App. 439, 448 (1995). Further, service connection may not be awarded on the basis of aggravation without establishing a pre-aggravation baseline level of disability and comparing it to the current level of disability. 38 C.F.R. § 3.310(b). Direct incurrence service connection The Veteran has a current diagnosis of peripheral neuropathy of the bilateral upper extremities. See September 2018 VA examination. Thus, the first element of service connection, the existence of a present disability, has been met. See Shedden, 381 F.3d at 1167. With respect to the second element of service connection, in-service injury or disease, the Veteran’s service treatment records show he injured his back in the line of duty in a motor vehicle accident on active duty in July 1985. See July 1985 service treatment records. Thus, the second element of service connection has been met. See Shedden, 381 F.3d at 1167. The remaining question before the Board is whether the Veteran’s peripheral neuropathy of the bilateral upper extremities is etiologically related to his active duty service, including the motor vehicle accident. In that regard, the Veteran’s service treatment records are silent for complaints or findings suggestive of signs or symptoms indicative of peripheral neuropathy of the bilateral upper extremities. Additionally, a January 1984 medical examination indicates the Veteran’s upper extremities were normal upon examination. The earliest medical record demonstrates the Veteran reported bilateral numbness in his arms and was diagnosed with upper extremity numbness in November 2011, more than 30 years after service. See November 2011 VA treatment records. The Veteran was afforded a VA examination in May 2018. The May 2018 VA examiner opined that the Veteran’s claimed bilateral upper extremities conditions were less likely as not due to military service or aggravated beyond its natural progression by military service. See May 2018 VA examination. However, the May 2018 VA examiner did not diagnose right upper extremity peripheral neuropathy. Id. Additionally, the May 2018 VA examiner noted the most likely etiology of the Veteran’s neuropathic complaints of the left upper extremity is compression of the elbow of the ulnar nerve. Id. The Veteran was afforded a second VA examination in September 2018. The September 2018 VA examiner noted the Veteran was diagnosed with bilateral upper extremity peripheral neuropathy. See September 2018 VA examination. The VA examiner opined that the Veteran’s bilateral upper extremity peripheral neuropathy was less likely as not incurred in, caused by or a result of the neck pain from the motor vehicle accident during service. Id. As rationale, the VA examiner noted there is no anatomic or physiologic nexus with which to connect the conditions, and the Veteran’s bilateral upper extremity peripheral neuropathies are most likely caused by localized compression of the ulnar nerve (at the elbow) and median nerve (at the wrist) and therefore not caused by a remote neck injury. Id. The VA examiner noted review of the Veteran’s VA e-folder and VA treatment records and provided an adequate rationale. As such, the Board finds the September 2018 VA examiner’s medical opinion to be adequate and assigns it significant probative value. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302 (2008). To the extent the Veteran contends that his peripheral neuropathies of the bilateral upper extremities are etiologically related to his period of active duty service, the Board acknowledges that the Veteran can attest to factual matters of which he has first-hand knowledge and understanding as a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). However, he has not been shown to have the medical training or knowledge to be deemed competent to establish an etiological nexus between his diagnosed peripheral neuropathies of the bilateral upper extremities and his active duty service. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). As such, the Board attaches more weight to the September 2018 VA examination than to the Veteran’s lay statements. Moreover, the Veteran, nor his representative, have provided any competent evidence to the contrary. As such, there is no evidence of a link between the Veteran’s current peripheral neuropathies of the bilateral upper extremities and his active duty service. Accordingly, entitlement to service connection, on a direct-incurrence basis, is not warranted. Secondary service connection The Board also finds that secondary service connection is not warranted. The threshold legal requirements for a successful secondary service connection claim are: (1) evidence of a current disability for which secondary service connection is sought; (2) a disability for which service connection has been established; and (3) competent evidence that the disability for which service connection is sought is proximately due to, or aggravated beyond natural progression by, the service-connected disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). As noted, the Veteran is currently diagnosed with peripheral neuropathy of the bilateral upper extremities. The record demonstrates the Veteran is service-connected for degenerative disc disease of the thoracic spine. Therefore, the first and second criteria for secondary service connection have been met. See Wallin, 11 Vet. App. at 512. In regard to the third element of secondary service connection, the Board finds there is no competent evidence that the Veteran’s peripheral neuropathies of the bilateral upper extremities are proximately due to, or aggravated, by his service-connected thoracic spine disability. The Veteran’s VA treatment records do not contain any indication the Veteran’s peripheral neuropathies of the bilateral upper extremities were caused by or aggravated by his service-connected thoracic spine disability. Rather, the Veteran’s VA treatment records indicate ulnar and median neuropathy diagnoses. See January 2012, May 2012, August 2015, and August 2018 VA treatment records. The Veteran was initially afforded a VA examination in May 2018. The VA examiner concluded that the Veteran’s right upper extremity complaints and peripheral neuropathy of the left upper extremity were less likely proximately due to or the result of his service-connected thoracic spine degenerative disc disease as there is no anatomic or physiologic nexus by which to connect the conditions. See May 2018 VA examination. However, the May 2018 VA examiner did not diagnose right upper extremity peripheral neuropathy and did not indicate whether the Veteran’s conditions were aggravated by his service-connected thoracic spine disability. Id. Therefore, the May 2018 VA examination is inadequate for decision making purposes. See Nieves-Rodriguez, 22 Vet. App. at 302. The Veteran was afforded a second VA examination in September 2018. The VA examiner noted the Veteran’s bilateral upper extremity peripheral neuropathies are most likely caused by localized compression of the ulnar nerve (at the elbow) and median nerve (at the wrist). See September 2018 VA examination. However, the VA examiner did not provide a secondary medical opinion. Id. As such, the September 2018 VA examination is inadequate for decision making purposes. See Nieves-Rodriguez, 22 Vet. App. at 302. The Veteran was afforded an addendum VA medical opinion in October 2020. The VA examiner opined that the Veteran’s bilateral upper extremity peripheral neuropathies were less likely as not caused by or aggravated by his service-connected thoracic spine disability. Id. As rationale, the VA examiner explained that anatomically, the nerves which innerve the upper extremity do not emanate from the thoracic spine. Id. The VA examiner also noted the Veteran’s bilateral upper extremity peripheral neuropathies are most likely caused by localized compression of the ulnar and median nerves. Id. The VA examiner noted there is no anatomic or physiologic nexus with which to connect the Veteran’s upper extremity peripheral nerve condition to his service-connected thoracic spine condition. Id. Additionally, the VA examiner noted there is nothing in the currently available evidence of record to support any aggravation of the Veteran’s bilateral upper extremity peripheral nerve condition by his service-connected spine disability as it does not make sense anatomically that his upper extremity peripheral nerve condition was in any way caused by or aggravated by his thoracic spine condition. Id. The Board finds the October 2020 VA examiner’s medical opinion to be adequate and assigns it significant probative value. See Nieves-Rodriguez, 22 Vet. App. at 302. The Board finds that the only evidence in favor of the Veteran’s claim is his own statements concerning his belief that his peripheral neuropathies of the bilateral upper extremities are secondary to his thoracic spine disability. The Board acknowledges that the Veteran is competent and credible to describe symptoms that he can perceive and describe. See Jandreau, 492 F.3d at 1377. However, he has not been shown to have the medical training or knowledge to be deemed competent to establish an etiological nexus between his diagnosed peripheral neuropathies of the bilateral upper extremities and his service-connected thoracic spine disability, or aggravation beyond natural progression by his service-connected thoracic spine disability, as such opinions require medical expertise and knowledge that he has not been shown to possess. See Kahana, 24 Vet. App. at 435. As such, the Board attaches more weight to the October 2020 VA examination than to the Veteran’s lay statements. Moreover, the Veteran, nor his representative, have provided any competent evidence to the contrary. In sum, the Board finds that, other than unsupported contentions, there is no competent evidence in the record of any etiological relationship between the Veteran’s peripheral neuropathies of the bilateral upper extremities and his service-connected thoracic spine disability, or active duty service. Thus, the criteria for service connection for peripheral neuropathies of the bilateral upper extremities, to include as due to or aggravated by service-connected thoracic spine disability, have not been met. As the preponderance of the evidence is against the claim, the benefit of the doubt rule is not for application. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Accordingly, the Veteran’s claims are denied. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Yancy v. McDonald, 27 Vet. App. 484, 495 (2016); Doucette v. Shulkin, 38 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Tiffany Dawson Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. P. Moore, 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.