Citation Nr: 21007530 Decision Date: 02/09/21 Archive Date: 02/09/21 DOCKET NO. 11-20 862 DATE: February 9, 2021 ORDER Entitlement to service connection for diabetic neuropathy, right upper extremity, is denied. Entitlement to service connection for diabetic neuropathy, left upper extremity, is denied. Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), is denied. FINDINGS OF FACT 1. The Veteran does not have diabetic neuropathy of the right upper extremity. 2. The Veteran does not have diabetic neuropathy of the left upper extremity. 3. The Veteran does not have acquired psychiatric disorder, to include PTSD. CONCLUSIONS OF LAW 1. The criteria for service connection for neuropathy, right upper extremity, as secondary to service-connected diabetes mellitus, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 2. The criteria for service connection for neuropathy, left upper extremity, as secondary to service-connected diabetes mellitus, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 3. The criteria for service connection for an acquired psychiatric disorder, to include PTSD, have not been met. 38 U.S.C. § 5108; 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from July 1965 to February 1969. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from rating decisions in June 2010 (acquired psychiatric disorder) and March 2016 (diabetic neuropathy) of an Agency of Original Jurisdiction (AOJ) of the U.S. Department of Veterans Affairs (VA). In March 2016, as the Veteran's appeal for the acquired psychiatric disorder was underway, the AOJ denied, as relevant here, claims of service connection for degenerative joint disease (DJD) of the left wrist, degenerative disc disease (DDD) of the cervical spine, right wrist carpal tunnel syndrome, heart disease, and bilateral diabetic neuropathy of the upper extremities. He appealed those denials. In December 2017, the Board denied the Veteran's claim of entitlement to service connection for diabetes mellitus and an acquired psychiatric disorder, claimed as PTSD. In April 2019, pursuant to a joint motion by the appellant and VA, the United States Court of Appeals for Veterans Claims (Court) vacated the Board’s December 2017 decision and remanded the matter to the Board for action consistent with the terms of the joint motion. In July 2019 and September 2020, the Board considered the Veteran's two appeal streams. As relevant here, the Board remanded the issues in the title page in September 2020 for additional development. The AOJ completed that development, and the appeal has returned to the Board. Issue 1: Entitlement to service connection for diabetic neuropathy, right upper extremity Issue 2: Entitlement to service connection for diabetic neuropathy, left upper extremity Secondary Service Connection Service connection on a secondary basis is merited if there is (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a nexus (i.e., link) between the service-connected disability and the current disability. Wallin v. West, 11 Vet. App. 509, 512 (1998). Merits The Board service connected the Veteran's diabetes mellitus in September 2020. The AOJ implemented the Board's grant that same month. This satisfies the second prong of a secondary service connection claim for Issues 1-2. This appeal turns on the first prong of a secondary service connection claim for Issues 1-2, current disability. In that vein, the Board remanded the appeal in September 2020 for VA to examine the Veteran to determine if he has diabetic neuropathy of the bilateral upper extremities. VA examined the Veteran in November 2020. The examiner reported the Veteran did not have diabetic neuropathy of the bilateral upper extremities. He reported on both direct and secondary theories of service connection even though the Veteran never claimed a direct theory of entitlement. The opinions were: The claimed condition was less likely than not (less than 50 percent probability) incurred in, or caused by, the claimed in-service injury, event, or illness. Although Primary Care Physician records in the last few years reflect a diagnosis of Left Carpal Tunnel Syndrome, that diagnosis was noted well after active duty, so no nexus is reasonable. Additionally, current exam noted no objective findings to support a diagnosis for the left upper extremity. As a result, the claimed neuropathy, left upper extremity is less likely than not incurred in, or caused by, the neuropathy, left upper extremity during service. The claimed neuropathy, right upper extremity, diagnosed as Right Carpal Tunnel Syndrome, is less likely than not incurred in, or caused by, the neuropathy, left upper extremity during service. Medical records do not show complaints, treatment, or diagnosis of right CTS during service or close to separation. A diagnosis of Right Carpal Tunnel Syndrome is provided on current exam based on a positive Phalen’s sign, but is also largely vague for this pathology. STRs are absent for this as a history. Primary Care Physician records in the last few years reflect this diagnosis, but of the left hand. Given that the current diagnosis is well outside of active duty and the lack of supporting evidence in STRs, no nexus is reasonable. Neuropathy, Left Upper Extremity. Although the veteran is service connected for Diabetes Mellitus per rating decision dated 09/09/2020, there was no objective evidence noted on current exam to warrant rendering a diagnosis of a left upper extremity nerve condition. Neuropathy, Right Upper Extremity. The current examination is consistent with a diagnosis of Right Carpal Tunnel Syndrome which is unrelated to Diabetes. There is no clinical association between Carpal Tunnel Syndrome (CTS) and Diabetes Mellitus. CTS is a nerve compression condition and DM is a chronic ailment with the breakdown of nerve tissue. Diabetes does not cause CTS. There was no objective evidence on exam to support other diagnoses. Symptoms are not consistent with DM neuropathy. No nexus is reasonable. Because the Veteran does not have diabetic neuropathy of the bilateral upper extremities, he does not meet the current disability requirement of service connection. Moreover, the Board expressly denied service connection for a left wrist disability and a right wrist disability, to include carpal tunnel syndrome, in July 2019, so those claims were independent of the claims for diabetic neuropathy of the bilateral upper extremities. Because the Veteran has not satisfied all three prongs of a secondary service connection claim, the Board must deny the appeal. Issue 3: Entitlement to service connection for an acquired psychiatric disorder, to include PTSD Direct Service Connection Establishing service connection generally requires medical evidence or, in certain circumstances, lay evidence of the following: (1) A current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) nexus between the claimed in-service disease and the present disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed.Cir.2009); Jandreau v. Nicholson, 492 F.3d 1372 (Fed.Cir.2007); Hickson v. West, 12 Vet. App. 247 (1999); Caluza v. Brown, 7 Vet. App. 498 (1995), aff'd per curiam, 78 F.3d 604 (Fed.Cir.1996) (table). Merits In September 2020, the Board ordered the AOJ to examine the Veteran for this claim. VA, in turn, examined the Veteran in November 2020. The examiner stated the Veteran did not have, nor had he ever had, a psychiatric disorder, to include PTSD. Moreover, the examiner opined: This Veteran denied psychiatric symptoms such as depression or anxiety. The stressor he mentioned occurred well over 50 years ago. He left the service and worked at several different careers. He also denied ever seeking psychological or psychiatric help. He did not meet any DSMV criteria for a mental health disorder. On August 11, 2020, the United States Court of Appeals for Veterans Claims issued Martinez-Bodon v. Wilkie, 32 Vet. App. 393 (2020), which held that although the application of Saunders v. Wilkie, 888 F.3d 1356 (Fed. Cir. 2018), is not limited to pain, a diagnosis that conforms to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is required for compensation for psychiatric disabilities. Because there is no evidence of a diagnosis of a psychiatric disorder based on the DSM-5, the Board finds the Veteran does not meet the current disability requirement, i.e., the first prong, of a service connection claim. Accordingly, the Board must deny the appeal. N. RIPPEL Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Sopko, 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.