Citation Nr: 21009278 Decision Date: 02/22/21 Archive Date: 02/22/21 DOCKET NO. 15-01 354 DATE: February 22, 2021 ORDER Service connection for peripheral neuropathy of the right upper extremity is denied. Service connection for peripheral neuropathy of the left upper extremity is denied. FINDINGS OF FACT 1. The weight of the evidence is against a finding that the Veteran’s peripheral neuropathy of the right upper extremity is related to his active military service; or was caused or aggravated by his service-connected diabetes mellitus, type II. 2. The weight of the evidence is against a finding that the Veteran’s peripheral neuropathy of the left upper extremity is related to his active military service; or was caused or aggravated by his service-connected diabetes mellitus, type II. CONCLUSIONS OF LAW 1. The criteria for service connection for peripheral neuropathy of the right upper extremity have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for peripheral neuropathy of the left upper extremity have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303 REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from July 1968 to April 1970. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2011 rating decision. In October 2018, the Board remanded this issue for additional development. As the requested development regarding the Veteran’s claims have been completed, this matter is now properly returned to the Board for adjudication. See Stegall v. West, 11 Vet. App. 268 (1998). Service Connection 1. Service connection for peripheral neuropathy of the right upper extremity 2. Service connection for peripheral neuropathy of the left upper extremity Service connection can be established by evidence that shows “(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 the so-called “nexus” requirement.” 38 C.F.R. § 3.310 (a); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). With chronic disease shown as such in service so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date are service connected, unless clearly attributable to intercurrent causes. 38 C.F.R. § 3.303 (b). For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. Id. When the disease identity is established, there is no requirement of evidentiary showing of continuity. Id. For this purpose, a chronic disease is one listed at 38 C.F.R. § 3.309 (a). See Walker v. Shinseki, 708 F.3d 1331, 1338-39 (Fed. Cir. 2013) (holding that the term “chronic disease in 38 C.F.R. § 3.303 (b) is limited to a chronic disease listed at 38 C.F.R. § 3.309 (a)). A grant of service connection under 38 C.F.R. § 3.303 (b) does not require proof of the nexus element; it is presumed. Id. As the Veteran has not been shown to have a chronic disability during the appeal period, the theory of continuity of symptomatology is not for application with respect to the service connection claims decided herein. A disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. 38 C.F.R. § 3.310. Additionally, when aggravation of a Veteran’s nonservice-connected condition is proximately due to or the result of a service-connected condition, the Veteran shall be compensated for the degree of disability over and above the degree of disability existing prior to the aggravation. Allen v. Brown, 7 Vet. App. 439 (1995). The Veteran claims that he has peripheral neuropathy of the right and left upper extremities as a result of his service-connected diabetes mellitus type II. The Veteran is service-connected for diabetes mellitus type II, effective from May 2003. The Veteran’s service treatment records are absent of any complaints, treatment, or diagnosis of a neurologic disability of the bilateral upper extremities. The July 1968 entrance examination and the April 1970 separation examination did not identify any abnormalities of the upper extremities. It is noted that peripheral neuropathy is a disease that is presumptively associated with herbicide exposure, but only if it manifests within a year of the last exposure to herbicides. Here, there is no indication that the Veteran began experiencing his upper extremity symptoms within a year of service, and as such presumptive service connection will not be discussed further. As stated in the October 2018 Board remand, according to a July 2003 VA medical treatment record, the examiner noted that the Veteran complained of paresthesia in the right arm and the finger tips and that he experienced the symptoms every two weeks. A July 2010 VA treatment record reflects that the Veteran complained of paresthesias and burning in the hands. In the November 2010 VA Compensation and Pension Exam Report, a diagnosis of peripheral neuropathy of the bilateral lower extremities was advanced. The examiner did not indicate whether the Veteran exhibited any upper extremity disability. The tests, however, showed normal findings for left and right upper extremities in the median nerve area. The examiner noted that the claims file was reviewed but it does not appear that he took into account the Veteran’s complaints of tingling and burning of the hands. VA treatment records and progress notes dated from 2012 to 2015 mention numerous times, as part of the history of present illnesses, that the Veteran was diagnosed with peripheral neuropathy. A January 2014 VA treatment record showed that the Veteran had complained of bilateral hand tingling, and that he experienced tingling for approximately six years. In addition, the records reflected that the Veteran may exhibit median neuropathy. The medical records also reflected that the Veteran was on medication for gabapentin for his peripheral neuropathy but did not specify the location of his neuropathy. In the September 2018 informal hearing presentation, the Veteran’s representative requested that the Veteran be afforded another VA Compensation and Pension Examination to clarify whether the Veteran exhibits peripheral neuropathy of the right and left upper extremities. The Board determined that as the Veteran’s medical records showed that the Veteran is diagnosed with peripheral neuropathy, but the records were unclear as to whether he exhibits neuropathy in his lower extremity only or both his upper and lower extremities, additional development was necessary. Subsequently, the Veteran was afforded a VA examination for diabetic sensory-motor peripheral neuropathy in July 2019 where upon a physical examination, a review of the medical evidence of record, and the Veteran’s lay statements, the VA examiner determined that the Veteran’s claimed conditions were less likely than not (less than 50 percent probability) proximately due to, or the result of, his service-connected conditions. The VA examiner explained the Veteran had a diagnosis of bilateral carpal tunnel syndrome (CTS). The Veteran had diagnoses of cervical spine degenerative disc disease and stenosis “both of which are known to cause similar symptoms to CTS and match the symptoms [the Veteran] describes. Both his CTS or his neck spine condition are better explanations of his current symptoms. There is no objective evidence of diabetic peripheral neuropathy.” Further, the VA examiner cited to an August 2012 assessment indicating the Veteran was diagnosed with bilateral CTS and was recommended splints for this condition. The VA examiner stated that CTS is not affected by the service-connected diabetes. Rather CTS “is a condition caused by increased pressure of nerves running through the wrists and into the hand.” After consideration of the entire record and the relevant law, the Board finds that the Veteran’s bilateral peripheral neuropathy of the right and left upper extremities, to include bilateral CTS, are not related to service or to a service-connected disability, and service connection is not established. The Board acknowledges the Veteran has a confirmed diagnosis of CTS, however, there were no objective evidence of record that indicates injury or symptomatology pertaining to the current disability during service. Therefore, the Board finds that direct service connection is denied. The Veteran has not presented any medical evidence to support a finding of direct service connection. Regarding the secondary theory of entitlement, the July 2019 VA examiner provided a negative nexus opinion in regard to secondary service connection. Specifically, the VA examiner determined the Veteran had a diagnosis of CTS, rather than peripheral neuropathy, which was unrelated to his service-connected diabetes mellitus, type II. Neither the Veteran, nor his representative, has objected to the findings of this examination, and neither has offered any medical opinion that would call the VA examiner’s conclusions into question. To the extent that he believes that he has peripheral neuropathy of the bilateral upper extremities, to include bilateral CTS, is the result of, or is aggravated by his diabetes mellitus, or due to his military service, such a medical opinion requires medical expertise, and that determination cannot simply be made by lay observation alone; and the Veteran is not considered competent (meaning medically qualified by training or experience) to provide a medical opinion. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). In light of the above discussion, the Board concludes that the preponderance of the evidence is against the claim for service connection a right and left peripheral neuropathy of the upper extremities and there is no doubt to be otherwise resolved. As such, this claim is denied. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board H. Yoo, 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.