Citation Nr: 21021757 Decision Date: 04/13/21 Archive Date: 04/13/21 DOCKET NO. 14-22 211 DATE: April 13, 2021 ORDER Entitlement to service connection for right upper extremity neuropathy is denied. Entitlement to service connection for left lower extremity neuropathy is denied. Entitlement to service connection for right lower extremity neuropathy is denied. Entitlement to service connection for testicular hydroceles is denied. FINDINGS OF FACT 1. The Veteran does not have a current right upper extremity neuropathy disability. 2. The Veteran does not have a current bilateral lower extremity neuropathy disability. 3. The Veteran’s testicular hydroceles is not related to an in-service injury, disease, or event. CONCLUSIONS OF LAW 1.The criteria for service connection for right upper extremity neuropathy disability are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310. 2. The criteria for service connection for a left lower extremity neuropathy disability are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310. 3. The criteria for service connection for a right lower extremity neuropathy disability are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310. 4. The criteria for service connection for testicular hydrocele are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from March 1985 to September 2011. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2012 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). These matters were previously before the Board and were remanded for further development in a September 2019 decision. Regarding the Veteran’s claims to service connection for left upper extremity neuropathy and an enlarged prostate, the RO granted service connection for these disabilities in a September 2020 rating decision. As a result, these issues are no longer before the Board. Service Connection Laws and Regulations Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a 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.” Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Certain diseases, such as organic diseases of the nervous system, may be presumed to have been incurred in service when manifest to a compensable degree within one year of discharge from active duty. 38 U.S.C. § 1112 (2012); 38 C.F.R. §§ 3.307, 3.309 (2020). Under 38 C.F.R. § 3.303(b), an alternative method of establishing the second and third Shedden for certain chronic disabilities such as neuropathy is through a demonstration of continuity of symptomatology. In relevant part, 38 U.S.C. § 1154(a) requires that the VA give “due consideration” to “all pertinent medical and lay evidence” in evaluating a claim to disability or death benefits. Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional.” Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed.Cir.2007). In fact, competent medical evidence is not necessarily required when the determinative issue involves either medical etiology or a medical diagnosis. Id. at 1376-77; see also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006); Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Once evidence is determined to be competent, the Board must determine whether such evidence is also credible. See Layno, supra (distinguishing between competency (“a legal concept determining whether testimony may be heard and considered”) and credibility (“a factual determination going to the probative value of the evidence to be made after the evidence has been admitted”). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b). Neuropathy Factual Background and Analysis The Veteran’s record does not indicate he has definitively been diagnosed with a right upper extremity or bilateral lower extremity nerve condition. In June 2014, the Veteran said that he would like to be service connected for bilateral upper extremity arm and hand numbness, saying he had been diagnosed with conditions such as spinal stenosis, herniated disc ulna nerve neuropathy, disc degeneration, and cervical radiculopathy. However, some of these conditions are separate and distinct from his claimed conditions and the ulna nerve and radiculopathy found has been shown to be for his left upper extremity. The Veteran’s service treatment records (STRs) do not indicate he was seen in service for right upper extremity or bilateral lower extremity nerve problems. In September 2006, the Veteran said he had neck pain radiating down his neck into his left upper extremity. The Veteran was again seen for left upper extremity numbness and tingling in October 2006. Cervical radiculopathy was also mentioned in July 2008, but did not specific which extremity, but an August 2008 STR clarified the Veteran was referring to his left upper extremity. An April 2010 notation shows the Veteran was diagnosed with peripheral neuropathy. However, this note doesn’t indicate where this diagnosis came from or which extremities it was meant for. Additionally in April 2010, the Veteran complained of arm and finger problems. In March 2011, the Veteran was seen for tingling in his left arm and right leg. Assessments made were ulnar nerve neuropathy and cervical radiculopathy by history, peripheral neuropathy. However, no extremities were identified. In his April 2011 retirement exam, the Veteran reported chronic neck and back pain, but he did not mention any nerve problems. The examiner noted the Veteran had a “tardy left ulnar nerve, peripheral neuropathy.” Thus, it appears from the evidence, the Veteran’s complaints of nerve problems were related to his left upper extremity as no other extremities were mentioned. Per the September 2019 Board remand instructions, the Veteran underwent a VA examination for his peripheral nerves in February 2020. The Veteran reported having numbness in his left arm beginning in 2003 or 2004. The examiner noted the Veteran had symptoms in his left upper extremity, but there was no constant pain, intermittent pain, numbness or paresthesias in the right upper extremity or bilateral lower extremities. The examiner also reported the Veteran did not have an abnormal gait and that the Veteran suffered from mild median nerve incomplete paralysis, mild left ulnar nerve incomplete paralysis, and moderate incomplete paralysis of the middle radicular group. The Veteran also had radiculopathy of the left upper extremity but the right upper extremity and bilateral lower extremities were normal. The examiner opined the Veteran’s right upper extremity nerve condition was not diagnosed as the Veteran currently did not have any symptoms of numbness or tingling. Additionally, the examiner stated the Veteran did not have any symptoms in his right or left flank. Under the circumstances of this case, the Board concludes that service connection is not warranted for neuropathy of the right upper extremity and bilateral lower extremities as the Veteran has not been shown to have current neuropathy of the right upper extremity and bilateral lower extremities disabilities. The Board notes that the Veteran has been diagnosed with neuropathy of the left upper extremity for which he is service connected for based on the February 2020 VA examination. However, while significant treatment records have been associated with the record including the February 2020 VA examination, none of these records contain evidence of current neuropathy of the right upper extremity and bilateral lower extremities. Accordingly, neither the lay nor medical evidence of record supports a current diagnosis of the claimed neuropathy of the right upper extremity and bilateral lower extremities as there is no evidence in the record of a current neuropathy of the right upper extremity and bilateral lower extremities disabilities. Hence, whereas here, the competent evidence establishes that the Veteran does not have the disability for which service connection is sought, there can be no valid claim for service connection. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). In the instant appeal, the claims for neuropathy of the right upper extremity and bilateral lower extremities disabilities must be denied because the first criterion for the grant of service connection-competent evidence of the disability for which service connection is sought-is not met. The Board notes the Veteran’s contentions regarding the etiology of his claimed neuropathy of the right upper extremity and bilateral lower extremities disabilities. To the extent that the Veteran himself contends that a medical relationship exists between his claimed disability and service, the Board acknowledges that the Veteran is competent to testify as to his observations. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Furthermore, lay witnesses may, in some circumstances, opine on questions of diagnosis and etiology. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (finding that the Board’s categorical statement that “a valid medical opinion” was required to establish nexus, and that a layperson was “not competent” to provide testimony as to nexus because she was a layperson, conflicts with Jandreau). In the instant case, however, the Board finds that neuropathy of the right upper extremity and bilateral lower extremities disabilities are not disabilities subject to lay diagnosis as these diagnoses require medical training. More significantly, the Veteran and his representative do not have the medical expertise to provide an opinion regarding the neuropathy of the right upper extremity and bilateral lower extremities disabilities etiologies. Specifically, where the determinative issue is one of medical causation, only those with specialized medical knowledge, training, or experience are competent to provide evidence on the issue. See Jones v. West, 12 Vet. App. 460, 465 (1999). Additionally, the VA examiner provided detailed rationales in support of his opinions and cited to the relevant evidence when determining that there were no objective findings of neuropathy of the right upper extremity and bilateral lower extremities. For this reason, the VA examiner’s opinions are the most probative evidence of record. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000) (noting that a factor for assessing the probative value of a medical opinion includes the thoroughness and detail of the opinion). As the preponderance of the evidence is against this claim, the benefit-of-the-doubt doctrine does not apply, and the claim for entitlement to service connection for neuropathy of the right upper extremity and bilateral lower extremities disabilities must be denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Testicular Hydroceles The Veteran’s STRs do not show he was seen for testicular hydrocele, except in June 1997 when the examiner noted that “small hydroceles are within normal limits.” In May 2007, the Veteran was seen for benign prostatic hypertrophy. The Veteran was seen for a moderate sized varicocele on the left but the Veteran stated it had been there for years without change or pain. (See June 2009 STR.) Per the September 2019 Board remand instructions, the Veteran also had a VA examination for his reproductive disability in February 2020. The examiner noted the Veteran had diagnoses of prostate gland injuries, including prostate gland hypertrophy and spermatocele. A February 2020 ultrasound of the scrotum also revealed trace hydroceles bilaterally. The examiner reported the Veteran said he was diagnosed with hydroceles in 1987 but did not complain of pain or inflammation caused by this condition. The examiner opined that it was less likely than not that the Veteran’s testicular hydroceles was incurred in or caused by the claimed in-service event, injury or illness. The examiner noted that the Veteran was diagnosed with spermatocele in service but his STRs were silent for a diagnosis of bilateral hydroceles and that spermatocele and hydroceles were two separate, unrelated conditions of the scrotum. When considering the pertinent evidence of record in light of the above-noted legal authority, the Board finds that service connection for testicular hydroceles is not warranted. As there is a current diagnosis of testicular hydroceles, the first element of service connection is satisfied. However, a veteran seeking disability benefits must establish not only the existence of a disability, but also an etiological connection between his military service and the disability. Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); D’Amico v. West, 209 F.3d 1322, 1326 (Fed. Cir. 2000); Hibbard v. West, 13 Vet. App. 546, 548 (2000). The Board notes the Veteran has been service connected for other reproductive organ disabilities, including enlarged prostatic hypertrophy and erectile dysfunction. However, the Veteran’s service treatment records demonstrate that while the Veteran was treated for similar testicular conditions while in service, the STRs are negative for complaints or treatments related to testicular hydroceles. Additionally, the February 2020 VA examiner specifically indicated that while the Veteran was diagnosed with spermatocele in service, his STRs were silent for a diagnosis of bilateral hydroceles and that spermatocele and hydroceles were two separate, unrelated conditions of the scrotum. Furthermore, the only medical opinions addressing the etiology of the testicular hydroceles weigh against the claims. As noted above, VA examiner in February 2020 indicated that it was less likely than not that the Veteran’s testicular hydroceles was incurred in or caused by the claimed in-service event, injury or illness. The Board affords the VA examiners’ February 2020 opinions, which are supported by a detailed rationale and medical knowledge, great probative value. In forming his opinion, the VA examiner specifically discussed the in-service treatment for similar testicular conditions while in service but again noted that the Veteran’s STRs were silent for a diagnosis of bilateral hydroceles and that spermatocele and hydroceles were two separate, unrelated conditions of the scrotum. None of the competent medical evidence of record refutes these conclusions, and the Veteran has not presented or identified any such existing medical evidence or opinion. Thus, the Board finds the examiner’s February 2020 opinion to be persuasive. The Board notes the Veteran’s contentions regarding the etiology of his claimed testicular hydroceles. To the extent that the Veteran contends that a medical relationship exists between his claimed testicular hydroceles and his service, the Board acknowledges that the Veteran is competent to testify as to his observations. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Furthermore, lay witnesses may, in some circumstances, opine on questions of diagnosis and etiology. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (finding that the Board’s categorical statement that “a valid medical opinion” was required to establish nexus, and that a layperson was “not competent” to provide testimony as to nexus because she was a layperson, conflicts with Jandreau). In the instant case, however, the Board finds that testicular hydroceles is not a disability subject to lay diagnosis as this diagnosis requires medical training. More significantly, the Veteran does not have the medical expertise to provide an opinion regarding the claimed testicular hydroceles etiology. Specifically, where the determinative issue is one of medical causation, only those with specialized medical knowledge, training, or experience are competent to provide evidence on the issue. See Jones v. West, 12 Vet. App. 460, 465 (1999). Additionally, the VA examiner provided detailed rationales in support of his opinions and cited to the relevant evidence. For this reason, the VA examiner’s opinions are the most probative evidence of record. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000) (noting that a factor for assessing the probative value of a medical opinion includes the thoroughness and detail of the opinion). Thus, the Veteran assertions that there is a relationship between his claimed testicular hydroceles and his service are not sufficient in this instance and are outweighed by other probative evidence of record. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). (Continued on the next page)   In sum, the Board finds that service connection for testicular hydroceles must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). James A. DeFrank Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Snoparsky 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.