Citation Nr: 21021883 Decision Date: 04/14/21 Archive Date: 04/14/21 DOCKET NO. 12-22 498 DATE: April 14, 2021 ORDER Service connection for a neurological disorder manifested by numbness in fingers, to include as secondary to diabetes mellitus, type II is denied. FINDING OF FACT The preponderance of the evidence weighs against finding that the Veteran has a neurological disorder that is causally related to his service or is proximately due to or caused by a service-connected disability. CONCLUSION OF LAW The criteria for service connection for a neurological disorder manifested by numbness in fingers, to include as secondary to diabetes mellitus, type II have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1964 to June 1966, to include service in the Republic of Vietnam. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from February 2009 and July 2009 rating decisions issued by a Department of Veterans Affairs (VA) Regional Office. In August 2016, November 2017, December 2019, and October 2020, the Board remanded this matter for additional development. The Board finds that there has been substantial compliance with those remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding that a remand by the Board confers upon the Veteran, as a matter of law, the right to compliance with its remand instructions, and imposes upon VA a concomitant duty to insure compliance with the terms of the remand); see also D’Aries v. Peake, 22 Vet. App. 97, 105 (2008) (holding that only substantial rather than strict compliance with the Board’s remand directives is required under Stegall). The Veteran’s service connection for an acquired psychiatric disorder claim which was also remanded in October 2020 has since been granted and effectuated pursuant to a February 2021 rating decision. Entitlement to service connection for a neurological disorder manifested by numbness in fingers, to include as secondary to diabetes mellitus, type II Legal Criteria To establish an entitlement to service connection, the Veteran must establish (1) the existence of a present disability, (2) an in-service occurrence 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. 38 C.F.R. § § 3.303 (a). Service connection may also be granted as secondary to a currently service-connected disability. To meet the criteria for secondary service connection, a Veteran must prove that there is (1) a current disability that is not already service-connected; and (2) at least one service-connected disability; and (3) evidence that the non-service connected disability is either proximately due to or the result of a service-connected disability, or aggravated (increased in severity) beyond its natural progress by a service connected disability. 38 C.F.R. § 3.310; Allen v. Brown 7 Vet. App. 439 (1995). Factual Background & Analysis By way of background, a March 2009 VA examination reflects a diagnosis of peripheral neuropathy, without an indication whether such referred to the upper or lower extremities. However, as the associated opinion included conflicting statements and was based on a review of records pertaining to a different Veteran, the Board remanded the case in August 2016 in order to afford the Veteran a new VA examination so as to determine the nature and etiology of his claimed neurological disorder manifested by numbness in fingers. Following an examination in December 2016, a VA examiner found that the Veteran did not have a peripheral nerve disorder or peripheral neuropathy, and no functional impairment was associated with his claimed symptoms. He further determined that the Veteran’s claimed numbness in fingers was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. As a rationale for the opinion, the examiner indicated that the Veteran reported that his symptoms of numbness in fingers began several years following his discharge from active duty. The examiner further determined that the Veteran’s claimed peripheral neuropathy was less likely than not incurred in or caused by the claimed in-service injury, event, or illness as there was no clinical evidence to support his allegation that he had a neuropathy. However, the December 2016 VA examiner failed to discuss the cause of the Veteran’s claimed numbness in fingers, or determine whether such manifestations supported the finding of a diagnosis of a neurological disorder as directed by the August 2016 Board Remand. Additionally, the examiner did not reconcile his determination that the Veteran did not have a neurological disorder or peripheral neuropathy with the March 2009 VA examiner’s diagnosis of peripheral neuropathy. Thus, the claim was again remanded in November 2017 to afford the Veteran a new VA examination to determine the nature and etiology of his claimed numbness in fingers. Here, the Remand specifically directed the examiner, in part, to specifically state whether the Veteran’s symptoms of numbness in fingers were attributed to a known clinical diagnosis. However, as noted in the December 2019 Remand, no examination was subsequently provided. Rather, an addendum opinion was obtained in February 2018. In this regard, the examiner reported that numbness was a symptom, not a diagnosis, and an individual could not consider any active duty event as responsible for a condition that the Veteran did not have. However, as the Veteran was not provided an examination and the examiner did not address the cause of his claimed numbness in fingers or determine whether such manifestations supported the finding of a diagnosis of a neurological disorder, the Board remanded the case in order to afford the Veteran a VA examination addressing the nature and etiology of his claimed numbness in fingers. Thereafter, the Veteran was afforded a VA examination in January 2020, at which time the examiner found that he did not have a peripheral nerve disorder or peripheral neuropathy, and no functional impairment was associated with his claimed symptoms. He further opined that opined that the Veteran’s claimed condition is less likely than not proximately due to or the result of his service- connected diabetes mellitus, type II. As rationale, the VA examiner found that the Veteran does not have a diagnosis of diabetes mellitus, type II, and thus, could not be a result of his diabetes. He also stated that the numbness is a symptom, not a diagnosis and, therefore, the Veteran does not have a current disability. However, the examiner did not state whether the Veteran’s symptoms were attributed to a known clinical diagnosis or reconcile such determination with the March 2009 VA examination report reflecting a diagnosis of peripheral neuropathy as required by the December 2019 Remand directives. Consequently, the Board again remanded this matter in October 2020 for an addendum opinion while noting that the medical evidence of record shows a diagnosis of borderline diabetes mellitus and the Veteran is currently service-connected for diabetes mellitus, type II, and associated peripheral neuropathy of the bilateral lower extremities. A February 2021 VA addendum opinion found that the Veteran has not had a diagnosis for peripheral neuropathy during the appeal period based on a review of the claims file and all previous VA examinations of record. The examiner attributed reported symptoms of tingling and numbness to the Veteran’s prescribed medications of Lisinopril and/or Metoprolol to treat his hypertension. Metoprolol was specifically noted to cause a slower heart rate which makes it more difficult for blood to reach the extremities which can cause the sensation of coldness or tingling in the hands and feet. Also, Lisinopril was noted to cause symptoms of nervousness, numbness or tingling in the hands, feet or lips, as well as weakness and/or heaviness of the legs. After a review of the record, the Board finds that the preponderance of the evidence weighs against finding that the Veteran has a neurological disorder manifested by numbness in fingers, connected to service or a service-connected disability to include as secondary to diabetes mellitus, type II. The Board ascribes significant probative weight to the February 2021 VA examiner’s opinion and findings because of the examiner’s medical expertise and training in evaluating neurological disabilities and the side-effects of medications. Further, the opinion demonstrated a familiarity with the Veteran’s medical history and was supported with an adequate rationale based on the totality of the evidence. (Continued on the next page)   Importantly, the Veteran has not been shown to have the experience, training, or education necessary to provide a diagnosis or give a probative etiology opinion for his claimed neurological disability. Although lay persons are competent to provide opinions on some medical issues, the Board finds that a lay person is not competent to provide a probative opinion as to the specific issues in this case in light of the education and training necessary to make a finding with regard to the neurological system. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); see Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). In sum, the preponderance of the competent medical evidence weighs against finding that the Veteran has had a neurological disorder manifested by numbness in fingers, related to service to include as secondary to diabetes mellitus, type II during the period on appeal. Lack of evidence of a current disability notwithstanding, there is also no probative opinion (i.e., a clinical opinion based on review of pertinent records) that it is as likely as not that the Veteran has a neurological disorder that is causally related to, or aggravated by, his service or a service-connected disability. Consequently, as the preponderance of the evidence is against the claim, it must be denied. Jennifer White Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Kyle McKone 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.