Citation Nr: 21024397 Decision Date: 04/22/21 Archive Date: 04/22/21 DOCKET NO. 15-22 043 DATE: April 22, 2021 ORDER Entitlement to service connection for a back condition (previously claimed as back neuropathy) is denied. Entitlement to service connection for neuropathy of the left leg, to include as due to Agent Orange exposure is denied. FINDINGS OF FACT 1. The Veteran’s back condition was not shown as chronic in service; continuity of symptomatology has not been shown; and the disability is not otherwise etiologically related to an in-service injury, event, or disease. 2. The Veteran’s for neuropathy of the left leg was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology has not been shown; and the disability is not otherwise etiologically related to an in-service injury, event or disease, to include as due to Agent Orange exposure. CONCLUSIONS OF LAW 1. The criteria for establishing entitlement to service connection for a back condition (previously claimed as back neuropathy) have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107 (2014); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2018). 2. The criteria for establishing entitlement to service connection for neuropathy of the left leg, to include as due to Agent Orange exposure have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107 (2014); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had honorable active duty service with the United States Marine Corps from August 1967 to March 1969. For his exemplary service, he was awarded the National Defense Service Medal, Vietnam Service Medal, Vietnam Campaign Medal. This appeal comes before the Board of Veterans’ Appeals (Board) from a January 2013 Rating Decision of the VA Regional Office (RO) in Waco, Texas. Review of the record indicates that this matter has been remanded on multiple occasions, to include most recently in August 2020 Board decision. That decision directed the RO to schedule the Veteran for a new VA examination. Specifically, the examiner was requested to consider the Veteran’s assertion of a combat-related back injury. As the requested development is now complete, this matter has been returned to the Board for appellate consideration. Duty to Assist and to Notify VA is required to notify a claimant of what information or evidence is necessary to substantiate the claim; what subset of the necessary information or evidence, if any, the claimant is to provide; and what subset of the necessary information or evidence, if any, the VA will attempt to obtain. 38 C.F.R. § 3.159(b) (2018). Copies of compliant VCAA notices were located in the claim’s file. VA’s duty to assist includes providing a thorough and contemporaneous medical examination, especially where it is necessary to determine the current level of a disability. Peters v. Brown, 6 Vet. App. 540, 542 (1994). In this case, neither the Veteran nor his representative has raised any issues with the duty to notify or duty to assist. See Scott v McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to duty to assist argument). Thus, upon careful review of the file, the Board finds that all necessary development has been accomplished, and therefore appellate review may proceed without prejudice to the Veteran. See Bernard v. Brown, 4 Vet. App. 384 (1993). Presumptive Service Connection - Herbicide Exposure Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303 (d). Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). Veterans who served in the Republic of Vietnam between January 9, 1962, and May 7, 1975, shall be presumed to have been exposed to an herbicide agent, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service. 38 C.F.R. § 3.307 (a)(6). If a veteran was exposed to an herbicide agent during active military, naval, or air service, the diseases listed under 38 C.F.R. § 3.309 (e) shall be service-connected if the requirements of 38 C.F.R. § 3.307 (a)(6) are met, even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 C.F.R. § 3.307 (d) are also satisfied. The list of diseases associated with exposure to certain herbicide agents is as follows: AL amyloidosis; chloracne or other acneform disease consistent with chloracne; Type 2 diabetes (also known as Type II diabetes mellitus or adult-onset diabetes); Hodgkin’s disease; ischemic heart disease; all chronic B-cell leukemias; multiple myeloma; non-Hodgkin’s lymphoma; Parkinson’s disease; early-onset peripheral neuropathy; porphyria cutanea tarda; prostate cancer; respiratory cancers (cancer of the lung, bronchus, larynx, or trachea); and soft-tissue sarcoma (other than osteosarcoma, chondrosarcoma, Kaposi’s sarcoma, or mesothelioma). 38 C.F.R. § 3.309 (e). For early-onset peripheral neuropathy, the presumptive service connection is warranted if the disorder manifested to a degree of 10 percent or more within one year after the Veteran’s last exposure to herbicide agents. 38 C.F.R. § 3.307 (a)(6)(ii). Where the evidence does not warrant presumptive service connection, the United States Court of Appeals for the Federal Circuit has held that an appellant is not precluded from establishing service connection with proof of direct causation. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). That is to say, the Agent Orange presumption does not preclude a veteran from establishing direct service connection with proof of actual direct causation. Service connection may be granted for any current disability that is the result of a disease contracted or an injury sustained while on active duty service. 38 U.S.C. § 1110, 1131 (2014); 38 C.F.R. §§ 3.303 (a), 3.304 (2018). Entitlement to service connection benefits is established when the following elements are satisfied: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and, (3) a causal relationship between the current disability and the disease or injury incurred or aggravated during service (the medical ‘nexus’ requirement). See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); 38 C.F.R. § 3.303 (a) (2018). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107 (2014); 38 C.F.R. § 3.102 (2018); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of the matter, the benefit of the doubt will be given to the Veteran. Id. The Board notes that it has thoroughly reviewed the record in conjunction with this case. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the extensive evidence submitted by the Veteran or on his behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (the Board must review the entire record but does not have to discuss each piece of evidence). Rather, the Board’s analysis below will focus specifically on what the evidence shows, or fails to show, on the claim. See Timberlake v. Gober, 14 Vet. App. 122, 129 (2000) (noting that the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material evidence favorable to the claimant). Lay evidence, if competent and credible, may serve to establish a nexus in certain circumstances. See Davidson v. Shinseki, 581 F.3d 1313 (2009) (noting that lay evidence is not incompetent merely for lack of contemporaneous medical evidence). When considering whether lay evidence may be competent, the Board must determine, on a case by case basis, whether the Veteran’s particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (holding that “[w]hether lay evidence is competent and sufficient in a particular case is a factual issue. 1. Entitlement to service connection for a back condition (previously claimed as back neuropathy) The Veteran contends that his low back condition is causally related to active service, to include as due to a combat-related injury. As discussed in more detail below, the preponderance of the evidence is against his claim. In analyzing the Veteran’s claim, the threshold inquiry before the Board is whether the Veteran’s current diagnosis was incurred in or otherwise casually related to active service, to include as due to an in-service injury or disease. While the Board acknowledges that the Veteran has a current diagnosis of degenerative disc disease of the lumbar spine, the preponderance of the evidence weighs against finding that his current lumbar spine condition is casually related to active service, to include as due to a combat-related injury. According to military personnel records, the Veteran’s official military occupation was listed as a Small Arms Technician and Mortarmen. Service treatment records are largely silent for complaints of low back pain or any related condition. During a pre-induction examination in May 1967, no disqualifying defects were observed. Possible high frequency hearing loss at 4000 Hz in the left ear only was noted. Nevertheless, the Veteran was qualified for active service. The comments section referenced a history of knee and shoulder trouble. In a report of medical history, bearing the same date, the Veteran endorsed a prior history of leg cramps, broken bones, and trick or locked knee. No complaints of recurrent back pain or neuritis were listed. The comments section referenced a possible fracture to the knee during a high school football game. A fracture of the right elbow was referenced. The Veteran reported a prior experience with dizzy spells and headaches in June 1966 and May 1967. A back brace was previously used for support. In February 1969, no physical abnormalities were identified during a physical examination at separation. The Veteran was deemed qualified for separation. Post service treatment records show sporadic complaints of back pain. In September 2004, a treatment record referenced the Veteran’s lay reporting of a prior back injury and arthritis of the lower extremities. The Veteran previously underwent a new patient evaluation in December 2003. Although the physical examination was essentially negative, the Veteran endorsed arthritic joint pain impacting the bilateral lower extremities. Reportedly, his symptoms were aggravated by movement and relieved by rest and oral prescription medication, Celebrex. The Veteran listed his current occupation as a probation officer. During a mental health examination in September 2005, the Veteran reported serving with the United States Marine Corps in August 1967. He completed basic training at Camp Pendleton. His official duties included work as an 81-millimeter (mm) mortar gunner and ammunition carrier. Thereafter, he was transferred to Okinawa. On or about January 1968, he was stationed in the Republic of Vietnam, with the Second Division, First Marines. The Veteran reported involvement in the siege of Khe Sanh. According to the Veteran, he was honorably discharged in June 1969 and transferred to the United States Marine Corps Reserve. Post-service, he initially worked in an oilfield. Thereafter, he went on to complete his undergraduate and graduate degree. In a nursing note, dated July 2007, complaints of back and knee pain were noted. The Veteran rated pain as a 6 on a 10-point scale. Pain was described as a constant, dull, or sharp ache. Prolonged walking and weight-bearing exacerbated his symptoms. In January 2008, a primary care ambulatory note referenced a history of medical conditions, to include chronic back pain with sciatica-type symptoms. During the clinical interview, the Veteran reported low back pain with radiating symptoms to the hip, left groin and down the left leg. X-rays of the lumbar spine and hip were recommended. Pain was described as an intermittent aching and burning. Continuous leg cramps were also noted. The Veteran rated his pain as a 7 on a 10-point scale. Similar complaints of chronic back pain and left lower extremity neuropathy were reported in June 2012. Three months later, the Veteran requested an increase in dosage of the prescribed medication, Gabapentin. Specifically, he requested 200 milligrams (mg) to be taken at bedtime. In June 2014, the Veteran associated a lay statement with the claims file. Therein, he denied experiencing trauma to his back other than lifting heavy equipment and weapons during basic training and combat-activities in the Republic of Vietnam. In February 2015, the Veteran underwent magnetic resonance imaging (MRI) due to complaints of chronic low back pain with radiation into the legs. The diagnostic findings revealed degenerative disc disease of the lower three lumbar discs at L3-L4, L4-L5, and L5-S1. Severe bilateral foraminal stenosis was observed at the same locations. Mild to moderate degenerative disc changes were visible at L1-L2, with mild degenerative disc changes at T11-12, T12-L1, L1-L2. Pursuant to a December 2019 Board remand decision, the Veteran’s claim was remanded to schedule a VA examination. On examination in October 2019, current diagnoses included degenerative arthritis of the lumbar spine, intervertebral disc syndrome, spinal stenosis, and radiculopathy. During the clinical interview, the Veteran reported working as an ammunitions grunt and gunner in service. Performance of his official duties required carrying heavy equipment, to include large capacity guns. On onset of back pain dates back to that time and persisted since separation. Current symptoms include chronic back pain, aching, and periodic stabbing pain. Pain radiates down both legs, with numbness and tingling into the bilateral feet. Worsening symptoms impact the left versus the right leg. The Veteran endorsed periodic treatment for low back pain since separation. In 2006, he was prescribed oral medication, Gabapentin to treat pain and neuropathic symptoms. No flare-ups were reported. Functional loss was described as difficulty with prolonged sitting, standing, bending, lifting more than 10 pounds (lbs.). Range of motion testing revealed forward flexion limited to 60 degrees, extension limited to 5 degrees, right and left lateral flexion limited to 10 degrees, and right and left lateral rotation limited to 15 degrees. Range of motion itself, does not contribute to functional loss. Pain was observed with all ranges of motion and weight-bearing. It contributes to functional loss. Mild localized tenderness to palpation impacted the mid-to low back area. No additional loss of range of motion was observed with repetitive use testing. Pain, weakness, and lack of endurance limit functional ability over time. The examiner noted an inability to describe these factors in terms of loss of range of motion and the Veteran’s symptoms vary with the type and amount of activity. No muscle spasms or guarding was reported. Muscle strength was slightly reduced in the left knee, ankle, and great toe. There was no evidence of muscle atrophy. Deep tendon reflexes were normal. Sensation was decreased in the bilateral thighs, lower legs, and feet. In the left foot, the sensation was described as absent. Straight leg raise testing was positive on the left side only. Evidence of radiculopathy was described as mild intermittent pain in the bilateral lower extremities. Paresthesias and/or dysesthesias was described as mild in the right lower extremity and moderate in the left lower extremity. Mild numbness impacted the right lower extremity and moderate in the left lower extremity. Involvement of the sciatic and femoral nerve was noted. Mild radiculopathy impacted the right side and moderate in the left. There was no evidence of ankylosis. Although favorable findings of intervertebral disc syndrome (IVDS) was indicated, there was no evidence of incapacitating episodes. The Veteran endorsed regular use of a cane. Other pertinent findings include an antalgic gait. Diagnostic testing revealed confirmed arthritis. Other significant findings included advanced degenerative disc disease in the lower three lumbar discs at L3-4, L4-5, L5-S1 and bilateral severe foraminal stenosis at L3-4, L4-5, L5-S1 first observed in 2015. Mild to moderate degenerative disc changes were noted at L1-L2, T11-12, and T12-L1, with vertebral hemangiomas located in the right lateral aspect of L2 and L5. No vertebral body compression fractures were found. A computerized tomography (CT) scan, dated July 2009, revealed degenerative disc disease without obvious canal stenosis. The Veteran described a functional impact as difficulty with prolonged sitting, standing, bending, lifting more than 10 lbs. Considering the Correia factors, evidence of pain was observed with passive motion. There was no evidence of pain with non-weight bearing. Following the clinical evaluation, the examiner opined that it was less likely than not that the Veteran’s low back disability (less than 50 percent probability) was incurred in or otherwise causally related to active service. In support of the stated conclusion, the examiner noted that the Veteran’s service records were silent for complaints of symptoms or treatment for a low back condition during active service. In fact, there were no complaints of symptoms within one year of separation or for decades thereafter. Accordingly, there is no basis for establishing a causal link between active service and new complaints of low back pain and neuropathy 36-years later. Alternatively, the Veteran’s treatment history suggests a correlation between his current symptoms and age-appropriate arthritic changes. In August 2020, the Veteran’s claim was again remanded for a VA examination. Specifically, an opinion was requested to address the Veteran’s assertion of a combat-related injury. On examination in January 2021, the Veteran’ current diagnoses were listed as spinal stenosis, mild thoracic lumbosacral degenerative disc disease, and lumbar degenerative joint disease. Other diagnoses included left lower extremity radiculopathy. During the clinical interview, the Veteran reported mild to moderate constant pain dating back to active service. At that time, performance of his official duties required carrying heavy items, including ammunition and base plates. He also reported sleeping on unconventional surfaces and wearing the same equipment/boots for multiple days at a time. The Veteran suggests a correlation between his duties and active service, to include exposure to Agent Orange. No specific injury was identified. His current complaints of back pain are different than he experienced during active service, to include back pain and numbness in the bilateral feet that travels to the knee. Beginning around 2000, the Veteran reported left lower extremity. Right lower quadrant pain was eventually associated with colon cancer. Prescribed medications include Neurontin and Hydrocodone. Mild to moderate flare-ups recur 3-4 times per day. After onset, his symptoms persist for 15-30 minutes at a time. Activities of daily living caused an increase in pain. Oral medications and rest improve his symptoms. The examiner found that the claimed condition is less likely than not (less than 50 percent probability) proximately due to or the result of the veteran's service-connected condition. They noted there is some lay statement of low back pain and numbness of the feet during service in Vietnam by the claimant due to general military activity but nonspecific to combat injuries. However, the pain, numbness was acute in nature and reported by claimant as different from the onset of pain that began in 2000 with the low back and left lower extremity. There may have been acute low back pain and some other condition that caused numbness at the time of Vietnam service, but according to lay statement and claims file there were no chronic back complaints, treatments and or diagnosis after Vietnam until around 2000. The degenerative disc disease, DJD of the lumbar spine as well as the spinal stenosis and LLE radiculopathy are more likely related at onset due to age and less likely due to complaints in Vietnam. In making all determinations, the Board has fully considered all medical evidence and lay assertions of record. Generally, the Veteran is presumed competent to report on the onset of current symptoms, their impact on daily living and employment, and such reporting is deemed credible. Layno v. Brown, 6 Vet. App. 465, 470 (1994); see also Jandreau v. Nicholson, 492 F.3d 1372, 1377. However, in the absence of proof of medical expertise, he is not qualified to offer a complex etiological opinion. While the Board acknowledges the Veteran’s report of low back pain with radiating symptoms dating back to active service and the suggestion of a combat-related injury, there is no evidence of any such injury or chronic symptomology related thereto. Moreover, the Veteran’s post-service employment history included work in oil fields and as a probation officer. Both roles likely included prolonged walking, standing, and repetitive motion. Although the Veteran’s treatment history includes favorable diagnoses of multiple lumbar spine conditions, the diagnoses were first rendered decades after separation. While the Board is sympathetic to the Veteran’s subjective belief that his lumbar spine conditions were causally related to active service, to include as due to combat-related injury, the evidence of record does not support his contentions. In this case, the Board affords greater probative weight to the VA examiner opinions of record, which fully analyzed the Veterans complaints of symptoms, their onset, along with the absence of in-service treatment for a lumbar spine condition or chronic symptomology until decades after separation. Moreover, the Veteran’s post-service employment history included years of physically demanding work, to include in oil fields and as a probation officer. Under the circumstances, the Veteran’s current condition cannot be logically related to his period of active service. Since the preponderance of the evidence is against the claim, the provisions of 38 U.S.C. § 5107 (b) regarding reasonable doubt are not applicable. The Veteran’s claim of entitlement to service connection for a back condition must be denied. 2. Entitlement to service connection for neuropathy of the left leg, to include as due to Agent Orange exposure The Veteran contends that he is entitled to service connection for neuropathy of left leg, to include as due to Agent Orange exposure during active service. According to military personnel records, the Veteran served in the Republic of Vietnam during the Vietnam Era. Accordingly, Agent Orange exposure is conceded. See 38 U.S.C. §§ 1116, 1154 (2014). While exposure to herbicides is conceded, the Board concludes that the Veteran’s current diagnosis left lower extremity neuropathy did not have its onset in-service, within the one year presumptive period, and is not otherwise casually related to active service, to include as due to in-service Agent Orange exposure. Service treatment records are silent for complaints of neuropathy or in-service treatment for a bilateral lower extremity condition. Post-service treatment records were silent for neurological abnormalities or complaints of neurological symptoms until on or about January 2008. During a nursing evaluation, complaints of chronic back, leg, and groin pain. Pain was described as an intermittent aching and burning. The Veteran rated his pain as a 7 on a 10-point scale. Continuous leg cramps were also noted. In July 2009, the Veteran reported left lower back pain with occasional sciatica-type symptoms and left lower extremity weakness. On physical examination, deep tendon reflexes were normal. The Veteran’s sensation was also intact. Complaints of chronic back pain and neuropathy primarily involving the left lower extremity was again reported, in June 2012. In May 2015, an ambulatory care note listed the Veteran’s current conditions as including degenerative joint disease, chronic back pain with left sciatica, and bilateral knee. In December 2018, the Veteran’s claim was remanded to obtain a VA etiological opinion. Consideration was requested regarding a possible linkage to the Veteran’s back condition. On examination of the peripheral nerves in October 2019, a current diagnosis of bilateral lower extremities radiculopathy was identified. During the clinical interview, the Veteran endorsed participation in heavy lifting activities while working as an ammunitions grunt and gunner in service. Reportedly, an onset of low back pain resulted from physical labor in service and persisted since separation. Current symptoms include daily aching in the low back, with periodic stabbing. Radiation to the bilateral lower legs with numbness, tingling in bilateral feet was also reported. Beginning on or about 2006, the Veteran was prescribed oral medication, Gabapentin to treat neuropathy. Worsening symptoms impacted the left leg versus the right. Peripheral nerve neuropathy was described as mild intermittent pain in the bilateral lower extremity. Mild paresthesias and/or dysesthesias impacted the right lower extremity, with moderate symptomology in the left lower extremity. Numbness was mild in the right lower extremity and moderate in the left lower extremity. Muscle strength was slightly reduced in the left lower knee and ankle. There was no evidence of muscle atrophy. Deep tendon reflexes were normal. Sensation was decreased in the left thigh, knee, and absent in the ankle and toe. In the right thigh lower leg, ankle, and foot was decreased. The Veteran’s gait was described as antalgic. Moderate incomplete paralysis impacted the sciatic nerve, bilaterally. Mild incomplete paralysis impacted the femoral nerve, bilaterally. Due to chronic low back pain, the Veteran endorsed regular use of a cane to aid with ambulation. A functional impact was described as difficulty with prolonged sitting, standing, bending, lifting more than 10 lbs. Following the clinical evaluation, the examiner opined that the Veteran’s left leg neuropathy was less likely than not (less than 50 percent probability) was incurred in or caused by Agent Orange exposure during service. It is also less likely as not that the condition was aggravated beyond its natural progression by the Veteran’s low back pain, claimed as back neuropathy. Moreover, as the Veteran’s low back condition is unrelated to service, therefore there is no aggravation can be established. Pursuant to an August 2020 Board remand decision, the Veteran’s claim was again remanded. An additional etiological opinion was requested as due to his suggestion of a combat-related low back injury. In January 2021 an addendum VA opinion was obtained. Specifically, the examiner opined that it is less likely than not (less than 50 percent probability) that the Veteran’s left lower extremity radiculopathy is proximately due to or the result of any service-connected condition. The examiner acknowledged that the Veteran’s lay assertions regarding low back pain and numbness of the feet as causally related to nonspecific to combat injuries. However, even if the Veteran experienced pain and numbness in service, the symptoms were acute in nature and otherwise unrelated to a new onset of low back pain with radiation to the left lower extremity in the 2000s. In fact, there is no evidence of complaints of chronic low back pain or lower extremity symptoms, treatments, or any related diagnosis after separation from service in the Republic of Vietnam until 2000. Therefore, the Veteran’s current diagnoses of degenerative disc disease, degenerative joint disease of the lumbar spine, spinal stenosis and left lower extremity radiculopathy are more likely related age-degeneration and less likely related to any in-service incident, injury, disease or exposure while stationed in the Republic of Vietnam. In making all determinations, the Board has fully considered all medical evidence and lay assertions of record. Generally, the Veteran is deemed competence to report on his current symptoms and their onset. However, there is no evidence that he possesses the specialized skills and expertise necessary to render complex medical opinions or opine as nature and etiology of his current symptoms. Layno v. Brown, 6 Vet. App. 465, 470 (1994); see also Jandreau v. Nicholson, 492 F.3d 1372, 1377. Further, mere conclusory or generalized lay assertions that an in- service event or illness caused a current disability are insufficient to establish nexus in the absence of competent medical evidence. Waters v. Shinseki, 601 F.3d 1274, 1278 (2010). In this case, the Veteran had not presented competent medical evidence linking his left lower extremity neuropathy to active service, to include as due to aggravation. The record is also silent for a favorable medical opinion which directly connected his exposure to herbicides to left lower extremity neuropathy initially diagnosed decades later. While the Veteran’s left lower extremity condition has been linked to his currently diagnosed conditions of the lumbar spine, the record is also silent for any basis for linking those diagnoses to active service. In fact, the Veteran’s degenerative changes of the lumbar spine have been related to age-related degeneration. Although the Veteran has submitted multiple lay assertions suggesting a causal linkage between his left lower extremity neuropathy to active service, to include as secondary herbicidal exposure therein, the medical evidence does not support his contentions. Moreover, while the Veteran has also suggested aggravation due to his lumbar spine condition, service connection has not been granted for that condition. In fact, the VA medical opinions of record document consideration of the Veteran’s lay assertions, his complete medical history to include relevant diagnostic testing; and provided etiological conclusions that reflect complex analyses and medical expertise. At no time has the medical evidence revealed a correlation between the Veteran’s low back condition or left lower extremity neuropathy and active service, to include as due to Agent Orange exposure. As service connection for the Veteran’s lumbar spine condition has not been established, aggravation also has not been shown. As the preponderance of the evidence weighs against a nexus between the Veteran’s left lower extremity neuropathy and active service, to include as due to Agent Orange exposure, service connection is denied. In reaching this decision the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the appellant’s claim, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). N. RIPPEL Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. Whitaker, 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.