Citation Nr: 21026043 Decision Date: 04/29/21 Archive Date: 04/29/21 DOCKET NO. 20-30 324 DATE: April 29, 2021 ORDER Service connection for peripheral neuropathy of the right upper extremity, as secondary to service-connected diabetes, is granted. Service connection for peripheral neuropathy of the left upper extremity, as secondary to service-connected diabetes, is granted.   FINDINGS OF FACT 1. The Veteran’s right upper extremity peripheral neuropathy is proximately due to service-connected diabetes mellitus. 2. The Veteran’s left upper extremity peripheral neuropathy is proximately due to service-connected diabetes mellitus. CONCLUSIONS OF LAW 1. The criteria for service connection for right upper extremity peripheral neuropathy, as secondary to service-connected diabetes, are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 2. The criteria for service connection for left upper extremity peripheral neuropathy, as secondary to service-connected diabetes mellitus, are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1966 to July 1968. The matter is on appeal from a July 2016 rating decision. Although a June 2017 notice of disagreement (NOD) referenced an April 2017 rating decision, the NOD was timely as to the July 2016 rating decision. Thus, that is the rating decision on appeal. By rating decision in October 2020, service connection was granted for peripheral neuropathy of the right and left lower extremity secondary to service-connected diabetes. This represents a full grant of the benefits sought with respect to those issues. In April 2021, the Veteran testified at a Board hearing. 1. Service connection for peripheral neuropathy of the right upper extremity as secondary to service-connected diabetes mellitus. 2. Service connection for peripheral neuropathy of the left upper extremity as secondary to service-connected diabetes mellitus. Legal Criteria Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303. A veteran seeking compensation under these provisions must establish three elements: “(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.” Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may also be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. See 38 C.F.R. § 3.310. Where there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Discussion The Veteran seeks service connection for peripheral neuropathy of his right and left upper extremity. He maintains that his bilateral upper extremity peripheral neuropathy is proximately due to his service-connected diabetes. Lending credibility to the Veteran’s assertions is the October 2020 VA examination report reflecting a current diagnosis of peripheral neuropathy of the bilateral upper extremities, together with a September 2016 medical record reflecting that the Veteran had diabetes with neuropathy complications of the upper extremities. Moreover, and although the June 2016 VA examiner noted that clinical testing indicated neuropathy of the bilateral upper extremities was unrelated to diabetes, a January 2021 medical record reflecting diabetic peripheral neuropathy of the upper extremities associated with diabetes notes clinical test results suggestive of small fiber diffuse neuropathy that is likely secondary to diabetes. In addition, and although the October 2020 VA opinion attributes bilateral upper extremity symptoms to bilateral carpal tunnel syndrome with left ulnar neuropathy, noting no aggravation of peripheral neuropathy of the bilateral upper extremities beyond the natural progress by diabetes, there is no opinion in the claims file that the conditions cannot co-exist and/or that the presence of the other conditions precludes a relationship between the current peripheral neuropathy of the bilateral upper extremities and diabetes. Moreover, the October 2020 VA examination report states that diabetic peripheral neuropathy progresses with age and poor glucose control, and the Veteran’s laboratory results reflect high glucose. See October 2020 CAPRI documents. (Continued on the next page)   Further, and even though the April 2017 VA opinion indicates that it is less than likely that peripheral neuropathy of the upper extremities is related to diabetes, noting diabetic peripheral neuropathy is a symmetrical sensory neuropathy, and that the symptoms in the Veteran’s upper extremities exceeded those in the lower extremities, the October 2020 VA examination report reflects essentially the same symptom severity due to peripheral neuropathy of the bilateral upper and lower extremities. Resolving doubt in favor of the Veteran, the Board finds that the evidence supports the service connection claims. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Thus, service connection for peripheral neuropathy of the right and left upper extremity, as secondary to service-connected diabetes, is warranted. RYAN T. KESSEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Taylor 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.