Citation Nr: 21026419 Decision Date: 05/03/21 Archive Date: 05/03/21 DOCKET NO. 20-25 206 DATE: May 3, 2021 ORDER Entitlement to service connection for diabetic peripheral neuropathy, bilateral lower extremities, is denied. FINDING OF FACT The preponderance of the evidence of record is against finding that the Veteran has had diabetic peripheral neuropathy at any time during or approximate to the pendency of the claim. CONCLUSION OF LAW The criteria for service connection for peripheral neuropathy, bilateral lower extremities, are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from October 1965 October 1968. This matter comes to the Board of Veterans' Appeals (Board) on an appeal from a December 2018 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In December 2020, the Board remanded the claim for further development. There has been substantial compliance with the remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c). 1. Entitlement to service connection for diabetic peripheral neuropathy, bilateral lower extremities, is denied. The Veteran contends that he has a current diagnosis of diabetic peripheral neuropathy as secondary to his service-connected diabetes mellitus. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) 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 in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Service connection may be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury, or is otherwise related to service. 38 C.F.R. § 3.310. The question for the Board is whether the Veteran has a current disability that is proximately due to or the result of, or is aggravated beyond its natural progress by a service-connected disability. The Board concludes that the Veteran does not have a current diagnosis of diabetic peripheral neuropathy of the lower extremities and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The Veteran's service treatment records (STRs) do not show any complaint or treatment for diabetic peripheral neuropathy or radiculopathy, or any related symptoms. A review of the Veteran's VA treatment records dated from September 2005 to January 2021 does not show any complaint of, treatment for, or a diagnosis of diabetic peripheral neuropathy or symptoms related to it. Similarly, the Veteran's private treatment records from RCS Client Information Record dated in May 2013 and Diabetes Mellitus Type II Doctor's Questionnaire from Dr. L.M. in July 2009 were without complaint or treatment of diabetic peripheral neuropathy. His VA treatment records dated from September 2005 to January 2021 reveal lumbar radiculopathy. In an August 2020 emergency room record, the Veteran reported pain in the left leg that started from the lower back and radiated to left groin and thigh. The diagnoses were lumbar radiculopathy and degenerative joint disease (DJD) of lumbar spine and left hip. An August 2020 VA treatment record noted assessments of scoliosis of the spine, lower lumbar DJD progression, and left hip DJD. His private treatment records did not reveal any radiculopathy. The Veteran received a VA examination in December 2018 that was found by the Board in December 2020 to be inadequate. As such, the Board will not discuss the examiner's findings or opinion. The Board, however, does note that the Veteran reported neuropathy symptoms started in 2011. The Veteran reported restless leg symptoms occur at night which has worsened over the last several years. He reported he takes Prazosin and Sertraline. He denied bilateral extremity pain. In a November 2019 VA examination report for diabetes mellitus, the examiner noted that the Veteran did not have diabetic peripheral neuropathy. In a January 2021 VA examination report for peripheral nerves conditions, the Veteran reported unknown onset of leg pains and "feet dancing." The Veteran was diagnosed with bilateral lumbar radiculopathy. There was no diagnosis of diabetic peripheral neuropathy for the upper or lower extremities. The examiner noted the Veteran did not have any symptoms attributable to any peripheral nerve conditions. Upon examination, the Veteran's right ankle plantar flexion displayed active movement against some resistance, and his right ankle was hypoactive. Sensory exam showed deceased senses in bilateral thighs and right foot/toes. The examiner noted there was mild, incomplete paralysis of the cutaneous nerve of the bilateral thighs. The examiner noted that the Veteran's condition did not impact his ability to work. The examiner opined that it is less likely as not that any diagnosed peripheral neuropathy of the upper and/or lower extremities was caused or aggravated by the Veteran's service-connected diabetes mellitus. The examiner explained that the Veteran has not been diagnosed with diabetic neuropathy, and that he did not have typical symptoms of diabetic neuropathy. The examiner noted that the Veteran has a diagnosis of lumbar radiculopathy which originates from the spine, and not due to his service-connected diabetes. The examiner noted that the Veteran had normal neurological exam of the feet with no signs or symptoms of neuropathy at his last visit for podiatry, and that there was no record of a diagnosis or treatment for diabetic neuropathy in his primary care physician records. The examiner added that the Veteran's blood sugars are well controlled. The Board concludes that the Veteran does not have a current diagnosis of diabetic peripheral neuropathy in the upper or lower extremities and has not had one at any time during the pendency of the claim or recent to the filing of the claim. See Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The December 2020 VA examiner evaluated the Veteran and determined that he did not have a diagnosis of diabetic peripheral neuropathy in the upper or lower extremities, nor any typical symptoms of it. The November 2019 VA examiner also noted that there was no diagnosis of diabetic peripheral neuropathy. The Board acknowledges that the January 2021 examiner noted diagnosis of bilateral lumbar radiculopathy. However, his STRs are silent for any complaint or diagnosis of lumbar radiculopathy or related symptoms. Further, the January 2021 examiner noted that the Veteran's lumbar radiculopathy originated from the spine, and not due to his service-connected diabetes. The Veteran has not been service-connected for a spine disability. The Board is mindful of Saunders v. Wilkie, 886 F.3d 1356, 1364-65 (Fed. Cir. 2018) in which the Federal Circuit held that "pain alone, without an accompanying diagnosis of a present disease, can qualify as a disability" if it "reaches the level of a functional impairment of earning capacity." Id. at 1367-69. However, in this case, there is no showing of impaired earning capacity due to a neuropathy disorder that is related to service or a service-connected disability. While the Veteran believes he has a current diagnosis of a diabetic peripheral neuropathy that is secondary to his diabetes, he is not competent to provide a diagnosis or nexus in this case. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body and the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the VA examiners' findings. The preponderance of the evidence is against the claim; there is no doubt to be resolved. Service connection for diabetic peripheral neuropathy, bilateral lower extremities, is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. TRACIE N. WESNER Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Jake Choi 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.