Citation Nr: 21028783 Decision Date: 05/12/21 Archive Date: 05/12/21 DOCKET NO. 16-30 852 DATE: May 12, 2021 ORDER Service-connection for peripheral neuropathy (PN) of the left lower extremity is denied. Service-connection for PN of the right lower extremity is denied. FINDING OF FACT The preponderance of the evidence is against finding that bilateral lower extremity PN began during active service or is otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for bilateral lower extremity PN are not met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active military service from August 1966 to August 1968, including service in the Republic of Vietnam. These claims are before the Board of Veterans' Appeals (Board) following a June 2015 rating decision by the Regional Office (RO). In November 2020, the Board remanded the claims for further development. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 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). The Veteran contends that he has PN in both of his lower extremities as a result of his active service, to specifically include exposure to herbicide agents while serving in the Republic of Vietnam (RVN). The Board concludes that, while the Veteran has a current diagnosis of bilateral lower extremity PN, and while the evidence shows that he served in RVN and was therefore exposed to Agent Orange, the preponderance of the evidence weighs against finding that the Veteran's current disability began during service or is otherwise related to service. If a veteran was exposed to an herbicide agent such as Agent Orange during active military, naval, or air service, certain diseases are presumed to be service connected if the requirements of 38 C.F.R. § 3.307(a)(6) are met, even though there is no record of the disease during service. 38 C.F.R. § 3.309(e). "Early onset peripheral neuropathy" is listed as a disease associated with exposure to herbicide agents. Several years ago, VA replaced the term "acute and subacute peripheral neuropathy" with the term "early onset peripheral neuropathy." See Disease Associated with Exposure to Certain Herbicide Agents: Peripheral Neuropathy, 78 Fed. Reg. 54763 (Sept. 6, 2013). Under the new version of the regulation, early onset PN must become manifest to a degree of 10 percent or more within one year after the date of last exposure to herbicides to qualify for the presumption of service connection. In the present case, the Veteran's PN was diagnosed in 2008, approximately 40 years after his discharge from service. Because PN was not diagnosed or symptomatic until decades after the Veteran's last exposure to Agent Orange, service connection cannot be granted on a presumptive basis. Service connection may still be established directly. However, the evidence does not include a competent medical opinion specifically linking current peripheral neuropathy to Agent Orange exposure. In September 2015, a podiatrist stated the neuropathy was from an unknown etiology, possibly agent orange exposure. The podiatrist recommended a consultation with a neurologist for further evaluation. The Board notes that the term "possibly" is speculative in nature; thus, the opinion expressed is of low probative value. See Polovick v. Shinseki, 23 Vet. App. 48 (2009) (holding doctor's statement that veteran's brain tumor "may well be" connected to Agent Orange exposure was speculative). In October 2015, a VA physician stated he believed neuropathy was only associated with agent orange exposure if the neuropathy presented at the time of exposure. No doctor has contradicted the October 2015 VA physician and others have cited him in subsequent medical records. This statement is in line with VA laws and regulations concerning neuropathy. Moreover, in November 2015, a VA physician characterized the neuropathy as idiopathic. Idiopathic is defined as "of unknown cause or spontaneous origin." Dorland's Illustrated Medical Dictionary at 912 (32nd ed. 2012). In November 2020, the Board remanded the claims in order to provide the Veteran with a VA examination to determine the etiology of his PN. The record reflects that the Veteran twice failed to attend scheduled examinations. When contacted by telephone regarding his failures to report, the Veteran stated that he did not wish to be examined for the disability and did not have any problem with neuropathy. See January 2021 Report of General Information. Neither he nor his representative have subsequently requested that the examination be rescheduled. The case must thus be decided based on the evidence of record. 38 C.F.R. § 3.655. To the extent that information may have been gained to the Veteran's benefit from the VA examination, VA made sufficient efforts to have him examined. The duty to assist is a two-way street, and the Veteran is responsible to assist VA in developing his claims. See Wood v. Derwinski, 1 Vet. App. 190 (1991). The Board has considered the Veteran's own assertions linking peripheral neuropathy to herbicide agent exposure. However, he has not demonstrated the necessary medical knowledge or expertise to provide a competent nexus opinion regarding this issue. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Therefore, service connection on a direct basis has not been established. Considering the pertinent evidence in light of the governing legal authority, the Board finds that the preponderance of the evidence is against the claims. In reaching this decision the Board considered the doctrine of reasonable doubt, however, the doctrine is not for application and the claims must be denied. JOHN Z. JONES Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Chalker, Phillip 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.