Citation Nr: 21032207 Decision Date: 05/26/21 Archive Date: 05/26/21 DOCKET NO. 14-35 204A DATE: May 26, 2021 ORDER Service connection for peripheral neuropathy (PN) of the bilateral lower extremities (BLE) is granted. FINDINGS OF FACT 1. The Veteran had active service from June 1968 to May 1970; he is the recipient of the Combat Infantryman Badge. He has been 100 percent disabled since August 2016. 2. PN of the BLE was caused or permanently worsened in severity by service-connected diabetes mellitus (DM). CONCLUSION OF LAW PN of the BLE is caused or aggravated by a service-connected disability. 38 U.S.C. §§ 1110, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.310 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSION In April 2018, the Veteran testified before the undersigned Veterans Law Judge. A copy of the transcript has been associated with the claims file. In July 2018, the Board reopened the claim of entitlement to service connection for PN and remanded it for further development. The case has now been returned to the Board for further appellate action. Turning to the relevant laws and regulations, service connection may be granted on a secondary basis for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury under 38 C.F.R. § 3.310. Allen v. Brown, 7 Vet. App. 439 (1995). In order to establish service connection on a secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a link between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). The evidence reflects that the Veteran has a current diagnosis of PN of the right and left lower extremities. Therefore, he has a current diagnosis with regard to this claim, and the first element of service connection is met. In addition, service connection is in effect for DM. Accordingly, the criterion of a primary service-connected disability is met, and the second element of service connection on a secondary basis is met. As to a link between PN and DM, an April 2007 VA examination noted paresthesias in the fingertips present since 2002. DM was diagnosed in 2005, and the examiner attributed the neuropathy symptoms to alcohol use. However, subsequent medical evidence reflects neuropathy symptoms in the BLE. A January 2011 VA examiner diagnosed lower leg neuropathy, indicating that the symptoms had been present for four months. The examiner stated that the DM played a role in the neuropathy but was not the sole cause. In December 2011, a VA examiner noted a diagnosis of diabetic peripheral neuropathy but did not describe specific symptoms. A March 2012 VA examiner diagnosed mild PN indicating it was most likely service-connected, but also did not discuss specific symptoms. In June 2019, a VA examiner diagnosed diabetic PN of the BLE with symptoms of moderate intermittent pain, moderate dysesthesias/paresthesias, and moderate numbness in both the right and left legs. The examiner indicated that the etiology of the PN was multifactorial, but that DM played a role in the PN. In August 2019, the examiner provided an addendum opinion stating that PN symptoms pre-dated DM but that a baseline of symptomatology could not be determined without resorting to speculation. Taking all the evidence into consideration, it is at least as likely as not that PN of the BLE was caused or aggravated by his DM. While the June 2019 VA examiner could not establish baseline symptoms, the medical evidence shows that in 2007, the Veteran had numbness and tingling in his fingertips that pre-dated his DM, but no symptoms in the lower extremities were reported. The PN symptoms now include intermittent pain, paresthesias/dysesthesias, and numbness involving the lower extremities, as well as the upper extremities. Thus, the PN symptoms in the lower extremities both developed after DM and became worse when comparing the 2011 and 2019 examination findings. Further, it is established that the Veteran's DM has played a role in his PN symptoms. While nonservice-connected disorders, including hepatitis C and alcohol and cocaine use (as noted in the June 2019 VA examination), have also contributed to the PN symptoms, DM need not be the sole cause or aggravating factor for service connection to be warranted. Moreover, despite the other factors impacting the PN symptoms, the Veteran has been clinically diagnosed with diabetic peripheral neuropathy. Therefore, in light of the totality of the evidence, PN of the BLE is at least as likely as not caused or aggravated by service-connected DM. Accordingly, service connection for PN of the BLE is granted on a secondary basis. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. M. Schaefer, 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.