Citation Nr: 21032670 Decision Date: 05/27/21 Archive Date: 05/27/21 DOCKET NO. 14-04 974 DATE: May 27, 2021 ORDER Service connection for a bilateral hand condition, to include Raynaud's disease and neuropathy, claimed as numbness in both hands, is denied. FINDINGS OF FACT 1. The preponderance of the competent evidence of record does not support a direct connection between any in-service injury, disease, or event, to include exposure to herbicide agents, and the Veteran's diagnosed bilateral Raynaud's disease and neuropathy of the hands. 2. The preponderance of the evidence of record does not support that the Veteran's diagnosed bilateral Raynaud's disease or neuropathy of the hands manifested to a compensable degree within a year of separation from service. CONCLUSION OF LAW The criteria for service connection for a bilateral hand condition, to include Raynaud's disease and neuropathy, have not been met. 38 U.S.C. § 1110; 38 U.S.C. §§ 3.303(b), 3.307(a), 3.309(a), (e). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from April 1968 to April 1970. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2012 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In October 2020, the Board remanded the claim for an addendum medical opinion. Because the directives of the prior decision have been complied with, the Board may now adjudicate the claim on the merits. Dyment v. West, 13 Vet. App. 141, 14647 (1999); Stegall v. West, 11 Vet. App. 268, 271 (1998). The Veteran seeks service connection for a bilateral hand condition, claimed as numbness in both hands. Service connection may be established for disability resulting from personal injury suffered or disease contracted in the line of duty in the active military, naval, or air service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Establishing service connection generally requires evidence of (1) a current disability, (2) an in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the claimed in-service event, injury, or disease and the present injury or disease. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Additionally, service connection may be presumed if a chronic disease manifests itself and is identified as such in service, or within the presumptive period of one year under 38 C.F.R. § 3.307, and the Veteran presently has the same condition, unless the condition is clearly attributable to intercurrent causes. 38 U.S.C. § 1112; 38 C.F.R. §§ 3.307(a), 3.309(a); see Walker v. Shinseki, 708 F.3d 1331, 1336 (Fed. Cir. 2013). Alternatively, under 38 C.F.R. § 3.303(b) service connection is available for continuity of symptomatology of a chronic disease listed in 38 C.F.R. § 3.309(a). See Walker, 708 F.3d at 1331. Raynaud's disease and peripheral neuropathy, which is an organic disease of the nervous system, are among the chronic diseases listed in 38 C.F.R. § 3.309(a). Moreover, for Veterans exposed to an herbicide agent during service, service connection may be presumed for early-onset peripheral neuropathy, defined as peripheral neuropathy that manifests to a compensable degree within one year after the last date on which the Veteran was exposed to an herbicide agent. 38 C.F.R. §§ 3.307(a)(6)(ii), 3.309(e). In this case, the evidence shows that the Veteran served in the Republic of Vietnam, and therefore he is presumed to have been exposed to herbicide agents. 38 C.F.R. § 3.307(a)(6)(iii). Turning to the evidence, the Veteran's January 1967 entrance examination found him in normal condition, and at an April 1968 periodic examination he was likewise found in normal health. The Veteran's separation examination unfortunately has been found unavailable. In the present February 2011 claim for service connection for numbness in both hands, the Veteran wrote that the condition "originally started in 1970 or 1971 with the ring finger on the l[eft] hand [and] has since spread to both hands." The Veteran submitted an August 2015 letter from a private provider diagnosing the Veteran with "vasospastic arterial disease, possibly Raynaud's phenomenon, and polyneuropathy syndrome with cervical spine degenerative disc disease." Private treatment records from another provider recorded a history of Raynaud's disease in both hands, reportedly for "several years, a 'long time.'" In his February 2014 substantive appeal the Veteran stated that he is suffering from peripheral neuropathy of the upper extremities, "not Raynaud's syndrome," and that the peripheral neuropathy "is caused by Agent Orange exposure." On August 19, 2015, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. The Veteran related that in service he "only had one or two fingers that would get a little bit numb" but that the condition never went away and instead worsened after service, affecting fingers more and more through the years. A VA examination was provided in August 2016. The examiner diagnosed vasospastic artery disease and polyneuropathy syndrome with cervical degenerative disc disease. The Veteran described that during service his left-hand ring finger would become white and would become symptomatic "in cool weather in the fall." After service he had a career as a plumber for 50 years, a job that required hand tools including jackhammers and sewer machines. The examiner remarked that polyneuropathy, which is "interchangebl[e] with 'peripheral neuropathy,'" could be nerve damage, which can "occur with use in hand tools," or could be related to the Veteran's reported occupational exposure to drain cleaner in 1999. Overall, the examiner opined that the Veteran's hand condition is "more likely a result of factors that include civilian occupational exposures, repetitive-use hand tools, and degenerative neck condition that can compress some nerves, and possibly [vitamin] B12 deficiency." Following the Board's prior October 2020 decision, addendum VA opinions were provided in November 2020 and December 2020. The clinician acknowledged the Veteran's report of tingling and numbness in his hands during service but also noted that there were no service records with further details about the symptoms or any descriptions of circumstances that may have contributed to the condition. Combined with the absence of any intercurrent medical records for over 40 years since service, the clinician found it was less likely than not that the Veteran's condition was incurred in service. Rather, the clinician noted the Veteran's 50-year career as a plumber and that use of hand-vibrating tools is a common occupational activity associated with developing Raynaud's disease, and that neuropathy is a condition that requires more than reports of symptoms of numbness and tingling alone to confirm. Moreover, the clinician noted imaging studies that "confirmed D[egenerative] D[isc] D[isease] encroaching on neural foramina" in the cervical spine. Based on the totality of the evidence and the Veteran's reports and medical history, the clinician found it less likely than not that either Raynaud's disease or neuropathy were incurred in service, within one year of separation, or are directly related to service. Based on all the evidence of record, the Board finds that the preponderance of the competent evidence is against a connection to service. The August 2016, November 2020, and December 2020 opinions together establish that polyneuropathy and Raynaud's conditions are less likely than not related to service, to include the in-service event of presumed herbicide-agent exposure. The etiology opinions were based on review of the Veteran's complete medical history, the medical literature, and the Veteran's own statements about his in-service numbness in his left-hand ring finger. The Board finds that these opinions are the most probative evidence of record; the Veteran's belief that his condition is related to herbicide exposure, as contended in his February 2014 substantive appeal, is noted, but the Veteran has not presented evidence that he has the education, training, or experience to opine on the etiology of his hand condition, which is a medically complex issue beyond observation by the senses. Layno v. Brown, 6 Vet. App. 465, 470 (1994). The Board notes that in addition to finding that there was less likely than not a direct relationship between the Veteran's current hand conditions and any in-service condition, the clinicians indicated that the Veteran's current condition may be associated with his occupational experiences in his post-service career or with a non-service-connected condition of the cervical spine. The Board further finds that the evidence is insufficient to establish a presumed connection to service. As explained above, a connection to service for both Raynaud's disease and neuropathy may be presumed only where there is sufficient evidence of manifestation to a compensable degree within one year after service. 38 C.F.R. § 3.307(a)(3), (6)(ii). Here, the Board finds, as also noted in the VA opinions, that the preponderance of the evidence fails to support that the Veteran's condition manifested to a compensable degree within one year of his service. The Board acknowledges, as the most recent VA opinions did, that the Veteran had numbness and tingling in his left-hand ring finger around 1970 or 1971. However, the Board does not find this evidence alone would be sufficient to support a compensable rating for the manifestation at that time, and the Board moreover finds that there is insufficient evidence to establish a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity. Id.; 38 C.F.R. § 3.303(b). Accordingly, a presumed connection to service cannot be established for Raynaud's disease or neuropathy, either as chronic diseases or as related to herbicide exposure. 38 C.F.R. § 3.307(a)(3), (6)(ii). (Continued on the next page) Thus, because the preponderance of the evidence is against a connection to service, the claim for service connection for a bilateral hand condition, to include Raynaud's disease and neuropathy, must be denied. 38 U.S.C. § 1110; 38 U.S.C. §§ 3.303(b), 3.307(a), 3.309(a), (e). K. Parakkal Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Davis, Associate 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.