Citation Nr: 21040174 Decision Date: 07/02/21 Archive Date: 07/02/21 DOCKET NO. 18-08 399 DATE: July 2, 2021 ORDER Entitlement to service connection for truncal neuropathy as due to service-connected diabetes mellitus type II is granted. FINDING OF FACT The Veteran's truncal neuropathy is proximately due to his service-connected diabetes mellitus type II. CONCLUSION OF LAW The criteria for service connection for truncal neuropathy as secondary to diabetes mellitus type II are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1966 to September 1970. This matter comes to the Board of Veterans' Appeals (Board) on appeal from an October 2017 rating decision by the Regional Office (RO) of the Department of Veterans Affairs (VA). The Veteran presented testimony at a Board hearing in December 2020. A transcript of the hearing is associated with the Veteran's claims folder. Entitlement to service connection for truncal neuropathy as due to service-connected diabetes mellitus type II. The Veteran asserts that he has a current diagnosis of truncal neuropathy that was caused by 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 also be granted for a disability that is proximately due to or was aggravated by a service-connected disease or injury. 38 C.F.R. § 3.310. Establishing secondary service connection requires evidence of: (1) a current disability (for which secondary service connection is sought); (2) a service-connected disability; and (3) that the current disability was either caused or aggravated by the service-connected disability. 38 C.F.R. § 3.310 (a); see also Allen v. Brown, 7 Vet. App. 439 (1995). The question for the Board is whether the Veteran's truncal neuropathy is proximately due to or the result of his diabetes mellitus type II, or was aggravated beyond its natural progress by his diabetes mellitus type II. On this question there are probative opinions in favor of and against the claim. The evidence against the claim includes a September 2016 VA examination, wherein a VA examiner opined that the Veteran's pain in his abdomen is not related to diabetes mellitus type II. In rendering this opinion, the examiner indicated that he knows "of no medical process whereby [] diabetes would preferentially impact dermatomes on his abdomen in the manner described." (9/20/2016, C&P Exam, p. 10). The evidence in favor of the claim includes a March 2016 VA examination wherein a VA examiner opined that the Veteran has polyradiculopathy that is due to diabetic neuropathy. The March 2016 VA examiner noted that the Veteran has pain in his "lateral sides" which radiates into his legs and that on occasion his polyradiculopathy causes breathing problems. (3/30/2016, C&P Exam, p. 14, 20). Additionally, in a September 2017 letter, the Veteran's private endocrinologist opined that the Veteran has two forms of diabetic neuropathy, distal symmetric polyneuropathy and focal neuropathy, which he indicated was "from" diabetes. (10/2/2017, Medical Treatment Record, p. 1). The private endocrinologist's opinion is supported by the Veteran's private medical records from Loma Linda University Health Care. These records indicate that the Veteran was seen by the Division of Endocrinology and was diagnosed with diabetes and two types of neuropathy. (3/20/2018, Medical Treatment Record, p. 8). The Veteran also submitted private medical records from his general care provider which noted "stocking-type neuropathy of his feet," and "truncal neuropathy on his right and left sides." The assessment rendered at the time was diabetic neuropathy, unspecified. (9/25/2019, Medical Treatment Record, p. 1-2). The probative value of medical opinion evidence is based on the medical expert's personal examination of the patient, the physician's knowledge and skill in analyzing the data, and the medical conclusion that the physician reaches. Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). Whether a physician provides a basis for his or her medical opinion goes to the weight or credibility of the evidence in the adjudication of the merits. See Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998). Other factors for assessing the probative value of a medical opinion are the physician's access to the claims folder and the thoroughness and detail of the opinion. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000); Nieves-Rodriguez, 22 Vet. App. 295 (2008); Prejean v. West, 13 Vet. App. 444, 448-9 (2000). Here, the March 2016 VA opinion and the September 2017 opinion from the Veteran's private endocrinologist were provided by medical professionals who possess the necessary education, training, and expertise to provide the requested opinions. Additionally, the opinion is also shown to have been based on a review of the Veteran's record and is accompanied by a sufficient explanation as to why the Veteran's truncal neuropathy was caused by his service-connected diabetes. Conversely, the September 2016 VA examiner's opinion is inconsistent with the Veteran's medical records and the medical treatises the Veteran submitted. Specifically, the examiner indicated that he knew of no medical process whereby diabetes would cause pain in a belt-like distribution below the Veteran's ribs; however, as previously mentioned, the Veteran's private medical records clearly establish a diagnosis of truncal neuropathy and the medical treatises submitted by the Veteran indicate that diabetic truncal neuropathy should be considered in patients with diabetes who have a painful abdominal mass. (9/25/2019, Correspondence, p. 1). The September 2016 VA examiner's failure to consider evidence which contradicts his conclusion, renders his opinion inadequate for evaluation purposes. The Board thus places more probative weight on the March 2016 VA opinion and the September 2017 private medical opinion. Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran's current truncal neuropathy is proximately due to his service-connected diabetes. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for truncal neuropathy is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Eric S. Leboff Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Glenn, 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.