Citation Nr: 21041783 Decision Date: 07/10/21 Archive Date: 07/10/21 DOCKET NO. 16-04 491 DATE: July 10, 2021 ORDER Entitlement to service connection for left lower extremity neuropathy is denied. Entitlement to service connection for right lower extremity neuropathy is denied. FINDINGS OF FACT 1. There is no current diagnosis of peripheral neuropathy of the left lower extremity. 2. There is no current diagnosis of peripheral neuropathy of the right lower extremity. CONCLUSIONS OF LAW 1. The criteria for service connection for peripheral neuropathy of the left lower extremity are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.304. 2. The criteria for service connection for peripheral neuropathy of the right lower extremity are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.304. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the Army from October 2013 to October 2014 and on active duty for training (ACDUTRA) from June 2011 to October 2011. These matters come before the Board of Veterans' Appeals (Board) on appeal from a May 2015 rating decision by the St. Paul, Minnesota Regional Office (RO) of the United States Department of Veterans Affairs. These issues were previously before the Board in April 2019 at which time they were remanded for additional development. Duty to Notify and Assist VA has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C. §§ 5100, 5102, 5103, 5103A, 5107, 5126; 38 C.F.R. §§ 3.102, 3.159, 3.326(a). These duties have been satisfied in this case. Appropriate notice was provided in Fully Developed Claim Form filed by the Veteran in January 2015. The RO associated the Veteran's service and VA private outpatient treatment records with the claims file. All released or submitted private treatment records have been associated with the claims file. No other relevant records have been identified and are outstanding. Appropriate and necessary examinations were afforded the Veteran, and are adequate for evaluation, as they include needed findings to permit application of the rating schedule and identification of current disability. As such, VA has satisfied its duty to assist with the procurement of relevant records. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c). Neither the Veteran nor her representative have raised any issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016). Service Connection Service connection may be established for disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty, in the active military, naval, or air service. 38 U.S.C. §§ 1110, 1131. Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In order to establish service connection on a direct basis, the record requires competent evidence showing: (1) the existence of a present disability; (2) in service incurrence or aggravation of an injury or disease; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). In the absence of proof of a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Competent medical evidence is evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. Competent medical evidence may also include statements conveying sound medical principles found in medical treatises. It also includes statements contained in authoritative writings, such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159(a)(1). Competent lay evidence is any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a)(2). This may include some medical matters, such as describing symptoms or relating a contemporaneous medical diagnosis. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). A layperson is generally not capable of opining on matters requiring medical knowledge. Routen v. Brown, 10 Vet. App. 183, 186 (1997). See also Bostain v. West, 11 Vet. App. 124, 127 (1998). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence, the benefit of the doubt is afforded the claimant. Peripheral Neuropathy, Bilateral Lower Extremities The Veteran asserts she has peripheral neuropathy of the bilateral lower extremities that is related to her time in service to include as due to her service-connected lumbar strain. The Veteran's service treatment records (STRs) are negative for treatment for symptoms of peripheral neuropathy of the lower extremities and/or for a diagnosis of this condition in service. At a March 2015 VA general medical examination, a VA hip and thigh examination, and a VA back examination, no peripheral neuropathy of the lower extremities was reported or documented. VA treatment records are negative for treatment for and/or a diagnosis of peripheral neuropathy of the bilateral lower extremities. I 2017, she did report radiation of pain to the legs, particularly the left, in association with a flare-up of back problems. In its April 2019 remand, the Board directed the Veteran should be scheduled for a VA examination to determine the nature and etiology of any right or left lower extremity neuropathy, to include and opinion as to whether it is at least as likely as not that any diagnosed neuropathy is proximately due to or the result of a service connected disease or injury or aggravated by a service-connected disease or injury. The Veteran underwent a peripheral nerves examination in December 2019. The Veteran reported onset of back pain with episodes of flare-ups associated with sciatica pain in buttocks and legs bilaterally, which occurred 1 to 2 times per month and usually lasted for 3 to 6 days. The Veteran was diagnosed with sacroiliitis which was treated with cortisone injection. She was service connected for lumbosacral strain. Subjective complaints included intermittent numbness and tingling sensation in the lower extremities, usually after prolonged sitting or driving over 30 minutes and lasted for about 30 minutes to an hour. She reported the numbness and tingling was not associated with the sciatica pain. She takes gabapentin daily for pain. Symptoms included moderate intermittent pain, mild paresthesias and/or dysesthesias, and mild numbness in the bilateral lower extremities. Muscle strength and reflex examination results were normal. Gait was normal. Sciatic nerves were normal bilaterally, as were all other nerve groups of the bilateral lower extremities. The VA examiner determined that it was less likely than not that the Veteran's claims condition was caused by the claimed in-service injury, event, or illness. The VA examiner noted that the Veteran reports a history of intermittent sciatica pain, the symptoms were related to the flare-up of her sacroiliitis, and probably caused by intermittent irritation of sciatic nerve while during the acute inflammation of the sacroiliitis phase. The VA examiner determined that "the sciatic pain is part of the symptoms of her sacroiliitis, and probably caused by intermittent irritation of sciatic nerve while during acute inflammation of the sacroiliitis phase. Therefore, the sciatic pain is part of the symptoms of sacroiliitis; rather than a separate diagnosis of peripheral neuropathy condition." Additionally, "on the exam, she has no symptoms and the examination was normal. Previously documents also showed symptoms and exam were not enough to diagnose radiculopathy of the lower extremity. Therefore, the diagnosis of peripheral neuropathy or radiculopathy cannot be established based on the history and current exam. There is no evidence to support that those symptoms are caused by right and left leg pain during service." An August 2020 VA contract examination of the back also indicated that the reported neurological symptoms of the legs were related to sacroiliitis, and not the low back disability. No neuropathies or radiculopathies were found on examination. As outlined above, the medical evidence does not reveal a diagnosis of peripheral neuropathy of the bilateral lower extremities, or of any neurological manifestation of the low back, to include radiculopathies. Although the Veteran believes she has peripheral neuropathy, her lay statements are outweighed by medical opinions and objective testing. Where the evidence does not support a finding of current disability upon which to predicate a grant of service connection, there can be no valid claim for that benefit. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The Board finds that the evidence weighs against a finding of a current disability and service connection must therefore be denied. WILLIAM H. DONNELLY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Margaret M. Lunger 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.