Citation Nr: 21042011 Decision Date: 07/11/21 Archive Date: 07/11/21 DOCKET NO. 16-45 278 DATE: July 11, 2021 ORDER Entitlement to service connection for median nerve neuropathy, also referred to as peripheral neuropathy, is denied. REMANDED Entitlement to service connection for a lung condition is remanded. FINDING OF FACT The probative evidence of record does not show that the Veteran's neuropathy is related to his active duty service. CONCLUSION OF LAW The criteria for service connection for median nerve neuropathy have not been met. 38 U.S.C. §§ 101, 1131; 38 C.F.R. §§ 3.6, 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served in the United States Army from August 1969 to August 1971. In October 2019, the Veteran was provided a hearing with the undersigned Veteran's Law Judge and a transcript of the proceeding is of record. In January 2020, the claims were brought before the Board and were remanded for further development. Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). In order to establish service connection, the record must show competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d, 1362, 1366 (Fed. Cir. 2009). When considering such a claim for service connection, the Board must consider on a case-by-case basis, the competence and sufficiency of lay evidence offered to support a finding of service connection. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (quoting Jandreau v. Nicholson, 492 F.3d 1372, 1377 Fed. Cir. 2007)). The mere conclusory or generalized lay statements that a service event or illness caused a current disability are insufficient. Waters v. Shinseki, 601 F.3d 1274, 1278 (2010). The law provides that diseases associated with exposure to certain herbicide agents used in support of military operations in the Republic of Vietnam (Vietnam) during the Vietnam era will be considered to have been incurred in service. 38 U.S.C. § 1116(a)(1); 38 C.F.R. § 3.307(a)(6). A veteran is presumed to have been exposed to herbicides if he or she served in Vietnam between January 9, 1962, and May 7, 1975, unless there is affirmative evidence to establish that the Veteran was not exposed to any such agent during that service. 38 U.S.C. § 1116(f); 38 C.F.R. § 3.307(a)(6)(iii). The presumption of service connection requires exposure to an herbicide agent and manifestation of the disease to a degree of 10 percent or more within the time period specified for each disease. Entitlement to Service Connection: Neuropathy The Veteran contends that his neuropathy is related to his active duty service, to include as due to Agent Orange exposure. As an initial matter, the Board acknowledges that the Veteran has been diagnosed with general peripheral neuropathy. Further, the Veteran had qualifying service in the Republic of Vietnam, and therefore, exposure to Agent Orange is presumed. Thus, the issue turns upon whether there is evidence of a nexus between the said in-service event or injury and the present diagnosed disability. See 38 C.F.R. § 3.303; Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The Board finds there is not. In March 2020, the Veteran was provided a VA examination. The examiner opined that it was less likely than not that the Veteran's condition had its onset during or is otherwise related to his active duty service. The examiner noted that the Veteran's symptomatology is more consistent with bilateral peripheral neuropathy than median nerve neuropathy. The examiner then rationalized that the Veteran has diffuse peripheral neuropathy that is more consistent with diabetic neuropathy, although he has not yet been diagnosed with diabetes. The examiner explained that the symptoms suggest potential diabetes and the Veteran should be tested for such. The Board notes that VA treatment records show notations of potential median nerve neuropathy and general neuropathy. However, none of the records relate the Veteran's condition to his active duty service, to include his presumed Agent Orange exposure. The Board also notes that the Veteran has not been officially diagnosed with diabetes nor has the Veteran submitted a claim for diabetes. Therefore, the Board finds the March 2020 VA opinion to be of significant probative value in determining that the Veteran's neuropathy condition is not related to his active service. The Board notes that the probative value of medical opinion evidence is based on the medical experts' personal examination of the patient, their knowledge, and skill in analyzing the data, and their medical conclusion. As is true with any piece of evidence, the credibility and weight to be attached to these opinions are within the province of the adjudicator. 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). Here, the reviewing physician's opinion was based on review of the Veteran's lay contentions, his reported medical history, and review of the medical evidence of record. Further, a complete and thorough rationale was provided for the opinion rendered and is consistent with the medical evidence of record. The Board acknowledges the Veteran's assertions that his neuropathy is related to his active duty service. The Board also recognizes that lay persons are competent to provide medical opinions on some medical issues. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). However, although the Veteran is competent to report his symptoms, any opinion regarding whether any neuropathy disability is related to his service, to include exposure to Agent Orange, requires medical expertise that the Veteran has not demonstrated since neuropathy disabilities can have many causes. See Jandreau v. Nicholson, 492 F.3d 1372, 1376 (2007). Further, the Board again notes that the examiner found the Veteran's neuropathy is more likely due to an undiagnosed diabetes condition, which the Veteran has not sought service connection for. The Board acknowledges that early onset peripheral neuropathy is to be considered for presumption purposes under 38 C.F.R. §§ 3.307(a), 3.309(e). However, the evidence of record does not show complaints for numbness and tingling in the Veteran's hands until 2012. Therefore, consideration under presumption purposes is not warranted. In light of the foregoing, the Board concludes that the preponderance of evidence is against the claim and the benefit of the doubt doctrine is not for application. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F.3d 1361 (Fed Cir. 2001). REASONS FOR REMAND Although the Board sincerely regrets further delay, another remand is necessary to afford the Veteran every possible consideration for his remaining claim. Entitlement to Service Connection: Lung Condition The Veteran contends that he currently suffers from a lung condition that is related to his active duty service, to include as due to exposure to herbicides. The Veteran was provided a VA examination in March 2020. The examiner diagnosed the Veteran with herbicide-induced pulmonary pneumonitis with residual exertional dyspnea. The examiner opined that the Veteran's condition was less likely than not related to his active duty service. However, the examiner did not provide a rationale. In August 2020, an addendum opinion was obtained. The examiner again opined that the condition less likely than not had its onset during or is otherwise related to his active duty service, to include his presumed exposure to Agent Orange. The examiner rationalized that the Veteran's March 2020 test did not demonstrate any significant abnormality and the CXR only showed hilar adenopathy. The Board finds the August 2020 opinion is inadequate to fairly adjudicate the claim. The examiner opined that the Veteran's condition was not related to his service due to March 2020 testing showing no abnormalities. However, in the March 2020 examination, the examiner noted the March 2020 diagnostic testing showed severe increased bilateral interstitial lung markings. The examiner also noted the Veteran had recurrent exertional dyspnea secondary to interstitial lung disease. Moreover, the Veteran's records show the Veteran was previously diagnosed with lung infection and lobectomy. Thus, the examiner should have considered all of the above noted diagnoses in the opinion provided. The matters are REMANDED for the following action: 1. Obtain and associate with the Veteran's electronic claims file any outstanding VA and private treatment records relevant to the Veteran's claimed condition. 2. Send the claims file to an appropriate examiner to determine the etiology of the Veteran's lung condition. The claims file should be reviewed in conjunction with the examination a copy of this remand should be provided to the examiner. Following a review of the entire record, the Veteran's competent lay statements, as well as the Veteran's report regarding the onset and progression of his current symptomatology, the examiner should opine whether it is at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran's lung condition, to include the noted interstitial lung disease, lobectomy, and lung infection, had its onset during, or is otherwise related to, his active duty service, to include his presumed exposure to Agent Orange/herbicides. A complete rationale for all opinions expressed should be provided and must not be based solely on the lack of any in-service records. If the examiner is unable to provide an opinion without resort to speculation, he/she should explain whether the inability is due to the limits of the examiner's medical knowledge, medical knowledge in general or there is evidence that, if obtained, would permit the opinion to be provided. JENNIFER HWA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Negron, Jasmine 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.