Citation Nr: 21051072 Decision Date: 08/18/21 Archive Date: 08/18/21 DOCKET NO. 18-29 142 DATE: August 18, 2021 ORDER Entitlement to service connection for neuropathy of the right hand, as secondary to unspecified trauma and stressor disorder, major depressive disorder, and alcohol use disorder, is granted. Entitlement to service connection for neuropathy of the left hand, as secondary to unspecified trauma and stressor disorder, major depressive disorder, and alcohol use disorder, is granted. FINDINGS OF FACT 1. The Veteran's neuropathy of the right hand is proximately due to unspecified trauma and stressor disorder, major depressive disorder, and alcohol use disorder. 2. The Veteran's neuropathy of the left hand is proximately due to unspecified trauma and stressor disorder, major depressive disorder, and alcohol use disorder. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for neuropathy of the right hand, as secondary to unspecified trauma and stressor disorder, major depressive disorder, and alcohol use disorder, are met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.301, 3.310. 2. The criteria for entitlement to service connection for neuropathy of the left hand, as secondary to unspecified trauma and stressor disorder, major depressive disorder, and alcohol use disorder, are met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.301, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from July 1978 to July 1983. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2016 rating decision by an agency of original jurisdiction (AOJ) of the Department of Veterans Affairs (VA). In June 2019, the Board in relevant part denied entitlement to service connection for an acquired psychiatric disorder and a disability manifested by tingling of the left and right hands. The Veteran appealed the June 2019 Board decision to the United States Court of Appeals for Veterans Claims (CAVC). In an April 2020, the CAVC granted a Joint Motion for Partial Remand (JMPR) submitted by the Veteran and the Secretary of Veterans Affairs (Parties), vacated the June 2019 Board decision insofar as it denied entitlement to service connection for an acquired psychiatric disorder and a disability manifested by tingling of the left and right hands, and remanded that matter to the Board for compliance with the JMPR instructions. The Parties to the JMPR agreed that the Board erred by failing to ensure that the duty to assist was met with respect to the claim for an acquired psychiatric disorder. The Parties also agreed that the claims for disabilities manifested by tingling of the right and left hands was intertwined, as the evidence indicates that the Veteran has a diagnosis of chronic alcohol neuropathy and this "this has likely also been affecting his hands." See April 2020 JMPR at 5. In March 2021, the Board granted entitlement to service connection for unspecified trauma and stressor disorder, major depressive disorder, and alcohol use disorder. The Board remanded the issue of secondary service connection for neuropathy of the left and right hands to provide the Veteran an examination and secure a medical opinion. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. See 38 C.F.R. § 3.303. Direct service connection may be granted for claims that were incurred in the line of duty, and not the result of the veteran's own willful misconduct or, for claims filed after October 31, 1990, the result of his or her abuse of alcohol or drugs. See 38 C.F.R. § 3.301. Secondary service connection may be granted for a disability that is proximately due to or aggravated by a service-connected disability. See 38 C.F.R. § 3.310. Here, the theory of entitlement is that the Veteran's neuropathy is secondary to alcohol use disorder. While direct service connection for a disability to a veteran's willful misconduct may not be granted, secondary service connection may be granted for a disability due to service-connected alcohol use disorder. In June 2021, the AOJ afforded the Veteran a VA peripheral nerves examination. The examiner determined that the Veteran did not have a diagnosed peripheral nerve condition. The examiner noted that there was no formal EMG testing of record, and there were no objective motor or sensory deficits, and no significant reflex abnormalities documented on the current examination or in previous examinations to suggest nerve involvement as the etiology of the Veteran's subjective complaints. The examiner explained that the Veteran's symptoms were most likely due to arthritis. See June 2021 VA Peripheral Nerves Examination Report. Initially, the Board observes that the June 2021 examination was the first Compensation & Pension examination of record, and thus the examiner's reference to the lack of positive evidence at "prior examinations" is puzzling. Additionally, a current disability may constitute a disability manifest during an earlier period on appeal, even if that disability has since resolved. Moreover, there is no requirement for objective evidence of neurological impairment by EMG testing. The Veteran's VA treatment records are probative evidence in favor of the claim. The Veteran has long carried a diagnosis of alcohol-related neuropathy of the hands. See, e.g., March 2, 2018 VA Treatment Note (noting chief complaint of "neuropathy" and noting burning and cramping with pins and needles in his lower extremities and hands). Indeed, the Veteran's VA treatment notes reflect "severe peripheral neuropathy, likely alcohol related" and indicated that "neurology did not want to see the patient, agreed with the diagnosis of alcohol causing neuropathy." See April 1, 2019 VA Treatment Note. Here, there is probative evidence both for and against the claim. The record reflects a difference of medical judgment between the June 2021 VA examiner and the Veteran's primary care clinicians. However, neither the Veteran's VA primary care clinicians nor the June 2021 examiner are neurologists. While the VA neurologist declined to see the Veteran, the neurologist agreed with the diagnosis of alcohol causing neuropathy. While there is evidence both for and against the claim, the opinion of the VA neurologist of neuropathy due to alcohol tips the balance in favor of the Veteran. To the extent that there is any reasonable doubt in this question, the Board resolves it favor of the Veteran. Accordingly, the appeal is granted. S. BUSH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D.M. Badaczewski, 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.