Citation Nr: 22013577 Decision Date: 03/10/22 Archive Date: 03/10/22 DOCKET NO. 16-14 913 DATE: March 10, 2022 ORDER Entitlement to service connection for peripheral neuropathy of the left lower extremity is granted. FINDING OF FACT 1. The evidence is at least in equipoise as to whether the Veteran has a diagnosis of peripheral neuropathy of the left lower extremity. 2. The evidence is at least in equipoise as to whether the Veteran's peripheral neuropathy of the left lower extremity is the result of his exposure to herbicide agents during his active service. CONCLUSION OF LAW The criteria for entitlement to service connection for peripheral neuropathy of the left lower extremity have been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from February 1971 to April 1972. These matters come before the Board of Veterans' Appeals (Board) on appeal of an April 2015 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO) that denied entitlement to a disability characterized as peripheral neuropathy of the left lower extremity. The Board has reviewed all of the evidence in the record, with an emphasis on the evidence relevant to this appeal. Although there is an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Hence, the Board will summarize the relevant evidence as deemed appropriate and the Board's analysis will focus specifically on what the evidence shows, or fails to show, as to the claim. 1. Entitlement to service connection for peripheral neuropathy of the left lower extremity is granted. The Veteran contends that his claimed left lower extremity peripheral neuropathy is the result of exposure to herbicide agents during his period of active service. See 04/17/2015, NOD, p. 3. 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 military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present disability. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); 38 C.F.R. § 3.303. A veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, shall be presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service. 38 C.F.R. § 3.307(a)(6)(iii). The Veteran's military personnel records reflect that he had active service in the Republic of Vietnam from August 1971 to August 1972. Military Personnel Records, p. 9. Accordingly, the Veteran's exposure to herbicide agents is conceded. A nexus between peripheral neuropathy and herbicide agent exposure may be presumed where the peripheral neuropathy manifested to a degree of 10 percent or more within one year after the last date on which a Veteran was exposed to an herbicide agent during their period of active service. 38 C.F.R. § 3.307(a)(6)(ii). Here, the Board does not find that such manifestation occurred. The Veteran has submitted private medical treatment records reflecting his statements to treating providers that his left lower extremity symptoms began in 1972 and/or 1973. 11/05/2021, Medical Treatment Record Non-Government Facility. The Board finds these statements inconsistent with the Veteran's testimony at his October 2021 Board hearing, and a written statement received by the Board in October 2021, reflecting that the first time he felt the onset of left lower extremity symptoms was in 1977. However, a claimant is not precluded from establishing service connection with proof of direct causation. Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994); Stefl v. Nicholson, 21 Vet. App. 120 (2007). The private medical records submitted by the Veteran reflect treatment for left lower extremity pain from at least October 2016 through September 2021. In December 2021 the Board received a written statement from one of the private treating providers stating that the Veteran "does suffer" from left lower extremity peripheral neuropathy, and that their findings concerning the Veteran's disability were consistent with exposure to herbicide agents. The Board finds this opinion highly probative, as it is predicated on a treating relationship of several years and familiarity with the Veteran's symptoms, presentation, and medical history. The Board acknowledges an April 2015 VA examination report reflecting no diagnosis of peripheral neuropathy. However, the intended meaning of the examiner's report is unclear. The examiner noted that no diagnosis was made and followed that by stating that the Veteran was unavailable for diagnostic electromyography and nerve conduction velocity testing due to travel plans. 04/02/2015, C&P Exam, p. 8. It is thus unclear whether the April 2015 report stating no diagnosis of peripheral neuropathy reflects an affirmative finding by the examiner that the Veteran did not have the claimed disability, or whether the examiner was simply declining to make an affirmative diagnosis in the absence of diagnostic test results. Accordingly, the Board finds the April 2015 VA examination to be of minimal probative value. In adjudicating claims for VA benefits, the burden of proof only requires an "approximate balance" of the evidence for and against a claim. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1991). This low standard of proof is "unique" to the VA adjudicatory process, and "the nation, 'in recognition of our debt to our veterans,' has 'taken upon itself the risk of error' in awarding such benefits." Wise v. Shinseki, 26 Vet. App. 517, 531 (2014). In evaluating a claim for disability benefits, when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107. In light of the foregoing, the Board finds that the evidence is at least in equipoise as to whether the Veteran has a diagnosis of peripheral neuropathy of the left lower extremity; and whether the claimed peripheral neuropathy of the left lower extremity is the result of exposure to herbicide agents during his period of active service. Resolving doubt in favor of the Veteran, the Board concludes that the criteria for entitlement to service connection for peripheral neuropathy of the left lower extremity are met, and the same is hereby granted. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307. Eric S. Leboff Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Sametshaw, Eric C. 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.