Citation Nr: 22017242 Decision Date: 03/24/22 Archive Date: 03/24/22 DOCKET NO. 15-16 407 DATE: March 24, 2022 ORDER Service connection for a neurological disorder of the extremities is denied. REMANDED Entitlement to service connection for a heart condition, claimed as chest pain and heart attack, is remanded. FINDING OF FACT The neurological symptoms, which have been attributed to radiculopathies and venous insufficiency, are not related to service or secondary to a service-connected disability. CONCLUSION OF LAW The criteria for service connection for a neurological disorder have not been met. 38 U.S.C. §§ 1110, 1112, 1117, 1118, 1131, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.317. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the Army from November 1983 to March 1992, to include service in Southwest Asia from October 1990 to April 1991. In February 2018, the Veteran appeared at a Board videoconference hearing before the undersigned Veterans Law Judge. This matter was previously before the Board, most recently in April 2021 when it was remanded for additional development. Service Connection Service connection may be established for disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection may be granted for any disease initially diagnosed after discharge, when all the evidence, including that pertinent to service, establishes the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection may be granted to a Persian Gulf veteran who exhibits objective indications of chronic disability resulting from an undiagnosed illness or a medically unexplained chronic multi symptom illness (such as chronic fatigue syndrome, fibromyalgia, and functional gastrointestinal disorders ) that is defined by a cluster of signs or symptoms, or resulting from an illness or combination of illnesses manifested by one or more signs or symptoms, including signs or symptoms involving the respiratory system. The symptoms must be manifest to a degree of 10 percent or more. By history, physical examination, and laboratory tests, the disability cannot be attributed to any known clinical diagnosis. Objective indications of chronic disability include both "signs" in the medical sense of objective evidence perceptible to an examining physician, and other, non-medical indicators that are capable of independent verification. Disabilities that have existed for 6 months or more and disabilities that exhibit intermittent episodes of improvement and worsening over a 6-month period will be considered chronic. 38 U.S.C. §§ 1117, 1118; 38 C.F.R. § 3.317. A Persian Gulf veteran is defined as a veteran who served on active duty in the Armed Forces in the Southwest Asia Theater of Operations during the Persian Gulf War. The Southwest Asia Theater of Operations include Iraq, Kuwait, Saudi Arabia, the neutral zone between Iraq and Saudi Arabia, Bahrain, Qatar, the United Arab Emirates, Oman, the Gulf of Aden, the Gulf of Oman, the Persian Gulf, the Arabian Sea, the Red Sea, and the air space above these locations. 38 C.F.R. § 3.317(d)(1)(2). Service treatment and examination records, including the March 1992 separation examination, do not reveal findings or histories indicative of the reported neurological disorder. A September 1994 treatment record reveals the Veteran's history of left hand numbness from the elbow down. An October 1994 treatment record reveals diagnosis of improved bilateral carpal tunnel syndrome. A November 1994 treatment record reports diagnosis of possible mild bilateral cubital tunnel syndrome. A December 1994 treatment record reports that an electromyography (EMG) was within normal limits. A February 2000 VA examination record reveals the Veteran's history of numbness in the hands and feet and tingling in the arms, predominantly the hands. The Veteran reported that past nerve conduction studies were negative for carpal tunnel syndrome. The diagnosis was rule out bilateral carpal tunnel syndrome. The examiner stated that the involvement of the feet raised the possibility of polyneuropathy, but the Veteran lacked objective physical findings consistent with polyneuropathy and polyneuropathy usually affects the legs worse than the arms. A subsequent electrodiagnostic report reports that the testing showed minimal compression of the right median nerve in the carpal tunnel and no evidence of neuropathy. A June 2012 VA "hand and fingers" examination record reveals the Veteran's history of intermittent pain and swelling of the hands. The examiner determined there was no diagnosis of the hands. A February 2015 VA "central nervous system and neuromuscular disease" examination record reveals the Veteran's negative history of symptoms of a neurological disability of the upper and lower extremities. The examiner noted that the Veteran's problem list did not report any neurological disorder. A February 2015 VA "hand" examination record reveals the Veteran's history of intermittent swelling of the hands. The record notes that a past EMG showed mild right medial nerve radiculopathy but that the Veteran denied symptoms related to carpal tunnel syndrome. An August 2019 VA examination record reveals the Veteran's history of numbness in the hands, arms, and shoulders due to bulging discs in his neck. He also reported numbness in the feet approximately twice a week that last a "couple of minutes" and swelling of the feet from venous insufficiency. Finally, he reported dizziness and light-headedness, occasionally with the numbness, which could be from hyperventilation syndrome. Examination of the peripheral nerves was normal. The examiner stated that the Veteran probably had extremely mild cervical radiculopathy in the upper extremities and lower extremity symptoms due to venous insufficiency and possibly hyperventilating. The examiner determined the issues were not related to service. A November 2021 VA examination record reports that the Veteran was asymptomatic. Clinical evaluation was normal. The examiner noted that the Veteran reported smoking, which was a known risk factor for developing small vessel disease and peripheral neuropathy leading to neuropathic pain. The examiner determined no diagnosis was warranted of a peripheral nerve condition. The examiner reported that the claimed condition was not likely related to service or caused or aggravated by a service-connected disability because objective examination was normal, and there is no causal relationship between any service-connected disability and the reported symptoms and no evidence of aggravation. The examiner added that there was no objectifiable neurological condition in the records. VA treatment records dated during the period of the claim reveal negative histories and findings of motor weakness or sensory deficit. The records do reveal prescription of medication for neuropathy due to degenerative disc disease of the cervical spine and lumbar spine. The Board finds service connection is not warranted for a neurological disorder of the extremities. The service treatment and examination records do not reveal the existence of a neurological disorder or impairment. The Veteran was diagnosed with carpal tunnel syndrome soon after discharge from service. The record does not indicate that the Veteran currently has carpal tunnel syndrome or has had carpal tunnel syndrome during the period of the claim, however. Notably, the record includes normal clinical findings and negative histories of carpal tunnel syndrome when asked during the period of the claim, and the Board finds the VA examiners' determinations and histories indicate that the record is absent a current disability of carpal tunnel syndrome. The record does show findings that the reported symptoms are due to cervical and lumbar radiculopathies, venous insufficiency, and hyperventilation syndrome. Service connection is not in effect for cervical or lumbar spine disorders, hyperventilation syndrome, or a venous disorder, the records do not suggest that the service connected psychiatric disability is associated with hyperventilation or panic attack symptoms, and the 2021 VA examiner has determined the neurological symptoms are not related to service (through date of onset or etiology) and are not secondary to service-connected disability. The record is absent any medical evidence linking the reported symptoms to service or service-connected disability, and the Board finds the evidence does not indicate that the Veteran has additional symptoms due to undiagnosed illness and not the above diagnoses. Although the Veteran has reported symptoms since service, the Board notes that the symptoms reported after service were linked to the carpal tunnel syndrome which resolved prior to the period of the appeal. In sum, the evidence of record indicates that the reported symptoms were not present during and since service, are due to diagnosed disorders, and are not etiologically related to service or are secondary to service-connected disability. For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether service connection is warranted. Rather, the evidence persuasively weighs against the claim. The benefit of the doubt doctrine, see 38 U.S.C. § 5107(b), is therefore not for application as to this claim. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc) (only when the evidence persuasively favors one side or another is the benefit of the doubt doctrine not for application). REASONS FOR REMAND Further development is needed for the claims for service connection for a heart disorder. Specifically, although the record includes opinions about the chest pain, diagnosed as angina, and reported heart attacks, the record would benefit if opinions were obtained pertaining to the other diagnoses, such as the ascending aortic aneurysm. The matters are REMANDED for the following action: Obtain a competent medical opinion to determine the etiology of the heart disorders noted in the record during the period of the claim. All pertinent evidence of record must be made available to and reviewed by the medical professional providing the opinion. An appropriate medical professional should clarify whether the Veteran has or has had ascending aortic aneurysm and coronary artery disease. For any diagnosed disorder, the medical professional should address whether the disorder was incurred in service, is etiologically related to service, or is secondary to service connected disability If the medical professional is unable to provide any required opinion, the medical professional should explain why. If the examiner cannot provide an opinion without resorting to mere speculation, a complete explanation as to why this is so should be provided. If the inability to provide a more definitive opinion is the result of a need for additional information, the additional information that is needed should be identified. STEVEN D. REISS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N. Snyder, 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.