Citation Nr: 23014343 Decision Date: 03/09/23 Archive Date: 03/09/23 DOCKET NO. 17-21 485 DATE: March 9, 2023 ORDER Entitlement to service connection for peripheral neuropathy of right upper extremity is denied. Entitlement to service connection for peripheral neuropathy of left upper extremity is denied. Entitlement to service connection for peripheral neuropathy of right lower extremity is granted. Entitlement to service connection for peripheral neuropathy of left lower extremity is granted. FINDINGS OF FACT 1. The evidence of record persuasively weighs against finding that the Veteran has had peripheral neuropathy of the right or left upper extremity at any time during or approximate to the pendency of the claim. 2. Resolving reasonable doubt in the Veteran's favor, his peripheral neuropathy of the right and left lower extremity is at least as likely as not related to herbicide agent exposure during service. CONCLUSIONS OF LAW 1. The criteria for service connection for peripheral neuropathy of the right upper extremity are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for peripheral neuropathy of the left upper extremity are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for peripheral neuropathy of the right lower extremity are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for service connection for peripheral neuropathy of the left lower extremity are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1967 to April 1970. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a May 2015 rating decision issued by Regional Office (RO) of the Department of Veterans Affairs (VA). Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. 1. Entitlement to service connection for peripheral neuropathy of right upper extremity 2. Entitlement to service connection for peripheral neuropathy of left upper extremity The Veteran contends that he is entitled to service connection for peripheral neuropathy of the right and left upper extremities because the claimed disabilities are the result of active service. More specifically, the Veteran asserts that his in-service herbicide agent exposure caused the claimed disabilities. The RO has previously acknowledged the Veteran's herbicide agent exposure. The Board concludes that the Veteran does not have a current diagnosis of peripheral neuropathy or the right or left upper extremity and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). An April 2013 VA examination showed that the Veteran did not have a peripheral nerve condition. In an July 2013 addendum opinion, the examiner also noted that there was no functional impact since the Veteran did not have a peripheral neuropathy disability. Subsequent medical treatment records showed complaints of tingling and numbness in the feet but did not indicated complaints for the upper extremities. A May 2015 VA examination noted a diagnosis of peripheral neuropathy for the right and left lower extremity, as well as a vitamin b12 deficiency, but did not show peripheral neuropathy of the right or left upper extremities. A separate May 2015 VA examination revealed the same findings of peripheral neuropathy for the right and left lower extremity and a vitamin B12 deficiency. The medical evidence of record consistently shows the Veteran's complaints of peripheral neuropathy of the lower extremities, but no complaints for the upper extremities. While the Veteran believes he has a current diagnosis of peripheral neuropathy of the right and left upper extremity, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. 3. Entitlement to service connection for peripheral neuropathy of right lower extremity 4. Entitlement to service connection for peripheral neuropathy of left lower extremity The Veteran contends that his peripheral neuropathy of the right and left lower extremities is the result of herbicide agent exposure. The Board concludes that the Veteran has a current disability that is related to his in-service herbicide agent exposure. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). The April 2013 VA examination was normal with no abnormal findings noted. EMG testing was normal and there was no finding of functional impact. During a November 2014 private treatment evaluation, the Veteran reported numbness and tingling of the right and left lower extremities that has increased in severity over the past few years. Dr. A.D. noted that the Veteran has "numbness to pin at the tips of the toe, which is not typical for B12 deficiency, represents neuropathy." In a November 2014 private treatment letter, Dr. C.N.B. opined that agent orange is a known cause of neuropathy. The physician also highlighted that the Veteran was exposed to "TCE" while cleaning helicopters. No further rationale or explanation was provided. The physician also did not address the B12 deficiency and what contributions, if any, it had to the development of the claimed disabilities. As such, this opinion is of little probative value. In a separate December 2014 private treatment letter, Dr. A.D. opined that the claimed disabilities were "likely caused by exposures to toxins during tours of duty in Vietnam." The physician highlighted that Agent Orange exposure to repeated vibration from the helicopter are potential causes of neuropathy. "The absent pin sensation in the toes cannot be explained by B12 deficiency and there are no other causes for neuropathy identified in extensive laboratory testing." It was also emphasized that the Veteran's complaints of neuropathy have been worsening for years prior to the B12 deficiency diagnosis. At a May 2015 VA examination, the examiner noted a 2013 diagnosis of peripheral neuropathy bilateral lower extremities and a 2014 diagnosis of a Vitamin B12 deficiency. The Veteran reported being exposed to herbicide agents during service and experiencing numbness of the lower extremities since the exposure. The examiner opined that the claimed disability was less likely than not related to service. The rationale provided was that the Veteran was diagnosed with B12 deficiency causing myelopathy and peripheral neuropathy. "The neuropathy caused by B12 deficiency would effectively mask any other causes of peripheral neuropathy, and it is therefore impossible to speculate on what role, if any, Agent Orange has played in his peripheral neuropathy." In a May 2015 VA neurology outpatient note, the neurologist noted Dr. A.D.'s 2014 medical opinion. He provided a diagnosis of peripheral neuropathy and myelopathy secondary to B12 deficiency The Veteran submitted several buddy statements detailing observations of his neuropathy since his separation from service. More specifically, the spouse's January 2016 statement noted observing the Veteran experience problems with the lower extremities as early as 1985 around the time they were married. In January 2016 Dr. A.D. submitted another private treatment letter further emphasizing that B12 deficiency would not affect small sensory fibers and does not cause loss of sensation during pin testing. Dr. A.D. indicated that he has examined the Veteran more than once. The evidence against the claim includes the May 2015 medical findings that the claimed disabilities are related to the vitamin B12 deficiency. The evidence in favor of the claim includes the 2014 and 2016 private treatment findings that the Veteran experienced peripheral neuropathy of the right and left lower extremity prior to the diagnosis of the vitamin B12 deficiency. The private examiners also found a medical correlation between the claimed disabilities and the Veteran's previously acknowledged herbicide agent exposure. Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran's current peripheral neuropathy of the right and left lower extremities is related to herbicide agent exposure during service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for peripheral neuropathy of the right and left lower extremity is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. D. SMART Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Cross, 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.