Citation Nr: A25035151 Decision Date: 04/16/25 Archive Date: 04/16/25 DOCKET NO. 250107-506209 DATE: April 16, 2025 ORDER Entitlement to service connection for left lower peripheral arterial disease is granted. Entitlement to service connection for right lower peripheral arterial disease is granted. FINDINGS OF FACT 1. The evidence is at least evenly balanced as to whether left lower peripheral arterial disease is related to in-service toxic exposure. 2. The evidence is at least evenly balanced as to whether right lower peripheral arterial disease is related to in-service toxic exposure. CONCLUSIONS OF LAW 1. With reasonable doubt resolved in favor of the Veteran, the criteria for service connection for left lower peripheral arterial disease have been met. 38 U.S.C. § 1110, 5107(b); 38 C.F.R. § 3.102, 3.303. 2. With reasonable doubt resolved in favor of the Veteran, the criteria for service connection for right lower peripheral arterial disease have been met. 38 U.S.C. § 1110, 5107(b); 38 C.F.R. § 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1961 to October 1964. This case initially came before the Board of Veterans' Appeals (Board) from an October 2023 rating decision by the Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ). In that decision the AOJ denied service connection for left and right lower peripheral arterial disease. In an October 2023 VA Form 10182 Notice of Disagreement the Veteran appealed to the Board selecting the hearing docket. A hearing was scheduled for December 13, 2023. The Veteran did not attend the scheduled hearing with the Veteran's representative submitting a brief in lieu of the hearing. In a March 2024 decision, the Board remanded the Veteran's claims for left and right lower peripheral arterial disease to obtain VA examinations and opinions. New examinations were conducted and opinions were obtained and added to the claims file in August 2024. The AOJ issued a December 2024 rating decision that denied service connection for left and right lower peripheral arterial disease. In the January 7, 2025, VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket. Therefore, the Board may only consider the evidence of record at the time of the December 2024 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran with, within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801. If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 1. Entitlement to service connection for left lower peripheral arterial disease is granted. 2. Entitlement to service connection for right lower peripheral arterial disease is granted. Service connection will be granted if the evidence demonstrates that current disability resulted from an injury or disease incurred in active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service disease or injury; and (3) a relationship between the current disability and the in-service disease or injury. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted for a disease first diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). The August 2024 VA examination report contains a diagnosis of left and right lower peripheral arterial disease. The current disability requirement has thus been met. In a December 2024 rating decision, the AOJ favorably found and conceded the Veteran's participation in a toxic exposure risk activity (TERA). The Veteran was exposed to solvents, VOCs and jet fuel during military service based on military occupational specialty of Jet Engine Mechanic. Therefore, the in-service injury element has been met. The remaining issue is thus whether there is a relationship between the current left and right peripheral arterial disease and in-service TERA. There are conflicting medical opinions on this question. In August 2024 VA opinions the clinician found that it was less likely than not that the Veteran's left and right lower peripheral arterial disease was related to an in service TERA. The clinician reported, after an extensive medical literature search and a review of an exhaustive CDC report, there is no authoritative medical literature that states that exposure to jet fuels, solvents, or COD alone or in any combination with or without ankle injury causes peripheral arterial disease. Thus, the clinician concluded it was less likely than not that the Veteran's left and right lower peripheral arterial disease was related to an in-service TERA. As the clinician explained the reasons for his conclusions, his opinion is entitled to some probative weight. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) ("most of the probative value of a medical opinion comes from its reasoning") In a January 2025 private medical opinion, the clinician noted the AOJ's favorable finding that the Veteran had a TERA. The clinician opined given the Veteran's specific medical history, which includes his in-service jet fuel exposure, it is at least as likely as not that the Veteran's left and right lower peripheral arterial disease is a result of his in service exposure to jet fuels. The private clinician reviewed and explained the medical literature and their relevance to her findings. She reported that the Veteran's left and right lower peripheral arterial disease resulted from in service exposure to jet fuels while he was in service, but the disease would not have developed during service. She noted the medical literature as well as the Veteran's medical records and found that the medical literature demonstrated that development of left and right lower peripheral arterial disease is a process of years or decades. Further, the Veteran's medical record is consistent with the findings in the medical literature. The private clinician opined that the VA clinician's contention that the Veteran's peripheral arterial disease could not have been caused by his exposure to toxins in service is flawed because, as noted above, the evidence of damage to vasculature does not occur immediately. Thus, the private clinician explained, the Veteran's onset of peripheral arterial disease is consistent with what the field of medicine and medical literature reviewed in this opinion advised would happen with exposure to jet fuels. Thus, the private clinician opined, when considering the evidence of record, the claims file, medical records, lay statements, and medical literature, it was at least as likely as not that the Veteran's peripheral arterial disease was related to his in-service jet fuel exposure. As the private clinician explained the reasons for his conclusions based on an accurate characterization of the evidence, his opinion is entitled to substantial probative weight. Nieves-Rodriguez, 22 Vet. App. at 304. To the extent that the negative VA opinion is probative, it is not of greater probative weight than the private opinion, which contained a thorough, detailed rationale. Consequently, the evidence is at least evenly balanced as to whether the Veteran's left and right lower peripheral arterial disease is related to in-service toxic exposure. As the reasonable doubt created by this relative equipoise must be resolved in favor of the Veteran, entitlement to service connection for left and right lower peripheral arterial disease is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Jonathan Hager Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J.D. Strain, 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.