OSTEONECROSIS

Summary

The Veteran, a Navy Veteran who served from October 1970 to August 1972, including ACDUTRA in Mississippi and North Carolina, appeals the denial of service connection for avascular necrosis of the bilateral shoulders and hips, and secondary service connection for acquired psychiatric disorder (depression) and neurological impairments of the bilateral upper and lower extremities. The Veteran claimed avascular necrosis was due to herbicide agent exposure during service in Gulfport, Mississippi. The Board found the Veteran was exposed to herbicide agents, establishing in-service exposure on a facts-found basis, but denied service connection for avascular necrosis. The Board found a current disability of avascular necrosis was established by private and VA medical records, and in-service exposure was established. However, the Board found no causal relationship between the avascular necrosis and herbicide exposure. The Board found private medical opinions linking avascular necrosis to herbicides lacked probative value due to speculative reasoning and reliance on inapplicable studies. Conversely, VA medical opinions found no link, citing that herbicides do not cause avascular necrosis directly but rather atherosclerosis, and that the private physician's conclusion was inconsistent with known pathophysiology. The Board also noted the absence of in-service complaints or treatment for avascular necrosis, with the first diagnosis occurring over a decade post-service, and no continuity of symptoms. The secondary claims for psychiatric and neurological conditions were denied because the primary condition (avascular necrosis) was not service-connected. The Board also denied direct service connection for these conditions due to lack of in-service complaints, treatment, or nexus opinions.

Rationale

Current disability established by private and VA medical records.; In-service exposure to herbicide agents established on facts-found basis.; No causal relationship found between avascular necrosis and herbicide exposure.; Private medical opinions lacked probative value due to speculative reasoning.; VA medical opinions found no link, citing lack of support in medical literature.; Absence of in-service complaints or treatment for avascular necrosis.; First diagnosis occurred over a decade post-service.; No continuity of symptoms since service.

Full Decision Text

Citation Nr: 25013825
Decision Date: 11/10/25	Archive Date: 11/10/25

DOCKET NO. 18-52 171
DATE: November 10, 2025

ORDER

The claim for service connection for avascular necrosis of the bilateral shoulders and hips, to include as due to exposure to herbicide agents, is denied.

The claim for service connection for an acquired psychiatric disorder, to include as secondary to avascular necrosis, is denied.

The claim for service connection for neurological impairment of the right upper extremity, to include as secondary to avascular necrosis, is denied.

The claim for service connection for neurological impairment of the left upper extremity, to include as secondary to avascular necrosis, is denied.

The claim for service connection for neurological impairment of the right lower extremity, to include as secondary to avascular necrosis, is denied.

The claim for service connection for neurological impairment of the left lower extremity, to include as secondary to avascular necrosis, is denied.

FINDINGS OF FACT

1. The Veteran was exposed to herbicide agents during his active military service in Gulfport, Mississippi, from January 1971 to August 1972 and during two weeks of ACDUTRA in May and June 1974. 

2. A causal relationship does not exist between the Veteran's avascular necrosis of the bilateral shoulders and hips and an in-service disease or injury, to include exposure to herbicide agents.

3. A causal relationship does not exist between the Veteran's acquired psychiatric disorder, currently diagnosed as depression, and an in-service disease or injury or service-connected disability, to include avascular necrosis.

4. A causal relationship does not exist between the Veteran's neurological impairment of the right upper extremity and an in-service disease or injury or service-connected disability, to include avascular necrosis.

5. A causal relationship does not exist between the Veteran's neurological impairment of the left upper extremity and an in-service disease or injury or service-connected disability, to include avascular necrosis.

6. A causal relationship does not exist between the Veteran's neurological impairment of the right lower extremity and an in-service disease or injury or service-connected disability, to include avascular necrosis.

7. A causal relationship does not exist between the Veteran's neurological impairment of the left lower extremity and an in-service disease or injury or service-connected disability, to include avascular necrosis.

CONCLUSIONS OF LAW

1. The criteria for establishing service connection for avascular necrosis of the bilateral shoulders and hips, to include as due to exposure to herbicide agents, are not met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.307, 3.309.

2. The criteria for establishing service connection for an acquired psychiatric disorder, to include as secondary to avascular necrosis, are not met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.310.

3. The criteria for establishing service connection for neurological impairment of the right upper extremity, to include as secondary to avascular necrosis, are not met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.310.

4. The criteria for establishing service connection for neurological impairment of the left upper extremity, to include as secondary to avascular necrosis, are not met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.310.

5. The criteria for establishing service connection for neurological impairment of the right lower extremity, to include as secondary to avascular necrosis, are not met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.310.

6. The criteria for establishing service connection for neurological impairment of the left lower extremity, to include as secondary to avascular necrosis, are not met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty with the United States Navy from October 1970 to August 1972 with additional active duty service for training (ACDUTRA) with the Navy Reserve.  This case comes before the Board of Veterans' Appeals (Board) on appeal from October 2017 and November 2017 rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO).

This appeal was developed in accordance with the VA Legacy appeals process. As such, the regulations specifically pertaining to VA's current appeals process
 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty with the United States Navy from October 1970 to August 1972 with additional active duty service for training (ACDUTRA) with the Navy Reserve.  This case comes before the Board of Veterans' Appeals (Board) on appeal from October 2017 and November 2017 rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO).

This appeal was developed in accordance with the VA Legacy appeals process. As such, the regulations specifically pertaining to VA's current appeals process under the Appeals Modernization Act (AMA) are not for application.

The Veteran testified before the undersigned Veterans Law Judge (VLJ) at the agency of original jurisdiction (AOJ) in May 2021. A transcript of the hearing is of record. 

This case was previously before the Board in April 2022 and September 2023 when it was remanded for further development. It has now returned to the Board for additional appellate action.

As a final procedural matter, the Board notes that the Veteran submitted evidence of VA and private treatment after the issuance of the most recent July 31, 2024, supplemental statement of the case (SSOC). Under the Legacy appeal system, the Board may generally not consider evidence unless it is first reviewed by the AOJ unless a waiver of initial AOJ review is obtained from the veteran. See Disabled Am. Veterans v. Sec'y of Veterans Aff., 327 F.3d 1339 (Fed. Cir. 2003). However, if a veteran filed a substantive appeal on or after February 2, 2013, as occurred here, an automatic waiver of initial AOJ review is implied for new evidence submitted by the appellant or representative. 38 U.S.C. § 7105(e). The Board will therefore proceed with a decision in this case. 

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).

Service connection is also provided for a disability that is proximately due to, the result of, or aggravated by a service-connected disease or injury. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439 (1995).

1. Entitlement to service connection for avascular necrosis of the bilateral shoulders and hips, to include as due to exposure to herbicide agents.

The Veteran contends that service connection is warranted for avascular necrosis affecting the bilateral shoulders and hips as it was incurred due to herbicide agent exposure during active duty in Gulfport, Mississippi. He testified at the May 2021 Board hearing that he worked as an equipment operator in Gulfport near where herbicide agents were stored, and was exposed through digging in the dirt and drinking the water. The Board concludes that while the Veteran was exposed to herbicide agents during active duty, his avascular necrosis is not etiologically related to such exposure and service connection is not warranted. 

As a preliminary matter, the Board notes that avascular necrosis (also known as osteonecrosis) is a degenerative condition characterized by the death of bone tissue due to an interruption of the blood supply. In other words, avascular necrosis impairs the flow of blood to the bone leading to the loss of bone tissue. In this case, the Veteran contends that his bilateral shoulders and hips were affected by avascular necrosis, leading to various surgeries and joint replacements. 

Turning to the elements of service connection, the Board first finds that a current disability is established. Private medical records document findings of avascular necrosis dating from 1985, with various surgical treatments. The Veteran underwent a left shoulder replacement in January 1987, decompression surgery of both hips in April 1990, a left hip replacement in 1991, and a right shoulder replacement in 2008. VA examinations in December 2022 diagnosed the presence of bilateral avascular necrosis of the shoulders and hips, resulting in various impairments to the affected joints, to include shoulder instability and osteoarthritis. The VA and private treatment records also all attribute the Veteran
ascular necrosis, leading to various surgeries and joint replacements. 

Turning to the elements of service connection, the Board first finds that a current disability is established. Private medical records document findings of avascular necrosis dating from 1985, with various surgical treatments. The Veteran underwent a left shoulder replacement in January 1987, decompression surgery of both hips in April 1990, a left hip replacement in 1991, and a right shoulder replacement in 2008. VA examinations in December 2022 diagnosed the presence of bilateral avascular necrosis of the shoulders and hips, resulting in various impairments to the affected joints, to include shoulder instability and osteoarthritis. The VA and private treatment records also all attribute the Veteran's various shoulder and hip abnormalities to avascular necrosis, as confirmed via MRI reports. A current disability-avascular necrosis affecting the shoulders and hips-is therefore demonstrated. 

The Board also finds that an in-service injury is present as the evidence establishes the Veteran's exposure to herbicide agents during active duty on a direct facts found basis. 

VA regulations provide some presumptions regarding exposure to certain herbicide agents based on various geographic locations. For example, 38 C.F.R. § 3.307(a)(6) provides for a presumption of exposure for veterans who served in the Republic of Vietnam during the period beginning January 9, 1962 and ending May 7, 1975 and in or near the Korean demilitarized zone (DMZ) between April 1968 and August 1971. The geographic locations recognized as associated with herbicide agent exposure were also recently expanded. The Honoring our PACT Act of 2022 (PACT Act) added several countries to the list, including military bases in Thailand, Laos, Cambodia, Guam, and the Johnston Atoll. See Honoring our PACT Act of 2022, Pub. L. No. 117-168, § 403(d)(2) (2022). Gulfport, Mississippi was not included on the previous or expanded list of locations VA now presumes to include exposure to herbicide agents. 

The Board therefore finds that the Veteran's exposure to herbicide agents is not presumed under 38 C.F.R. § 3.307(a)(6) or under the PACT Act. However, a veteran who cannot establish presumptive exposure to herbicide agents is still entitled to presumptive service connection for some conditions if he or she can prove "actual exposure" to herbicide agents on a facts-found basis. 38 C.F.R. § 3.309(e).

In this case, the Board finds the evidence establishes the Veteran was exposed to herbicide agents and the specific compounds identified in 38 C.F.R. § 3.307(a)(6)(i). In support of the claim, the Veteran has submitted various news articles reporting on the use of herbicides (characterized as Agent Orange) at the naval base at Gulfport, Mississippi from 1968 to 1977. The VA Records Research Center (RRC) also confirmed the Veterans herbicide agent exposure with a May 2023 report. The RRC found that the Veteran served with various construction battalions at Gulfport, Mississippi from January 1971 to August 1972 and with a reserve unit in June 1974. According to the RRC, "[a] review of the unredacted 2019 DOD Tactical Herbicide Location list verifies the use of herbicides at the location and time claimed by the Veteran." Based on the above, the Board finds that the Veteran's in-service exposure to herbicide agents is established. 

The remaining question for the Board is whether the evidence establishes a link between the Veteran's avascular necrosis and his in-service exposure to herbicide agents. Service and post-service records do not support the claim. Service records are negative for complaints, diagnosis, or treatment pertaining to the claimed disability. The Veteran's shoulders and hips were normal at the July 1972 separation examination with no complaints on the accompanying report of medical history. Thus, service records do not establish the presence of avascular necrosis during active duty. 

Private treatment records (as well as the Veteran's statements to VA) show that avascular necrosis was first diagnosed in 1985. Prior to that date, in 1979, the Veteran was involved in a motorcycle accident resulting in a skull fracture and right clavicle fracture. The Veteran also stated in a May 2017 statement that he fractured his left shoulder while working as a pipefitter in New York in 1985. Following this injury, he began to receive treatment for bilateral shoulder conditions and avascular necrosis, and a March 1986 shoulder MRI confirmed the presence of aseptic necrosis. A private physician also identified involvement of the bilateral hips due to avascular necrosis in May 
 active duty. 

Private treatment records (as well as the Veteran's statements to VA) show that avascular necrosis was first diagnosed in 1985. Prior to that date, in 1979, the Veteran was involved in a motorcycle accident resulting in a skull fracture and right clavicle fracture. The Veteran also stated in a May 2017 statement that he fractured his left shoulder while working as a pipefitter in New York in 1985. Following this injury, he began to receive treatment for bilateral shoulder conditions and avascular necrosis, and a March 1986 shoulder MRI confirmed the presence of aseptic necrosis. A private physician also identified involvement of the bilateral hips due to avascular necrosis in May 1986. As discussed above, the Veteran has since undergone multiple surgical procedures of the shoulders and hips to treat avascular necrosis, to include left shoulder, right shoulder, and left hip joint replacements. 

The Veteran's private treatment records do not identify any specific etiology for his avascular necrosis. The condition was identified following the Veteran's right clavicle and left shoulder fractures, but his private primary care doctor noted in April 1990 that a definite etiology for avascular necrosis had not been established. The private doctor did, however, note that the Veteran's "disease process" in the shoulders and hips were related to one another. The same physician stated in a February 1991 letter that the Veteran had avascular necrosis of an unknown etiology of both shoulders and hips.

The private treatment records also do not contain any evidence linking the Veteran's avascular necrosis to active duty service, to include his exposure to herbicide agents. None of the Veteran's treating doctors provided medical opinions in support of the claim, and as noted above, they have not identified any specific etiology for the condition. 

Additionally, the earliest evidence of avascular necrosis dates from 1985, more than 10 years after the Veteran's separation from active duty, when the condition was diagnosed following fractures of the right clavicle and left shoulder. The absence of any clinical evidence of the claimed disability for years after service weighs the evidence against a finding that the Veteran's current condition is causally connected to his military service, particularly as the Veteran does not allege the onset of avascular necrosis during service.

The record also contains VA and private medical opinions addressing the etiology of the Veteran's avascular necrosis. For the reasons discussed below, the Board finds the April 2024 VA medical opinions weighing against service connection are more probative and persuasive than the private opinions in favor of the claim. 

In support of the claim are June 2021 and August 2024 private medical opinions. The opinion reports were issued by the same private physician and are virtually identical-the only difference is the earlier June 2021 medical opinion includes references to a decision by the Board awarding service connection for another veteran for avascular necrosis. In both opinion reports, the private physician concludes that the Veteran's avascular necrosis was caused by the in-service exposure to herbicide agents. In support of this opinion, the private physician notes that herbicides are known to cause ischemic heart disease, and avascular necrosis is "nothing but ischemia of bone." The essential mechanism is similar, with the herbicides causing inadequate flow through the blood vessels of the heart and the bone. The private physician also cites to various studies addressing a connection between herbicide exposure and coronary artery disease, but does not cite to any studies indicating a link between avascular necrosis and herbicides. 

The June 2021 and August 2024 private medical opinions are of some probative value to the extent they do not rely on a previous Board decision pertaining to a different veteran and different facts. The private physician noted that herbicides can cause a reduction in blood flow to the heart and blood vessels, and found a similar relationship with avascular necrosis and the Veteran's bones. However, the Board notes that the medical literature cited by the private physician in support of these opinions did not pertain to avascular necrosis; rather, it only applied to cardiovascular diseases. The private physician also did not provide any other support for the stated conclusion beyond identifying a mechanism for the restriction of blood flow that "appears to be similar." The Board therefore finds that the June 2021 and August 2024 private medical opinion reports provide some limited support in favor of the claim, but are of reduced probative value as the rationale provided is essentially speculative in nature.  See Bloom v. West, 12 Vet. App. 185, 187 (1999) (A medical statement using the term "could," or in the moving party's case, "may" or "possibly," without supporting clinical data or other rationale, is too speculative in order to provide the degree of certainty required for medical nexus evidence).

In
 private physician also did not provide any other support for the stated conclusion beyond identifying a mechanism for the restriction of blood flow that "appears to be similar." The Board therefore finds that the June 2021 and August 2024 private medical opinion reports provide some limited support in favor of the claim, but are of reduced probative value as the rationale provided is essentially speculative in nature.  See Bloom v. West, 12 Vet. App. 185, 187 (1999) (A medical statement using the term "could," or in the moving party's case, "may" or "possibly," without supporting clinical data or other rationale, is too speculative in order to provide the degree of certainty required for medical nexus evidence).

In contrast, the record contains April 2024 VA medical opinions weighing against the claim for service connection that are of significant probative value, particularly the opinion rendered in direct response to the June 2021 private medical opinion report. In the April 2024 report, the VA clinician found that the Veteran's avascular necrosis was not etiologically related to herbicide agent exposure. With respect to the conclusions reached by the June 2021 (and August 2024) private physician, the VA clinician noted that the private report was based on an "incorrect assumption" regarding the impact of herbicides on the body. In essence, the herbicide agents do not reduce the blood flow to the vessels (or bone) as stated by the private physician. Instead, the herbicide agents have an "an impact on the development of atherosclerosis which is what leads to the impaired blood flow," and not the herbicide agent itself. While herbicide agents are associated with certain vascular issues, such as coronary artery disease, "there is nothing in the medical literature to support it as an etiology of AVN [avascular necrosis]." The VA clinician also noted that the private physician's report was "not consistent with the known pathophysiology and pathoanatomical causes of AVN." In support of this medical opinion, the VA clinician referenced web information provided by the National Institute of Health (NIH) and the National Library of Medicine. The NIH identified several possible etiologies for avascular necrosis including joint fractures, prolonged high-dose corticosteroid use, chemotherapy, and coagulation disorders. 

Additionally, a second April 2024 VA medical opinion was also issued in accordance with the PACT Act. The PACT Act requires the completion of a toxic risk exposure activity (TERA) examination "when there is evidence of a disability" and evidence of participation in a TERA. 38 U.S.C. § 1168(a). In this case, the Veteran's participation in a TERA was established via his exposure to herbicide agents. The April 2024 VA examiner's opinion was provided with consideration of the Veteran's total potential exposure and with consideration of the synergistic, combined effect of all the Veteran's TERAs. The Board further notes that the examiner found that a relationship between avascular necrosis and herbicide agents is "inconsistent with the universally established medical principles of how avascular necrosis is known to develop."

The Board therefore finds that the April 2024 medical opinions, particularly the non-TERA opinion directly addressing the private physician's findings, are of great probative value and weigh significantly against the claim for service connection. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008) (An opinion's probative value derives from the factually accurate, fully articulated, and sound reasoning for the conclusion.).

The Board has also considered the Veteran's contentions regarding a nexus between service and avascular necrosis, but notes that as a lay person, he is not competent to opine as to medical etiology or render medical opinions in that respect. Barr v. Nicholson, 21 Vet. App. 303 (2007); see Grover v. West, 12 Vet. App. 109, 112 (1999). The Board acknowledges that the Veteran is competent to report observable symptoms such as the identification of avascular necrosis following joint fractures, but his opinion simply cannot be accepted as competent evidence. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1131, 1336 (Fed. Cir. 2006).

The Board therefore finds that the weight of the competent evidence is against the presence of a link between the Veteran's avascular necrosis and in-service herbicide agent exposure. Furthermore, the Board notes that the Veteran has not reported a history of continuing symptoms since service. See 38 C.F.R. § 3.303(a) and (d); see also
 such as the identification of avascular necrosis following joint fractures, but his opinion simply cannot be accepted as competent evidence. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1131, 1336 (Fed. Cir. 2006).

The Board therefore finds that the weight of the competent evidence is against the presence of a link between the Veteran's avascular necrosis and in-service herbicide agent exposure. Furthermore, the Board notes that the Veteran has not reported a history of continuing symptoms since service. See 38 C.F.R. § 3.303(a) and (d); see also Davidson v. Shinseki, 581 F.3d 1313 (Fed.Cir.2009); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). 

In sum, the record shows that the first evidence of the Veteran's avascular necrosis was more than a decade after his separation from active duty service. In addition, the weight of the competent medical evidence weighs against a nexus between the Veteran's avascular necrosis and his in-service herbicide agent exposure. The Veteran is not competent to link his avascular necrosis to service, and has not provided a history of a continuity of symptoms since service which would tend to eliminate other intervening causes. The Board therefore concludes that the evidence is substantially against a link between the claimed condition and active military service. The Board must conclude that the evidence significantly and substantially weighs against the claim, and it is denied. 38 U.S.C. § 5107(b); see also Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

2. Entitlement to service connection for acquired psychiatric disorder, to include as secondary to avascular necrosis.

3. Entitlement to service connection for neurological impairment of the right upper extremity, to include as secondary to avascular necrosis.

4. Entitlement to service connection for neurological impairment of the left upper extremity, to include as secondary to avascular necrosis.

5. Entitlement to service connection for neurological impairment of the right lower extremity, to include as secondary to avascular necrosis.

6. Entitlement to service connection for neurological impairment of the left lower extremity, to include as secondary to avascular necrosis.

The Veteran contends that service connection is warranted for an acquired psychiatric disorder and neuropathy of the bilateral hands and feet as secondary to avascular necrosis. 

The Board finds that the disabilities claimed by the Veteran are present. VA and private treatment records document treatment for depression dating from January 1991 to the present. A private examiner in June 2021 also diagnosed the presence of major depressive disorder. Regarding the claimed neurological disabilities, the Veteran first reported having intermittent bilateral hand numbness in August 2016 at the VA Medical Center (VAMC). A January 2018 nerve conduction study confirmed the presence of bilateral carpal tunnel syndrome and mild left ulnar neuropathy of the forearm. The record therefore clearly documents the presence of chronic depression and neurological impairment of the bilateral upper extremities. 

Regarding the claimed neurological impairment of the lower extremities, VA and private treatment records are silent for complaints aside from a September 2010 VAMC record noting chronic low back pain radiating down the left leg. The Veteran has not provided any specific statements in support of his claims for neurological impairment of the lower extremities; however, by virtue of filing his claims, he has generally alleged the presence of the claimed disabilities. The Board will resolve any doubt in his favor regarding the presence of neurological impairment of the lower extremities, particularly as radiating pain and sensory changes are capable of lay identification. See Charles v. Principi, 16 Vet. App. 370, 374 (2002) (finding veteran competent to testify as to ringing in the ears (tinnitus); Jandreau v. Nicholson, 492 F.3d 1372, 1377, Note 4 (Fed. Cir. 2007) (holding that sometimes a layperson will be competent to identify a medical condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer, and remanding to the Board to decide whether lay evidence was competent and sufficient to establish a shoulder  dislocation).

As discussed earlier in this decision, the Board has determined that service connection is not warranted for avascular necrosis. Service connection for the claimed psychiatric and neurological conditions on a secondary basis is therefore not possible. See 38 C.F.R. § 3.310. 

The Board has also considered whether service connection is warranted for the Veteran's claimed disabilities on a direct basis due to active service
 (Fed. Cir. 2007) (holding that sometimes a layperson will be competent to identify a medical condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer, and remanding to the Board to decide whether lay evidence was competent and sufficient to establish a shoulder  dislocation).

As discussed earlier in this decision, the Board has determined that service connection is not warranted for avascular necrosis. Service connection for the claimed psychiatric and neurological conditions on a secondary basis is therefore not possible. See 38 C.F.R. § 3.310. 

The Board has also considered whether service connection is warranted for the Veteran's claimed disabilities on a direct basis due to active service. Service records are negative for complaints or treatment related to the Veteran's mental health or his arms, legs, or neurological system. All relevant systems were also normal at the July 1972 separation examination. 

Post-service treatment records also contain no evidence of a relationship between the Veteran's depression, neurological impairment, and active duty service. Private physicians opined in January 1991 and June 2021 that the Veteran's depression is due to his "multiple joint problems" and avascular necrosis. No medical provider has provided an opinion linking the Veteran's claimed neurological impairment to any aspect of active duty service, to include the Veteran's herbicide agent exposure. 

The Board acknowledges that "early-onset peripheral neuropathy" is a disease associated with exposure to certain herbicide agents in accordance with 38 C.F.R. § 3.309(e) However, the Veteran's neurological impairment is not considered "early-onset peripheral neuropathy" and presumptive service connection is not warranted. 

Early-onset peripheral neuropathy is defined by VA as peripheral neuropathy that became manifest to a degree of 10 percent or more within a year after the last date on which the Veteran was exposed to a herbicide agent during active service. 38 C.F.R. § 3.307(a)(6)(2). Thus, in order to be considered "early-onset," the Veteran would have to establish the presence of peripheral neuropathy of the upper and lower extremities within the year after June 1974, i.e., within a year of the date he was last present at Gulfport, Mississippi and was last exposed to herbicide agents. The record before the Board does not establish the presence of the claimed disabilities until at least August 2016-when the Veteran first complained of bilateral hand numbness at the VAMC.

Finally, the Veteran does not contend that he incurred chronic depression or neurological impairment of the extremities due to service, nor has he reported a continuity of symptoms of the same since active duty. Accordingly, the Board must conclude that the evidence significantly and substantially weighs against the claims for service connection on a secondary and direct basis and the claims for service connection for an acquired psychiatric disorder and neurological impairment of the bilateral upper and lower extremities are denied. 38 U.S.C. § 5107(b); see also Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

 

Tracie N. Wesner

Veterans Law Judge

Board of Veterans' Appeals

M. Riley, Attorney for the Board of Veterans' Appeals

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.