PERIPHERAL NERVE DISORDERS OF THE UPPER EXTREMITY

WILLIAM H. DONNELLY · 2026 · Case ID: 26001163

MIXED

Summary

The veteran, who served in the United States Air Force from January 1983 to June 2007, appeals the denial of service connection for peripheral neuropathy of the bilateral upper extremities and erectile dysfunction, each claimed as secondary to his service-connected thoracolumbar strain. He also appeals the denial of Total Disability based on Individual Unemployability (TDIU). The Board denied the neuropathy claims, finding that the service treatment records were negative for these conditions and that the VA examiner's opinion, which stated the thoracolumbar strain did not affect the nerves, was more persuasive than the veteran's lay assertions. The VA examiner diagnosed mild, incomplete paralysis of the bilateral radial, median, and ulnar nerves but found no nexus to service or the thoracolumbar strain, noting normal muscle strength and reflexes. Similarly, the erectile dysfunction claims were denied, with the VA examiner attributing the condition to obesity and lifestyle rather than the service-connected thoracolumbar strain, stating the strain did not affect the relevant nerve bundles. The Board granted entitlement to TDIU, finding that the veteran's combined service-connected disabilities, including PTSD, thoracolumbar strain, shoulder, ankle, hip, and headache conditions, prevent him from securing or following substantially gainful employment. The Board considered his physical limitations, pain, anxiety, avoidance behaviors, and limited work history in manual labor, concluding that these factors, combined with his education and training, render him unemployable.

Rationale

Service treatment records negative for neuropathy.; VA examiner opined less likely than not related to service.; VA examiner opined thoracolumbar strain does not affect nerves.

Service Branch

AIR FORCE

Special Benefit

TDIU

Docket No.

10-47 052A

Full Decision Text

Citation Nr: 26001163
Decision Date: 01/29/26 Archive Date: 01/29/26

DOCKET NO. 10-47 052A
DATE: January 29, 2026

ORDER

Entitlement to service connection for peripheral neuropathy of the left upper extremity, as secondary to service-connected thoracolumbar strain, is denied.

Entitlement to service connection for peripheral neuropathy of the right upper extremity, as secondary to service-connected thoracolumbar strain, is denied.

Entitlement to service connection for erectile dysfunction, as secondary to service-connected thoracolumbar strain is denied.

Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is granted.

FINDINGS OF FACT

1. The Veteran's peripheral neuropathy of the left upper extremity did not occur in service, is not related to service-connected thoracolumbar strain, and is not otherwise related to service.

2. The Veteran's peripheral neuropathy of the right upper extremity did not occur in service, is not related to service-connected thoracolumbar strain, and is not otherwise related to service.

3. The Veteran's erectile dysfunction did not occur in service, is note related to service-connected thoracolumbar strain, and is not otherwise related to service.

4. The evidence of record establishes the Veteran's service-connected disabilities prevent him from securing or maintaining substantially gainful employment.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for peripheral neuropathy of the left upper extremity are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310.

2. The criteria for entitlement to service connection for peripheral neuropathy of the right upper extremity are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310.

3. The criteria for entitlement to service connection for erectile dysfunction are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310.

4. The criteria for entitlement to TDIU are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.15, 4.16, 4.18.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Air Force from January 1983 to June 2007.

These matters come before the Board of Veterans' Appeals (Board) on appeal from a May 2008 rating decision by an Agency of Original Jurisdiction (AOJ) of the United States Department of Veterans Affairs (VA).

The Veteran testified at a February 2015 hearing held before a Veterans Law Judge (VLJ). A transcript of the hearing is associated with the claims file. The VLJ who presided over this hearing is no longer employed by the Board. The Veteran was afforded an opportunity for a new hearing but declined such in September 2024.

The procedural history of this case is quite long. The May 2008 rating decision assigned an initial noncompensable evaluation for the Veteran's service-connected thoracolumbar strain. In a June 2012 rating decision, the AOJ increased the Veteran's initial disability evaluation for his thoracolumbar spine to 10 percent, and in a December 2017 rating decision it was increased to 20 percent. In a May 2018 decision, the Board denied the Veteran's claim for an increased disability rating. In August 2018, the Veteran's attorney requested reconsideration of the May 2018 Board decision, indicating the issues of entitlement to service connection for neuropathy of the upper extremities and for erectile dysfunction, each as due to his thoracolumbar strain, and entitlement to TDIU were raised by the record.

The Board remanded these issues, as part and parcel of the matters considered in May 2018, in March 2021 for additional development. Importantly, the May 2018 decision did not involve the cervical spine, and so a claim for service connection as part of that condition was not raised. The requested development was completed and in June 2021 the AOJ issued a rating decision denying service connection for neuropathy of the upper extremities, denying service connection for erectile dysfunction, and denying entitlement to TDIU, rather than a supplemental statement of the case. As the June 2021 rating decision included a list of all the evidence considered in the decision, provided detailed explanation for the decisions denying each claim, and provided the applicable laws and regulations, and no additional evidence has been received, the Board will construe this rating decision as a supplemental statement of the case and proceed to adjudication of these issues. In May 2024, the AOJ issued a supplemental statement of the case regarding the issue of entitlement to TDIU.

With respect to the Veteran's claims decided herein, VA has met all statutory and regulatory notice and duty-to-assist provisions. See 38 U.S.C. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126; 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326. Neither the Veteran nor his representative has advanced any procedural arguments in relation to VA's duty to notify and assist. See Scott v. McDonald, 789 F.3d 1375 (Fed. Cir. 2015).

Service Connection

Service connection may be established for disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty, in the active military, naval, or air service. 38 U.S.C. §§ 1110, 1131. Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

In order to establish service connection on a direct basis, the record requires competent evidence showing: (1) the existence of a present disability; (2) in service incurrence or aggravation of an injury or disease; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). In the absence of proof of a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992).

Some chronic diseases may be presumed to have been incurred in service if they become manifest to a degree of ten percent or more within the applicable presumptive period. 38 U.S.C. §§ 1101(3), 1112(a); 38 C.F.R. §§ 3.307(a), 3.309(a). For those listed chronic conditions, a showing of continuity of symptoms affords an alternative route to service connection. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F. 3d 1331 (Fed. Cir. 2013). Peripheral neuropathy, as organic disease of the nervous system, is a listed chronic disease, with a presumptive period of one year following separation from service. However, as there is no evidence, argument or allegation of the currently claimed peripheral neuropathy of the right and left upper extremity within the first post-service year, the presumption is not applicable.

A disability which is proximately due to, or the result of a service-connected disease or injury shall be service connected. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. 38 C.F.R. § 3.310. To prevail on the issue of entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability and (3) nexus evidence establishing a connection between the service-connected disability and the current disability. Wallin v. West, 11 Vet. App. 509,
athy of the right and left upper extremity within the first post-service year, the presumption is not applicable.

In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether the weight of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant.

Peripheral Neuropathy of the Bilateral Upper Extremities

The Veteran asserts his peripheral neuropathy of the bilateral upper extremities is secondary to his service-connected thoracolumbar strain.

The Veteran's service treatment records (STRs) are negative for treatment for symptoms of and/or a diagnosis of neuropathy in the right and left upper extremities.

The Veteran submitted a private treatment record from a January 2017 visit in support of his claims. Dr. SK, the Veteran's treating physician, stated that the Veteran was experiencing back pain with associated symptoms of arm numbness and arm weakness; she did not offer any rationale or explanation supporting such association.

The Veteran was afforded a VA peripheral nerves examination in April 2021. The Veteran reported that he had back issues since 1989. The Veteran reported that he experiences tingling and numbness in his fingers. His symptoms are worse at night when he lays down. He stated that he has spasms in his upper back that cause worsening of the numbness and paresthesia to his arms and fingers. The Veteran reported experiencing mild constant pain, mild intermittent pain, moderate paresthesias and/or dysesthesias, and moderate numbness in his bilateral upper extremities. Muscle strength test results, reflex test results and sensory examination results were all normal. The VA examiner diagnosed mild, incomplete paralysis of the bilateral radial, median, and ulnar nerves. The VA examiner opined that it is less likely than not that the Veteran's upper extremity neurological disabilities were neither incurred in service or due to his service-connected thoracolumbar strain. The VA examiner stated that the thoracolumbar strain is a muscular deformity that does not impact or affect nerves. Additionally, the VA examiner opined that one would expect that with a 42 year history, with no surgery or treatment, that there would be significant muscle wasting from the progressive deterioration of the nerves. Yet, the Veteran had normal muscle strength bilaterally, normal sharp and light touch response, normal phalen and tinnels signs, no muscle wasting or atrophy, and no loss of grip strength. The VA examiner observed that there were no signs of aggravation beyond normal progression of what would be expected from the military.

Direct service connection peripheral neuropathy of the bilateral upper extremities must be denied because the competent evidence of record does not show such was caused by service, nor does it show the Veteran experienced symptoms of this condition that continued from service to the present. Additionally, the VA examiner opined that thoracolumbar strain is a muscular deformity that does not impact or affect nerves.

Although the Veteran has expressed a belief in a connection between his service connected thoracolumbar strain and his peripheral neuropathy of the upper extremities, he lacks the knowledge and training required to render a nexus opinion on a cause and effect relationship unobservable to a lay person. Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). Further, he has simply asserted his opinion, without a clear rationale or support; no probative value is given his statements beyond their worth as physical observations. No medical professional has rendered a positive nexus opinion, nor supported the position. Service connection for peripheral neuropathy of the bilateral upper extremities, including service connection on a secondary basis due to thoracolumbar strain, is not warranted. There is no reasonable doubt to be resolved in this case. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert
a cause and effect relationship unobservable to a lay person. Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). Further, he has simply asserted his opinion, without a clear rationale or support; no probative value is given his statements beyond their worth as physical observations. No medical professional has rendered a positive nexus opinion, nor supported the position. Service connection for peripheral neuropathy of the bilateral upper extremities, including service connection on a secondary basis due to thoracolumbar strain, is not warranted. There is no reasonable doubt to be resolved in this case. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, at 1 Vet. App. 49 (1990).

Erectile Dysfunction

The Veteran asserts his diagnosed erectile dysfunction is due to his service-connected thoracolumbar strain.

The Veteran's service treatment records (STRs) are negative for treatment for symptoms of erectile dysfunction and/or a diagnosis of erectile dysfunction.

The Veteran underwent a VA male reproductive examination in April 2021. The Veteran reported that due to his upper back pain it is hard to maintain an erection. He stated that there is a difference with medication, which he started taking around 2000. The Veteran reported that he takes sildenafil and Cialis. He has not had an orchiectomy and does not have any renal or voiding dysfunction. The VA examiner opined that the etiology of the Veteran's erectile dysfunction is obesity and his lifestyle. A physical examination was not performed at the Veteran's request. The VA examiner opined that the Veteran's erectile dysfunction is not due to his thoracolumbar strain. The VA examiner stated that the thoracolumbar strain has not affected the nerve bundle responsible for erections, micturition, or defecation, nor has it interfered with ambulation. The VA examiner opined that the most likely cause of the Veteran's erectile dysfunction is obesity and lifestyle.

Direct service connection for erectile dysfunction must be denied because the competent evidence of record does not show such was caused by service, nor does it show the Veteran experienced symptoms of this condition that continued from service to the present. Additionally, the VA examiner opined that thoracolumbar strain is a muscular deformity that does not impact or affect the nerve bundle responsible for erections. The VA examiner opined that the most likely cause of the Veteran's erectile dysfunction is obesity and lifestyle.

Although the Veteran has expressed a belief in a connection between his service connected thoracolumbar strain and his erectile dysfunction, he lacks the knowledge and training required to render a nexus opinion on a cause and effect relationship unobservable to a lay person. Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). Further, he has simply asserted his opinion, without a clear rationale or support; no probative value is given his statements beyond their worth as physical observations. No medical professional has rendered a positive nexus opinion, nor supported the position. Service connection for erectile dysfunction, including service connection on a secondary basis due to thoracolumbar strain, is not warranted. There is no reasonable doubt to be resolved in this case. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, at 1 Vet. App. 49 (1990).

TDIU

It is the established policy of VA that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. See 38 C.F.R. § 4.16. A finding of total disability is appropriate "when there is present any impairment of mind or body which is sufficient to render it impossible for the average person to follow a substantially gainful occupation." See 38 C.F.R. §§ 3.340(a)(1), 4.15.

The central inquiry is, "whether the veteran's service-connected disabilities alone are of sufficient severity to produce unemployability." Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). The issue is not whether the Veteran can find employment generally, but whether the Veteran is capable of performing the physical and mental acts required by employment. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). Consideration may be given to the Veteran's education, special training, and previous work experience, but not to his age or to the impairment caused by nonservice-connected disabilities. See 38 C.F.R. §§ 3.
1), 4.15.

The United States Court of Appeals for Veterans' Claims (Court) has held that the term "unable to secure and follow a substantially gainful occupation" in 38 C.F.R. § 4.16 has two components. First, there is an economic component which essentially contemplates an occupation earning more than marginal income (outside of a protected environment) as determined by the U.S. Department of Commerce as the poverty threshold for one person. Second, there is a non-economic component dealing with the individual veteran's ability to "follow and secure" employment. For the second component, attention must be given to: (a) the veteran's history, education, skill and training, (b) the veteran's physical ability (both exertional and non-exertional) to perform the type of activities (e.g., sedentary, light, medium, heavy or very heavy) required by the occupation at issue, with relevant factors such as lifting, bending, sitting, standing, walking, climbing, grasping, typing, reaching, auditory and visual, and (c) whether the Veteran has the mental ability to perform the type of activities required by the occupation at issue, with relevant factors such as memory, concentration, and ability to adapt to change, handle work place stress, get along with coworkers and demonstrate reliability and productivity. Ray v. Wilkie, 31 Vet. App. 58, 73 (2019).

The Veteran is in receipt of a 50 percent disability evaluation for posttraumatic stress disorder, a 30 percent disability evaluation for sinusitis, a 30 percent disability evaluation for painful scars, a 30 percent disability evaluation for headaches, a 20 percent disability evaluation for a right shoulder disability, a 20 percent disability evaluation for a left shoulder disability, a 20 percent disability evaluation for a cervical spine disability, a 20 percent disability evaluation for thoracolumbar strain, a 10 percent disability evaluation for a left hip disability, a 10 percent disability evaluation for a right hip disability, a 10 percent disability evaluation for a left ankle fracture, a 10 percent disability evaluation for tinnitus, a 10 percent disability evaluation for mass in left breast post excision, a 10 percent disability evaluation for right ankle fracture, and noncompensable disability evaluations for bilateral plantar fascitis, left inguinal hernia with scar, left shoulder surgical scar and residual skin cancer right lower eyelid and nose.

The Veteran has had a combined disability evaluation of 100 percent since May 10, 2017; prior to that, his combined rating was 90 percent, and it is for this period TDIU must be considered.

The Veteran submitted a VA Form 21-8940, Veteran's Application for Increased Compensation Based on Unemployability in May 2024. The Veteran stated that his PTSD and combined service connected conditions prevented him from securing or following substantially gainful employment. The Veteran indicated he last worked in May 2014 as an oil and natural gas storage and pipeline operator. He previously worked as fuel lab technician from January 2008 to September 2009. The Veteran completed three years of college and had additional training at golf academy.

The Veteran underwent a VA PTSD examination in 2014. The Veteran endorsed isolation and avoidance, decreased participation in leisure and recreational activities due to avoidance symptoms and physical injuries. The Veteran's symptoms included anxiety, chronic sleep impairment, flattened affect, disturbances of motivation and mood and difficulty in adapting to stressful circumstances including work and a work like setting.

The Veteran underwent a VA ankle examination in September 2015. The VA examiner indicated that the Veteran's service-connected ankle disabilities impacted his ability to perform occupational tasks as he avoids prolonged standing and walking.

The Veteran underwent a VA shoulder examination in September 2015. The VA examiner indicated the Veteran's service-connected shoulder disabilities impact his ability to perform occupational tasks as he has difficulty with overhead activities including reaching, lifting and carrying.

The Veteran underwent a VA hip and thigh examination in September 2015. The VA examiner indicated the Veteran's service-connected hip disabilities impact his ability to perform occupational
anxiety, chronic sleep impairment, flattened affect, disturbances of motivation and mood and difficulty in adapting to stressful circumstances including work and a work like setting.

The Veteran underwent a VA hip and thigh examination in September 2015. The VA examiner indicated the Veteran's service-connected hip disabilities impact his ability to perform occupational tasks as he has difficulty with sitting, standing, and climbing stairs.

The Veteran submitted a private treatment record from Maguire Family Medicine from a January 5, 2017 visit in support of his claims. Dr. SK, the Veteran's treating physician stated that the Veteran was experiencing back pain with associated symptoms of arm numbness and arm weakness. Dr. SK stated the Veteran was currently able to do activities of daily living with limitations, was unable to work, unable to participate in sports and his quality of married life was affected due to pain causing irritability and sexual dysfunction.

The Veteran underwent a VA back examination in May 2017. The VA examiner indicated the Veteran's service-connected back disability impacts his ability to perform occupational tasks as it affects his ability to perform physical activities. The Veteran has pain on motion which causes functional loss, and he experiences muscle spasms.

The Veteran underwent a VA shoulder examination in May 2017. The VA examiner indicated the Veteran's service-connected shoulder disabilities impact his ability to perform occupational tasks as it limits his ability to lift.

The Veteran underwent a VA headaches examination in June 2017. The VA examiner indicated the Veteran's service-connected headaches impact his ability to perform occupational tasks as his headaches interfere with his sleep. His nighttime headaches are debilitating, and he is not able to function; the headaches last for about an hour after taking Tylenol.

The Veteran submitted a vocational opinion completed by Dr. MF in November 2021. Dr. MF observed the Veteran is service connected for PTSD, sinusitis, painful scars, headaches, cervical strain, thoracolumbar strain, right and left hip injury, left ankle fracture and tinnitus. Dr. MF stated that he reviewed the Veteran's claims file, including his VA sinusitis, hip and thigh examinations conducted in 2015 and his VA ankle, mental disorders and shoulder examinations conducted in 2017. Dr. MF opined that the Veteran had several limitations to working between 2014 and 2017, due to numerous conditions. The Veteran stated his physical disabilities prevent him from continuing his prior line of work. Dr. MF stated that the Veteran has significant shoulder issues which impact his ability to lift and carry due to functional loss with limited motion and lifting per his VA examination report. The VA examiner did not identify a weight limit when it comes to the Veteran's ability to lift objects, but he made it clear that any lifting would be difficult. The Veteran has pain in all ranges of motion of his shoulders. The Veteran's hip disabilities also cause pain, and he has pain with flareups in his ankles. Dr. MF stated that the Veteran's employers indicate they terminate employees if the worker's production is a standard deviation below industry standards. Dr. MF opined that the Veteran would have difficulty with production due to dealing with pain on a constant basis and needing to take medication on a constant basis. Dr. MF stated that the Veteran's disabilities impact his ability to perform sedentary work as standing for long periods of time and sitting cause hip pain. Dr. MF opined that the Veteran's service connected disabilities preclude him from working, as he would not be able to perform even light exertional level jobs due to his difficulty with standing, walking and sitting.

Based upon a thorough review of the evidence of record, the Board finds that the Veteran is unemployable due to his service-connected PTSD, back, shoulder, ankle, hip and headache disabilities. The Veteran is unable to perform jobs which require manual labor and work that requires prolonged walking, standing, and sitting. He experiences debilitating headaches which cause nausea. He has anxiety, avoidance behaviors and difficulty getting along with others in a work like setting due to his PTSD. The Veteran has three years of college, with additional training at a golf academy. The Board finds the combination of service-connected disabilities, with limited physical functioning, his education, and his limited work history in manual labor, prevent him from securing and following substantially gainful employment. Therefore, entitlement to TDIU is warranted based on the combined effect .

As the award of TDIU is based on the combined effect of the Veteran's service-connected conditions, the award of the TDI
The Veteran is unable to perform jobs which require manual labor and work that requires prolonged walking, standing, and sitting. He experiences debilitating headaches which cause nausea. He has anxiety, avoidance behaviors and difficulty getting along with others in a work like setting due to his PTSD. The Veteran has three years of college, with additional training at a golf academy. The Board finds the combination of service-connected disabilities, with limited physical functioning, his education, and his limited work history in manual labor, prevent him from securing and following substantially gainful employment. Therefore, entitlement to TDIU is warranted based on the combined effect .

As the award of TDIU is based on the combined effect of the Veteran's service-connected conditions, the award of the TDIU does not satisfy the requirement of a single, totally disabling service-connected condition for consideration of special monthly compensation. 38 C.F.R. § 3.350; Bradley v. Peake, 22?Vet. App.?280 (2008); Buie v. Shinseki, 24?Vet. App.?242, 250 (2011). No further discussion is required.

WILLIAM H. DONNELLY

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Margaret M. Lunger

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.

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