PERIPHERAL NEUROPATHY

R. FEINBERG · 2026 · Case ID: A26025200

MIXED

Summary

The Veteran, a Veteran who served from October 1966 to December 1970, including service in Vietnam, appeals the denial of service connection for bilateral upper extremity neuropathy (carpal tunnel syndrome) and seeks service connection for bilateral lower extremity peripheral neuropathy. The Veteran claims both conditions are due to Agent Orange exposure during service. The Board found the Veteran competent and credible regarding his lower extremity symptoms, noting their in-service onset and progression. While the Veteran did not meet the regulatory presumption for early-onset peripheral neuropathy due to lack of timely manifestation, the Board found the evidence, including a favorable opinion from a VA APRN, to be in approximate balance with negative evidence. Applying the benefit of the doubt, service connection for bilateral lower extremity peripheral neuropathy was granted. For the upper extremity claim, the Board found the Veteran's bilateral carpal tunnel syndrome diagnosis distinct from the lower extremity neuropathy. The Board found a private physiatrist's opinion unpersuasive due to lack of reasoning and a VA examiner's opinion inadequate due to ambiguity. However, a July 2025 addendum opinion was found adequate, explaining that carpal tunnel syndrome is a focal compressive neuropathy unrelated to herbicide exposure or military duties. The Board found the evidence persuasively against a nexus for the upper extremity claim, denying service connection for bilateral carpal tunnel syndrome.

Rationale

Favorable opinion from VA APRN; Competent and credible lay evidence of in-service onset; Approximate balance of evidence; Benefit of the doubt applied

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250725-568720

Full Decision Text

Citation Nr: A26025200
Decision Date: 03/20/26 Archive Date: 03/20/26

DOCKET NO. 250725-568720
DATE: March 20, 2026

ORDER

Service connection for bilateral lower extremity peripheral neuropathy is granted.

Service connection for bilateral upper extremity neuropathy, diagnosed as bilateral carpal tunnel syndrome, is denied.

FINDINGS OF FACT

1. Resolving reasonable doubt in the Veteran's favor, his bilateral lower extremity peripheral neuropathy is related to his conceded herbicide agent exposure in Vietnam.

2. The weight of the most probative evidence is against finding that the Veteran's bilateral upper extremity neuropathy, diagnosed as bilateral carpal tunnel syndrome, began in service or is otherwise related to service, including conceded herbicide agent exposure or other exposures.

CONCLUSIONS OF LAW

1. The criteria for service connection for bilateral lower extremity peripheral neuropathy are met. 38?U.S.C. §§?1110, 1116, 5107; 38?C.F.R. §§?3.102, 3.303, 3.307, 3.309.

2. The criteria for service connection for bilateral upper extremity neuropathy, diagnosed as bilateral carpal tunnel syndrome, are not met. 38?U.S.C. §§?1110, 1116, 5107; 38?C.F.R. §§?3.102, 3.303, 3.307, 3.309.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from October 1966 to December 1970.

This case is before the Board of Veterans' Appeals (Board) on appeal from a July 2025 rating decision from a Department of Veterans Affairs (VA) agency of original jurisdiction (AOJ).

The Veteran elected the Direct Review docket in the July 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement). Therefore, the Board may only consider the evidence of record at the time of the July 2025 AOJ decision on appeal. 38 C.F.R. § 20.301. The Board cannot consider any evidence submitted after the July 2025 AOJ decision on appeal. 38 C.F.R. §§ 20.300, 20.301, 20.801.

The Board notes that the period to switch AMA dockets has not yet elapsed; however, in December 2025, the Veteran submitted a docket switch waiver. Accordingly, the Board may adjudicate the appeal under the Veteran's elected docket without delay. See Williams v. McDonough, 37 Vet. App. 305 (2024); 38 C.F.R. § 20.202(c)(2).

If the Veteran would like VA to consider any submitted evidence that the Board could not, 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.

Service Connection

Service connection will be granted for a current disability that resulted from an injury, disease, or aggravation while in active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Generally, service connection requires (1) a present disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the present disability and the in-service incurrence or aggravation of a disease or injury. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

If a veteran performed covered service in the Republic of Vietnam during the Vietnam era, exposure to an herbicide agent is presumed. 38 U.S.C. § 1116(f); 38 C.F.R. § 3.307(a)(6)(iii). The Veteran's military personnel records demonstrate that he served in Vietnam from September 1967 to October 1968; thus, exposure to herbicide agents is presumed.

Early-onset peripheral neuropathy is one of the diseases listed as associated with herbicide-agent exposure. 38 U.S.C. § 1116(a)(2); 38 C.F.R. § 3.309(e). However, for the herbicide presumption to apply to early-onset peripheral neuropathy, the disease must become
of Vietnam during the Vietnam era, exposure to an herbicide agent is presumed. 38 U.S.C. § 1116(f); 38 C.F.R. § 3.307(a)(6)(iii). The Veteran's military personnel records demonstrate that he served in Vietnam from September 1967 to October 1968; thus, exposure to herbicide agents is presumed.

Early-onset peripheral neuropathy is one of the diseases listed as associated with herbicide-agent exposure. 38 U.S.C. § 1116(a)(2); 38 C.F.R. § 3.309(e). However, for the herbicide presumption to apply to early-onset peripheral neuropathy, the disease must become manifest to a degree of 10 percent or more within one year after the date of the veteran's last exposure to an herbicide agent during active service. 38 U.S.C. § 1116(a); 38 C.F.R. §§ 3.307(a)(6)(ii), 3.309(e).

The Veteran is competent to report symptoms and experiences he can observe. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); 38 C.F.R. § 3.159(a). VA must give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed Cir. 2009).

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 57-58 (1990); 38 C.F.R. § 3.102.

1. Bilateral lower extremity peripheral neuropathy.

The Veteran contends that he developed neuropathy of the upper and lower extremities due to Agent Orange exposure while serving in Vietnam from September 1967 to October 1968. He reported that he was repeatedly exposed to Agent Orange and sometimes supervised spraying operations. He further contends that symptoms began in service; he first noticed tingling and numbness in his feet while still on active duty, with gradual worsening over the years, progressing from the toes to the feet and legs, and later involving the hands and arms.

The record demonstrates that the criteria for service connection for bilateral lower extremity peripheral neuropathy due to herbicide agent exposure are met.

The June 2025 VA examination shows a diagnosis of bilateral sciatica. VA treatment records summarize an April 2022 electromyography (EMG) test that shows decreased bilateral fibular motor response, a November 2022 EMG showing no abnormalities, and a December 2024 EMG test that found no significant changes from the April 2022 test. Taken together, a current lower extremity neurologic disability diagnosed as bilateral lower extremity peripheral neuropathy is established.

In-service herbicide agent exposure has been conceded; however, service connection based on a presumptive basis is not warranted because the record does not show that the Veteran's lower extremity neuropathy became manifest to a compensable degree within one year after his last herbicide exposure in Vietnam. See 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307(a)(6), 3.309(e). However, service connection may still be established on a direct basis if the evidence shows that the current disability was incurred in service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(d).

In a March 2025 letter, the Veteran's treating VA primary care advanced practice registered nurse (APRN) stated that she had personally reviewed the Veteran's medical history, including EMG and blood test results and primary care notes, and had also reviewed the circumstances of his military service, including Agent Orange exposure in Vietnam. She noted that the Veteran had been under her care since December 2020 and that his diagnosis was peripheral neuropathy of the bilateral lower extremities. She further stated that the Veteran had no other known risk factors that may have precipitated the condition, specifically identifying the absence of diabetes or prediabetes, Lyme disease, thyroid disease, autoimmune disease, and heavy metal toxicity. She acknowledged a mildly low B12 level in November 2024 but explained that B12 had been replete when neuropathy symptoms were first presented in 2021. She then opined that it was more likely than not that the Veteran's condition was a direct result of his Agent Orange exposure.

In a March 2025
Orange exposure in Vietnam. She noted that the Veteran had been under her care since December 2020 and that his diagnosis was peripheral neuropathy of the bilateral lower extremities. She further stated that the Veteran had no other known risk factors that may have precipitated the condition, specifically identifying the absence of diabetes or prediabetes, Lyme disease, thyroid disease, autoimmune disease, and heavy metal toxicity. She acknowledged a mildly low B12 level in November 2024 but explained that B12 had been replete when neuropathy symptoms were first presented in 2021. She then opined that it was more likely than not that the Veteran's condition was a direct result of his Agent Orange exposure.

In a March 2025 letter, the Veteran's treating VA physiatrist opined that his peripheral neuropathy was most likely caused by or a result of Agent Orange exposure because he served in Vietnam, was exposed to Agent Orange, and has peripheral neuropathy. The physiatrist cited a medical article in support of the opinion.

The June 2025 VA examiner opined that the Veteran's bilateral lower extremity peripheral neuropathy was less likely caused during service and more likely caused by his Agent Orange exposure in service during his time in Vietnam.

A July 2025 addendum medical opinion emphasized a normal November 2022 EMG, the absence of electrophysiologic abnormalities, the lack of documented neuropathy proximate to service, and the proposition that VA recognizes only early-onset peripheral neuropathy as presumptively associated with herbicide agent exposure and that chronic peripheral nervous system disorders are not positively associated with Agent Orange. The physician further stated that Camp Lejeune contaminants, such as PCE, TCE, and benzene, are not linked to late-onset neuropathy.

The Board finds the March 2025 VA APRN's opinion adequate and highly probative as to the etiology of the Veteran's bilateral lower extremity peripheral neuropathy because it is based on an accurate medical history, familiarity with the Veteran as a treating provider, review of pertinent testing and treatment records, consideration of the Veteran's exposure history, and a reasoned explanation that excluded several common alternative etiologies. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).

The Board finds the March 2025 VA physiatrist's opinion of limited probative value because he did not provide any reasoning for his opinion based on the circumstances specific to the Veteran. See id.

The Board finds the June 2025 VA examiner's opinion inadequate because it is plagued by ambiguity and inconsistency. Monzingo v. Shinseki, 26 Vet. App. 97, 109 (2012).

The Board finds the July 2025 addendum medical opinion inadequate regarding the lower extremity peripheral neuropathy because it relied heavily on a normal November 2022 EMG but did not reconcile those findings with the April 2022 and December 2024 EMG test findings, or with the March 2025 favorable opinions that excluded alternative causes for lower extremity peripheral neuropathy. See Stefl v. Nicholson, 21?Vet. App.?120, 124 (2007).

The Board finds the Veteran competent to report observable symptoms, such as tingling, numbness, and loss of balance, and that these symptoms progressed over time and began in his feet while he was still on active duty. The Board also finds the Veteran credible and that his reports of neuropathy in his feet have been consistent.

While the Veteran does not satisfy the regulatory presumption for early-onset peripheral neuropathy because the disease was not shown to have become manifest to a degree of 10 percent or more within one year after the Veteran's last exposure to herbicide agents, the competent and credible lay evidence of in-service onset and progressive continuity, together with the March 2025 favorable medical opinions, places the evidence at least in approximate balance with the negative July 2025 addendum.

Upon review of the record, the Board finds the evidence is in approximate balance. Accordingly, after resolving all reasonable doubts in the Veteran's favor, the Board finds that service connection for bilateral lower extremity peripheral neuropathy is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. The claim is granted.

2. Bilateral upper extremity neuropathy, diagnosed as bilateral carpal tunnel syndrome.

The Veteran contends that his bilateral upper extremity neuropathy is due to Agent Orange exposure while serving in Vietnam.

The record demonstrates that the criteria for service connection for bilateral upper extremity neuropathy due to herbicide agent exposure are not met.

The June 2025 VA examination and a December 2024 EMG test show a competent diagnosis of bilateral carpal tunnel syndrome. In-service herbicide agent exposure
's favor, the Board finds that service connection for bilateral lower extremity peripheral neuropathy is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. The claim is granted.

2. Bilateral upper extremity neuropathy, diagnosed as bilateral carpal tunnel syndrome.

The Veteran contends that his bilateral upper extremity neuropathy is due to Agent Orange exposure while serving in Vietnam.

The record demonstrates that the criteria for service connection for bilateral upper extremity neuropathy due to herbicide agent exposure are not met.

The June 2025 VA examination and a December 2024 EMG test show a competent diagnosis of bilateral carpal tunnel syndrome. In-service herbicide agent exposure has been conceded.

The VA treatment record discussing the December 2024 EMG test notes that symptoms in the bilateral hands began within the past few months, i.e., in 2024.

The June 2025 VA examiner opined that the Veteran's bilateral carpal tunnel syndrome was less likely caused during service and more likely caused by his Agent Orange exposure in service during his time in Vietnam.

A July 2025 addendum medical opinion explained that bilateral carpal tunnel syndrome is a focal, compressive neuropathy of the median nerve at the wrist, not a diffuse or systemic peripheral neuropathy. The examiner stated that the condition was unrelated to herbicide agent exposure, Camp Lejeune contaminants, combat duties, or parachuting, and noted the absence of wrist fractures, crush injuries, or hand trauma in service.

The Board finds the March 2025 VA physiatrist's opinion of limited probative value because he did not provide any reasoning for his opinion based on the circumstances specific to the Veteran, and did not distinguish peripheral neuropathy from carpal tunnel syndrome. Nieves-Rodriguez, 22 Vet. App. at 304; Stefl, 21?Vet. App. at 124.

The Board finds the June 2025 VA examiner's opinion inadequate because it is plagued by ambiguity and inconsistency. Monzingo, 26 Vet. App. at 109.

The Board finds the July 2025 addendum medical opinion adequate and probative as to the upper extremity claims because the examiner addressed the actual diagnosis of bilateral carpal tunnel syndrome, explained that it is a focal compressive neuropathy of the median nerve at the wrist rather than a diffuse toxic neuropathy, and explained why it was less likely related to herbicide agent exposure, Camp Lejeune contaminants, or the Veteran's military duties. See Nieves-Rodriguez, 22 Vet. App. at 304.

The Board notes that the March 2025 favorable APRN opinion does not help the upper extremity claim because it discussed only bilateral lower extremity peripheral neuropathy and did not address carpal tunnel syndrome.

The Board has also considered the Veteran's sincere belief that his hand and arm symptoms are related to the same exposures that caused his lower extremity peripheral neuropathy. Although there is favorable competent medical evidence of record in the form of the March 2025 physiatrist's opinion, the Board finds that evidence less probative than the July 2025 addendum for the reasons discussed above. Accordingly, the more persuasive evidence is against a nexus between the Veteran's bilateral upper extremity neuropathy, diagnosed as bilateral carpal tunnel syndrome, and service.

Accordingly, the evidence is persuasively against the claim. As there is no approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable, and service connection for bilateral upper extremity

neuropathy, diagnosed as bilateral carpal tunnel syndrome, is not warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. The claim is denied.

R. FEINBERG

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Costa, Stephanie D.

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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