Back to BVA DecisionsMIXEDService Branch ARMY Special Benefit NO SPECIAL BENEFIT Docket No. 200317-78627
PERIPHERAL NERVE DISORDERS
B. MULLINS · 2026 · Case ID: A26026821
Summary
The Veteran, an Army veteran who served from October 1986 to November 1988, appeals the denial of service connection for peripheral neuropathies in his upper and lower extremities, claimed as secondary to his service-connected low back syndrome with degenerative disc disease L4-5. The Board granted service connection for the right and left lower extremity peripheral neuropathies. The Veteran's claim for these conditions was supported by his own statements and testimony, a May 2024 private physician's assistant report indicating an in-service onset and continuity of symptoms, and the fact that his service-connected low back condition was established. The Board found the evidence for the lower extremity claims to be at least in approximate balance, affording the Veteran the benefit of the doubt and granting service connection. However, service connection for the right and left upper extremity peripheral neuropathies was denied. The Board relied on VA examination opinions stating it was anatomically impossible for a low back condition to cause upper extremity symptoms, and that it was less likely than not that the neuropathies were related to or aggravated by the service-connected low back condition, citing the Veteran's motor vehicle accident, weight gain, and diabetes as more likely causes. The Board found the Veteran's lay statements credible regarding his symptoms but not competent to opine on the medical etiology of the upper extremity neuropathies. The Board found the evidence persuasively weighed against the claim for the upper extremities.
Rationale
Current disability confirmed (right lower extremity peripheral neuropathy); Service-connected disability established (low back syndrome with degenerative disc disease L4-5); Evidence in approximate balance regarding nexus to service-connected low back condition; Benefit of the doubt afforded to Veteran
Full Decision Text
Citation Nr: A26026821 Decision Date: 03/25/26 Archive Date: 03/25/26 DOCKET NO. 200317-78627 DATE: March 25, 2026 ORDER Entitlement to service connection for right lower extremity peripheral neuropathy as secondary to low back syndrome with degenerative disc disease L4-5 is granted. Entitlement to service connection for left lower extremity peripheral neuropathy as secondary to low back syndrome with degenerative disc disease L4-5 is granted. Entitlement to service connection for right upper extremity peripheral neuropathy to include as secondary to low back syndrome with degenerative disc disease L4-5 is denied. Entitlement to service connection for left upper extremity peripheral neuropathy to include as secondary to low back syndrome with degenerative disc disease L4-5 is denied. FINDINGS OF FACT 1. The competent evidence of record demonstrates that the Veteran's right lower extremity peripheral neuropathy is causally related to the Veteran's service-connected low back syndrome with degenerative disc disease L4-5. 2. The competent evidence of record demonstrates that the Veteran's left lower extremity peripheral neuropathy is causally related to the Veteran's service-connected low back syndrome with degenerative disc disease L4-5. 3. The competent evidence of record fails to show that the Veteran's right upper extremity peripheral neuropathy is causally related to his active duty military service to include as secondary to the Veteran's service-connected low back syndrome with degenerative disc disease L4-5. 4. The competent evidence of record fails to show that the Veteran's left upper extremity peripheral neuropathy is causally related to his active duty military service to include as secondary to the Veteran's service-connected low back syndrome with degenerative disc disease L4-5. CONCLUSIONS OF LAW 1. The criteria for establishing entitlement to service connection for right lower extremity peripheral neuropathy as secondary to low back syndrome with degenerative disc disease L4-5 have been met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 2. The criteria for establishing entitlement to service connection for left lower extremity peripheral neuropathy as secondary to low back syndrome with degenerative disc disease L4-5 have been met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 3. The criteria for establishing entitlement to service connection for right upper extremity peripheral neuropathy to include as secondary to low back syndrome with degenerative disc disease L4-5 have not been met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 4. The criteria for establishing entitlement to service connection for left upper extremity peripheral neuropathy to include as secondary to low back syndrome with degenerative disc disease L4-5 have not been met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served honorably in the United States Army from October 1986 to November 1988. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2020 Statement of the Case (SOC) issued by a Department of Veterans Affairs (VA) regional office (RO). In the March 17, 2020, VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on May 21, 2024. A transcript of the hearing has been prepared and is associated with the claim file. Therefore, the Board may only consider the evidence of record at the time of the January 2020 SOC, as well as any evidence submitted by the Veteran [or representative] at the hearing or within 90 days following the hearing. 38 C.F.R. §?20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the January 2020 SOC and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801. If the Veteran would like VA to consider any associated with the claim file. Therefore, the Board may only consider the evidence of record at the time of the January 2020 SOC, as well as any evidence submitted by the Veteran [or representative] at the hearing or within 90 days following the hearing. 38 C.F.R. §?20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the January 2020 SOC and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801. If the Veteran would like VA to consider any evidence that was submitted and 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 claim[s], 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 is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. § 1110, 1131; 38 C.F.R. § 3.303 (a). Establishing service connection generally requires (1) evidence of a current disability; (2) evidence of in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F. 3d 1163, 1167 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F. 3d 604 (Fed. Cir. 1996) (table); 38 C.F.R. § 3.303. Service connection may also be granted for any disease diagnosed after the military discharge, when all the evidence, including that pertinent to the period of military service, establishes that the disease was incurred during the active military service. 38 U.S.C. § 1113 (b); 38 C.F.R. § 3.303 (d). Service connection may also be established on a secondary basis for a disability which is proximately due to, or aggravated by, a service-connected disease or injury. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.310. In order to prevail on the theory of secondary service connection, there must be evidence of a current disability; evidence of a service-connected disability; and evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). 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 evidence persuasively weighs 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 to the Veteran. The Board notes that the RO has identified the Veteran's peripheral neuropathies of the right and left upper and lower extremities as diabetic peripheral neuropathies. At no time has the Veteran requested service connection for diabetic peripheral neuropathies. Rather, the Veteran has requested service connection for peripheral neuropathies which he contends were caused by service-connected low back syndrome with degenerative disc disease L4-5. Given the foregoing, the Board has recharacterized the issue as styled on the title page. This will provide the Veteran with the most favorable review of his claims. 1. Entitlement to service connection for right lower extremity peripheral neuropathy as secondary to low back syndrome with degenerative disc disease L4-5 is granted. The Veteran contends that his right lower extremity peripheral neuropathy and left lower extremity peripheral neuropathy were caused by his service-connected low back syndrome with degenerative disc disease L4-5. Having carefully reviewed the evidence of record, and considering all pertinent laws and regulations, the Board finds that the Veteran's contention is warranted. As stated previously back syndrome with degenerative disc disease L4-5. Given the foregoing, the Board has recharacterized the issue as styled on the title page. This will provide the Veteran with the most favorable review of his claims. 1. Entitlement to service connection for right lower extremity peripheral neuropathy as secondary to low back syndrome with degenerative disc disease L4-5 is granted. The Veteran contends that his right lower extremity peripheral neuropathy and left lower extremity peripheral neuropathy were caused by his service-connected low back syndrome with degenerative disc disease L4-5. Having carefully reviewed the evidence of record, and considering all pertinent laws and regulations, the Board finds that the Veteran's contention is warranted. As stated previously, secondary service connection requires a showing of a current disability, evidence of a service-connected disability, and evidence establishing a connection between the service-connected disability and the current disability. The April 2018 VA examination confirms the diagnoses right lower extremity peripheral neuropathy and left lower extremity peripheral neuropathy. Further, a March 1997 rating decision granted service connection for low back syndrome with degenerative disc disease L4-5. Thus, the first two elements of secondary service connection have been met. The remaining issue to be decided is whether there is a causal connection between the Veteran's bilateral lower extremity peripheral neuropathies and his service-connected low back syndrome with degenerative disc disease L4-5. The Veteran attended a VA examination in April 2011. The examiner confirmed the diagnosis low back syndrome with degenerative disc disease L4-L5. The examiner indicated that diagnostic testing showed that the Veteran suffered from moderate degenerative spurring throughout his lumbar spine. The examiner further found that the Veteran suffered from degenerative joint changes from L3-L4 through L5-S1 and degenerative disc disease was suspected at L1-L2, L3-L4, and L5-S1. The examiner ultimately opined that the Veteran's bilateral lower extremity numbness was not related to his service-connected low back condition because the lower extremity numbness had only been present for 5 or 6 years and did not date back to the period during which the Veteran was in the military. The Veteran submitted a February 2018 VA Form 21-4178 Statement is Support of Claim. On this form, the Veteran indicated that he continues to experience bilateral lower extremity neuropathy as a result of his back injury. Specifically, the Veteran stated that when he goes to sleep his back hurts and his legs go numb. The Veteran was afforded a VA examination in April 2018. The examiner performed an examination of the Veteran's bilateral lower extremities. The examiner opined that it is less likely than not that the Veteran's service-connected low back syndrome with degenerative disc disease L4-5 caused or aggravated the Veteran's bilateral lower extremity peripheral neuropathies. The physician found that the Veteran was involved in motor vehicle accident after his discharge from service which significantly worsened his low back conditions. Further, the examiner found that subsequent to his motor vehicle accident the Veteran has gained a lot of weight. The examiner indicated that the Veteran weighs almost 400 pounds. Additionally, the examiner found that the Veteran has been diagnosed with diabetes. The examiner also indicated that he felt that the Veteran was exaggerating his symptoms. In light of his findings, the examiner reasoned that the Veteran's bilateral lower extremity neuropathies were most likely the result of the Veteran's motor vehicle accident, his weight gain, or his diabetes. Further, the examiner indicated that, in light of the Veteran's exaggerating his symptoms during his examination, he could not determine whether the Veteran's back injury had been aggravated beyond natural progression or to the point that the Veteran developed bilateral lower extremity neuropathies. The Veteran testified at a May 2024 Board hearing. The Veteran testified that his radiating back pain has been present since his initial in-service accident. The Veteran stated that, while still on active duty, he was told that he had a degenerative condition in his back which would worsen with time. The Veteran testified that, because of the severity of his back condition, the Veteran received a medical discharge under honorable conditions. The Veteran indicated that his back condition and his radiating pain and numbness have worsened over time and have persisted to the present. The Veteran submitted a May 2024 report from a private physician's assistant (PA) in support of his claim. The PA took a history of the Veteran initially injuring his low back in-service. The PA indicated that the Veteran has suffered from low back pain with radiculopathy since that time. Significantly, the PA stated that the Veteran's back pain and radiculopathy had an in-service onset and have continued which would worsen with time. The Veteran testified that, because of the severity of his back condition, the Veteran received a medical discharge under honorable conditions. The Veteran indicated that his back condition and his radiating pain and numbness have worsened over time and have persisted to the present. The Veteran submitted a May 2024 report from a private physician's assistant (PA) in support of his claim. The PA took a history of the Veteran initially injuring his low back in-service. The PA indicated that the Veteran has suffered from low back pain with radiculopathy since that time. Significantly, the PA stated that the Veteran's back pain and radiculopathy had an in-service onset and have continued to the present. The PA stated that the Veteran's lower extremity radiculopathy was confirmed by a July 2018 electromyography (EMG). The Board acknowledges the Veteran's statements in support of his claim, including his testimony at the May 2024 Board hearing and his February 2018 statement. To the extent that these statements describe the Veteran's symptoms and their onset, the Board finds these statements credible. A Veteran is competent to report on that of which he or she has personal knowledge. Layno v. Brown, 6 Vet. App. 465, 470 (1994). However, the Veteran is not competent to opine as to the etiology of his right lower extremity peripheral neuropathy or his left lower extremity peripheral neuropathy. The issue of causation is a medical determination outside the realm of common knowledge of a lay person. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). When the April 2011 and April 2018 VA reports are balanced against the May 2024 private medical report and the aforementioned Veteran's statement and testimony, the evidence is, at a minimum, equally balanced on this issue. As such, the Board finds the evidence is at least in approximate balance as to whether the Veteran's service-connected low back syndrome with degenerative disc disease L4-5 caused the Veteran's right lower extremity peripheral neuropathy and left lower extremity peripheral neuropathy. Accordingly, resolving all reasonable doubt in favor of the Veteran, service connection for right lower extremity peripheral neuropathy as secondary to low back syndrome with degenerative disc disease L4-5 and left lower extremity peripheral neuropathy as secondary to low back syndrome with degenerative disc disease L4-5 is warranted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). 2. Entitlement to service connection for left lower extremity peripheral neuropathy as secondary to low back syndrome with degenerative disc disease L4-5 is granted. See 1 above. 3. Service connection for right upper extremity peripheral neuropathy to include as secondary to low back syndrome with degenerative disc disease L4-5 is denied. The Veteran contends that his right upper extremity peripheral neuropathy and left upper extremity peripheral neuropathy were caused by his service-connected low back syndrome with degenerative disc disease L4-5. Having carefully reviewed the evidence of record, and considering all pertinent laws and regulations, the Board finds that the Veteran's contention is not warranted. Initially, the Veteran has not alleged that his bilateral upper extremity peripheral neuropathies are related to his military service on a direct causation basis. To the contrary, the Veteran testified at a May 2024 Board hearing and stated that he is seeking service connection for his bilateral upper extremity peripheral neuropathies as secondary to his service-connected low back syndrome with degenerative disc disease L4-5. As stated previously, in order to prevail on the theory of secondary service connection, there must be evidence of a current disability; evidence of a service-connected disability; and evidence establishing a connection between the service-connected disability and the current disability. In the case at hand, the April 2018 VA examination confirmed the diagnoses right upper extremity peripheral neuropathy and left upper extremity peripheral neuropathy. Further, a March 1997 rating decision granted service connection for low back syndrome with degenerative disc disease L4-5. Thus, the first two elements of secondary service connection have been met. The remaining issue to be decided is whether there is a causal connection between the Veteran's bilateral upper extremity peripheral neuropathies and his service-connected low back syndrome with degenerative disc disease L4-5. The Veteran was afforded a VA examination in April 2011. The examiner noted the Veteran's complaints of numbness and tingling in the bilateral upper extremities. Although there is , the April 2018 VA examination confirmed the diagnoses right upper extremity peripheral neuropathy and left upper extremity peripheral neuropathy. Further, a March 1997 rating decision granted service connection for low back syndrome with degenerative disc disease L4-5. Thus, the first two elements of secondary service connection have been met. The remaining issue to be decided is whether there is a causal connection between the Veteran's bilateral upper extremity peripheral neuropathies and his service-connected low back syndrome with degenerative disc disease L4-5. The Veteran was afforded a VA examination in April 2011. The examiner noted the Veteran's complaints of numbness and tingling in the bilateral upper extremities. Although there is no service-connected cervical condition in this claim, the examiner diagnosed the Veteran as suffering from degenerative disc disease at C5-C6 and degenerative spurring at C5, C6, and C7. The examiner also diagnosed the Veteran as suffering from low back syndrome with degenerative disc disease L4-5. Addressing the Veteran's claim that his upper extremity symptoms were caused by his service-connected low back condition, the examiner opined that the Veteran's upper extremity symptoms are not related to his service-connected low back syndrome with degenerative disc disease L4-5 because a low back condition would not cause upper extremity symptoms. The Veteran submitted a February 2018 VA Form 21-4178 Statement is Support of Claim. On this form, the Veteran indicated that he continues to experience bilateral upper extremity neuropathy as a result of his back injury. Specifically, the Veteran stated that when he goes to sleep his back hurts which causes his arms go numb. The Veteran attended a VA examination in April 2018. The examiner confirmed the diagnoses right upper extremity peripheral neuropathy and left upper extremity peripheral neuropathy. The examiner ultimately opined that it is less likely than not that the Veteran's bilateral upper extremity peripheral neuropathies are proximately due to or the result of the Veteran's service-connected low back syndrome with degenerative disc disease L4-5. The examiner further indicated that it is less likely than not that the Veteran's bilateral upper extremity peripheral neuropathies were aggravated beyond natural progression by the Veteran's service-connected low back syndrome with degenerative disc disease L4-5. The examiner found that it is not anatomically possible for the Veteran's bilateral upper extremity neuropathies to be related to the neurological status of his lower back. The Veteran testified at a May 2024 Board hearing. The Veteran was adamant that his bilateral upper extremity radiculopathies were caused by his service-connected low back syndrome with degenerative disc disease L4-5. The Veteran stated that he has been told that he has a degenerative condition of his spine which he feels is causing his upper extremity symptoms. The Veteran submitted a May 2024 private medical report. The physician's assistant (PA) took a history of the Veteran suffering an in-service injury to his neck and back when he fell into a fox hole. The PA opined that the Veteran has suffered from neck pain which has required ongoing treatment from that time. However, the Veteran is not currently service-connected for a cervical condition in this claim. The PA did not address whether the Veteran's bilateral upper extremity peripheral neuropathies are related to his service connected low back condition. The Board had considered the Veteran's contentions, including his testimony at the May 2024 Board hearing and his February 2018 statement, that his upper extremity peripheral neuropathies are related to his service-connected low back syndrome with degenerative disc disease L4-5. The Board acknowledges that the Veteran is competent to report his symptoms and on matters of which he has personal knowledge. Layno v. Brown, 6 Vet. App. 465, 470 (1994). However, there is no evidence that the Veteran in this case is competent to provide an opinion as to the etiology of his bilateral upper extremity peripheral neuropathies. The etiology of the Veteran's neuropathies is a medically complex issue. As such, it is outside the competence of the Veteran in this case because the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Considering the foregoing, the evidence persuasively weighs against the claim. Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021). The benefit of the the Veteran's neuropathies is a medically complex issue. As such, it is outside the competence of the Veteran in this case because the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Considering the foregoing, the evidence persuasively weighs against the claim. Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021). The benefit of the doubt doctrine, see 38 U.S.C. § 5107 (b), is therefore not applicable to this claim. Accordingly, service connection for right upper extremity peripheral neuropathy to include as secondary to low back syndrome with degenerative disc disease L4-5 and left upper extremity peripheral neuropathy to include as secondary to low back syndrome with degenerative disc disease L4-5 is denied. 4. Service connection for left upper extremity peripheral neuropathy to include as secondary to low back syndrome with degenerative disc disease L4-5 is denied. See 3 above. B. MULLINS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Litts, Norman W. Jr 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.