PERIPHERAL NEUROPATHIES

K. PARAKKAL · 2026 · Case ID: A26039678

GRANTED

Summary

The veteran, who served in the Navy from April 1969 to April 1973, appeals the denial of service connection for peripheral neuropathy of the bilateral upper and lower extremities. The veteran asserts this condition is due to herbicide exposure during service. The Board found that while the veteran's peripheral neuropathy did not manifest within the one-year presumptive period following herbicide exposure, the weight of the evidence supports a direct service connection. Key evidence included private medical opinions from Dr. J.B.M., an internal medicine specialist, who opined that the neuropathy was most likely related to toxins from Vietnam service and was more likely than not due to Agent Orange exposure, citing the Veteran's lack of other risk factors and abnormal nerve conduction studies. VA medical opinions from January 2024 and August 2025 also found a nexus between the peripheral neuropathy and herbicide exposure, noting the consistency of findings with toxic etiology and the Veteran's service in Vietnam. The Board found these opinions probative and well-reasoned, ultimately granting service connection for peripheral neuropathy of all four extremities.

Rationale

Private medical opinions found condition most likely related to Vietnam toxins and Agent Orange.; VA medical opinions found condition at least as likely as not caused by toxic exposure.; Electrodiagnostic testing showed generalized axonal polyneuropathy, consistent with toxin-induced conditions.

Service Branch

NAVY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250911-586682

Full Decision Text

Citation Nr: A26039678
Decision Date: 04/28/26 Archive Date: 04/28/26

DOCKET NO. 250911-586682
DATE: April 28, 2026

ORDER

Entitlement to service connection for peripheral neuropathy of the left upper extremity is granted.

Entitlement to service connection for peripheral neuropathy of the right upper extremity is granted.

Entitlement to service connection for peripheral neuropathy of the left lower extremity is granted.

Entitlement to service connection for peripheral neuropathy of the right lower extremity is granted.

FINDINGS OF FACT

1. The Veteran was exposed to an herbicide agent in the Republic of Vietnam.

2. Peripheral neuropathy of the left and right upper extremities and the left and right lower extremities are, at least as likely as not, related to exposure to an herbicide agent in service.

CONCLUSIONS OF LAW

1. The criteria for service connection for peripheral neuropathy of the left upper extremity have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for service connection for peripheral neuropathy of the right upper extremity have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for service connection for peripheral neuropathy of the left lower extremity have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

4. The criteria for service connection for peripheral neuropathy of the right lower extremity have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the Navy from April 1969 to April 1973.

The rating decision on appeal was issued in August 2025. The modernized review system, also known as the Appeals Modernization Act (AMA), applies. In the September 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held before the undersigned Veterans Law Judge on January 6, 2026. Therefore, the Board may only consider the evidence of record at the time of the August 2025 AOJ decision on appeal, 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 decision on appeal 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.

A review of the claims file shows that service connection for peripheral neuropathy of the upper and lower extremities was initially denied a July 2016 rating decision. The Veteran did not appeal the July 2016 decision or submit relevant evidence within one year of notice of the decision; therefore, the July 2016 decision became final.

The Veteran submitted a January 2023 Intent to File a Claim followed by a July 2023 Supplemental Claim Application for service connection for upper and lower extremity peripheral neuropathy. In April 2024, the AOJ found that new and relevant evidence had been received, and the claims were reconsidered. The AOJ continued to deny service connection for peripheral neuropathy. Because the AOJ reopened the claims for service connection, the Board may address the claims on the merits. The Veteran submitted a timely January 2025 appeal to the April 2024 denial of service connection for upper and lower extremity peripheral neuropathy, and in August 2025, the AOJ issued the decision currently on appeal. Therefore, the appeal stems from the January 2023 claim.

Entitlement to service connection for peripheral neuropathy of the bilateral upper and lower extremities

The Veteran seeks entitlement to service connection for peripheral neuropathy of the bilateral upper and lower extremities which he asserts in Board hearing testimony is due to herbicide exposure during service.

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
2025 appeal to the April 2024 denial of service connection for upper and lower extremity peripheral neuropathy, and in August 2025, the AOJ issued the decision currently on appeal. Therefore, the appeal stems from the January 2023 claim.

Entitlement to service connection for peripheral neuropathy of the bilateral upper and lower extremities

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).

Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013).

Pursuant to the authority granted by the Agent Orange Act of 1991, VA may determine that a presumption of service connection based on exposure to herbicides used in Vietnam is warranted for conditions that VA has found to have a statistically significant association with such exposure. VA has determined that a statistically significant association exists between exposure to herbicides and subsequent development of the following conditions: chloracne or other acneform disease consistent with chloracne, non-Hodgkin's lymphoma, soft tissue sarcoma, Hodgkin's disease, porphyria cutanea tarda (PCT), multiple myeloma, acute and subacute peripheral neuropathy, prostate cancer, cancers of the lung, bronchus, larynx, trachea, Type II (adult-onset) diabetes mellitus, chronic lymphocytic leukemia, AL amyloidosis, Parkinson's disease, ischemic heart disease, and B-cell leukemias, such as hairy cell leukemia, parkinsonism, bladder cancer, and hypothyroidism. 38 U.S.C. § 1116(a)(2); 38 C.F.R. § 3.309(e).

The diseases listed at § 3.309(e) shall have become manifest to a degree of 10 percent or more at any time after service, except that chloracne or other acneform disease consistent with chloracne, porphyria cutanea tarda, and acute and subacute peripheral neuropathy shall have become manifest to a degree of 10 percent or more within a year after the last date on which the veteran was exposed to an herbicide agent during active military, naval, or air service. 38 C.F.R. § 3.307(a)(6)(ii). VA regulations specify that the last date on which a veteran shall be presumed to have been exposed to an herbicide agent shall be the last date on which he or she served in the Republic of Vietnam during the period beginning on January 9, 1962 and ending on May 7, 1975. 38 C.F.R. § 3.307(a)(6)(iii).

The August 2025 rating decision made the favorable findings that the Veteran has current diagnoses of peripheral neuropathy of bilateral lower and upper extremities. The rating decision also found that the Veteran was exposed to Agent Orange in service in the Republic of Vietnam. A November 2024 Toxic Exposure Risk Activity (TERA) Memorandum shows that exposure to herbicides was conceded based on the Veteran's duty or visitation to the Republic of Vietnam. Thus, he is presumed to have been exposed to an herbicide agent in service.

Although herbicide exposure has been conceded, peripheral neuropathy was not shown to have become manifest to a degree of 10 percent or more within a year after the last date on which the veteran was exposed to an herbicide agent in service. See 38 C.F.R. § 3.307(a)(
peripheral neuropathy of bilateral lower and upper extremities. The rating decision also found that the Veteran was exposed to Agent Orange in service in the Republic of Vietnam. A November 2024 Toxic Exposure Risk Activity (TERA) Memorandum shows that exposure to herbicides was conceded based on the Veteran's duty or visitation to the Republic of Vietnam. Thus, he is presumed to have been exposed to an herbicide agent in service.

Although herbicide exposure has been conceded, peripheral neuropathy was not shown to have become manifest to a degree of 10 percent or more within a year after the last date on which the veteran was exposed to an herbicide agent in service. See 38 C.F.R. § 3.307(a)(6)(ii). The Veteran's hearing testimony and medical records from Woods Hospital show that the Veteran first had complaints related to numbness in the hands, legs, and feet in 1978 or 1979, a few years after his 1973 separation from service. Thus, peripheral neuropathy did not manifest within one year of his herbicide exposure. While presumptive service connection is not warranted, the Veteran is not precluded from establishing service connection as due to herbicide agent exposure with proof of direct causation. Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994).

The Board find that the weight of the evidence shows that currently diagnosed peripheral neuropathy of the bilateral upper and bilateral lower extremities is at least as likely as not related to the Veteran's herbicide exposure in service. The medical evidence in favor of the Veteran's claim includes March 2023, February 2025, and December 2025 private medical opinions from Dr. J.B.M., an internal medicine specialist. In March 2023, Dr. J.M.B. noted that the Veteran had been under her care since 2013; therefore, the Board finds that she was familiar with the Veteran's medical history. Dr. J.M.B. reviewed the Veteran's medical history from VA and had discussed his Vietnam exposures with him. She opined that the Veteran's diagnosis of neuropathy with paresthesias in the hands and feet were most likely related to toxins from when he was in Vietnam. She reasoned that he had no other known risk factors that may have precipitated his current condition, and opined that it was more likely than not due to exposure to Agent Orange. February 2025, and December 2025 opinions from Dr. J.M.B. note that a November 2024 nerve conduction study was grossly abnormal and showed generalized axonal polyneuropathy. Dr. J.M.B. opined that this type of peripheral neuropathy is classically seen in toxin induced conditions. The Veteran had a history of Agent Orange exposure, and she opined that that toxin had been known to be associated with peripheral neuropathy.

A report from the November 2024 electrodiagnostic testing of the upper and lower extremities at Aspirus Northland Orthopedics by Dr. B.B. is also of record. The study was stated to be abnormal. There was electrodiagnostic evidence suggestive of generalized sensory axonal polyneuropathy. Dr. B.B. stated that this type of peripheral neuropathy could be idiopathic/congenital, is rare, but is classically seen in paraneoplastic syndromes and can be seen in various other toxin induced conditions. It was noted that clinical correlation was indicated. The Board finds that Dr. J.M.B.'s opinions relating peripheral neuropathy to herbicide agent exposure are probative and well-reasoned, and the November 2024 electrodiagnostic testing lends further support for those opinions.

A January 2024 and August 2025 VA medical opinions, accompanying VA peripheral nerves examinations also related the Veteran's peripheral neuropathy to herbicide exposure in service. A January 2024 VA examiner opined that peripheral neuropathy was at least as likely as not caused by the indicated toxic exposure risk activity, after considering the synergistic, combined effect of all toxic exposure risk activities of the Veteran. The January 2024 VA examiner reasoned that the Veteran did not have other risk factors for peripheral neuropathy. He has bilateral upper and lower peripheral neuropathies without evidence of spinal pathologies or diabetes, Parkinson's or other drugs that cause peripheral neuropathy including chemotherapies. On point with this Veteran's exposure was the fact that neuropathies were diagnosed about 30 years after exposure. The examiner noted that the Veteran did serve in Vietnam for about 12 months and Agent Orange can increase the risk of peripheral neuropathy. The examiner concluded that a nexus can be established related to Agent Orange exposure. The examiner also included a link to NIH articles referenced.

The AOJ requested an addendum to this opinion requesting additional supporting literature to affirm the
January 2024 VA examiner reasoned that the Veteran did not have other risk factors for peripheral neuropathy. He has bilateral upper and lower peripheral neuropathies without evidence of spinal pathologies or diabetes, Parkinson's or other drugs that cause peripheral neuropathy including chemotherapies. On point with this Veteran's exposure was the fact that neuropathies were diagnosed about 30 years after exposure. The examiner noted that the Veteran did serve in Vietnam for about 12 months and Agent Orange can increase the risk of peripheral neuropathy. The examiner concluded that a nexus can be established related to Agent Orange exposure. The examiner also included a link to NIH articles referenced.

The AOJ requested an addendum to this opinion requesting additional supporting literature to affirm the January 2024 opinion. In a February 2024 addendum, the VA examiner stated that there is no medical literature that affirms herbicide exposure as a causation of peripheral neuropathy occurring decades following exposure. With regard to the addendum opinion, the Board finds that the premise that peripheral neuropathy did not manifest until decades following exposure is not applicable in this case, as the Veteran has submitted evidence from Woods Hospital showing that he reported symptoms of neuropathy in the hands, legs, and feet in 1978 or 1979, potentially related to exposure to toxic chemicals, a few years after his separation from service, rather than decades after service. Thus, the Board finds that the addendum is not relevant to the facts of this case, and is not probative.

An August 2025 VA examiner opined that the Veteran's peripheral neuropathy or the upper and lower extremities was at least as likely as not caused by the indicated toxic risk exposure activity of the Veteran. The rationale was that an electrodiagnostic study performed by an orthopedic specialist indicated findings consistent with a toxin-induced neuropathy. Agent Orange, which contains the chemical dioxin, is a recognized neurotoxic substance and has been associated in scientific literature with the development of peripheral neuropathy. Given the Veteran's confirmed toxic exposure, consistent clinical findings, and supportive electrodiagnostic evidence suggesting a toxic etiology, the examiner stated that it is reasonable to conclude that his peripheral neuropathy is at least as likely as not related to Agent Orange exposure during military service.

The Board finds that the January 2024 and August 2025 VA medical opinions are probative, are based on a review of the evidence of record, a discussion of his exposure to an herbicide agent in service, and include adequate rational for the nexus established based on relevant scientific evidence. Here, medical opinions from both private physicians and VA healthcare professionals relate the Veteran's peripheral neuropathy of the upper and lower extremities to in-service Agent Orange exposure. For these reasons, the Board finds that service connection for left and right upper extremity peripheral neuropathy and left and right lower extremity peripheral neuropathy is warranted.

(Continued on the next page)

K. Parakkal

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Kung, Christine

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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