PERIPHERAL NERVE DISORDERS

B. D. WATSON · 2026 · Case ID: A26040628

GRANTED

Summary

The veteran, who served from September 1966 to September 1968, including service in Vietnam, appeals the denial of service connection for bilateral neuropathies of the femoral nerves, sciatic nerves, and upper extremities. The veteran contends these conditions are attributable to Agent Orange exposure during service. The Board noted that while early-onset peripheral neuropathy is presumptively linked to herbicide exposure, delayed-onset neuropathy is not. However, direct service connection can still be established if the evidence shows causation. The Board reviewed the evidence, including service treatment records (STRs), VA treatment records, private treatment records, and two VA examinations. The initial VA examination provided a negative nexus opinion, citing a lack of in-service treatment records and the delayed onset of symptoms. A second VA examination also provided a negative opinion, finding no medical literature supporting an association between the veteran's MOS and TERAs with sciatic neuropathy or other neuropathies, and noting no association between herbicide exposure and delayed-onset peripheral neuropathy. In contrast, a private medical opinion from Dr. J.C. provided a positive nexus, finding the chronic peripheral neuropathies at least as likely as not related to herbicide exposure, citing studies showing an exposure-response relationship and biological plausibility independent of diabetes or delayed onset. The Board found Dr. J.C.'s opinion highly persuasive due to its detailed rationale, consideration of herbicide exposure's role, and supporting medical literature, assigning it significant probative weight over the VA examiners' opinions. Resolving reasonable doubt in the veteran's favor, the Board found a causal relationship established between the neuropathies and in-service herbicide exposure. Service connection for all claimed neuropathies was granted.

Rationale

Resolving reasonable doubt in the Veteran's favor.; Causal relationship established between herbicide exposure and neuropathy.; Private medical opinion from Dr. J.C. found persuasive.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250825-577506

Full Decision Text

Citation Nr: A26040628
Decision Date: 04/30/26 Archive Date: 04/30/26

DOCKET NO. 250825-577506
DATE: April 30, 2026

ORDER

Service connection for left lower extremity neuropathy of the femoral nerve (claimed as bilateral neuropathy of the femoral nerves) is granted.

Service connection for left lower extremity neuropathy of the sciatic nerve (claimed as bilateral neuropathy of the sciatic nerves) is granted.

Service connection for right lower extremity neuropathy of the femoral nerve (claimed as bilateral neuropathy of the femoral nerves) is granted.

Service connection for neuropathy of the left upper extremity (claimed as bilateral neuropathy of the upper extremities) is granted.

Service connection for neuropathy of the right upper extremity (claimed as bilateral neuropathy of the upper extremities) is granted.

FINDINGS OF FACT

1. Resolving reasonable doubt in the Veteran's favor, his bilateral lower extremity neuropathy of the femoral nerve is related to his in-service herbicide (i.e., Agent Orange) exposure.

2. Resolving reasonable doubt in the Veteran's favor, his left lower extremity neuropathy of the sciatic nerve is related to his in-service herbicide (i.e., Agent Orange) exposure.

3. Resolving reasonable doubt in the Veteran's favor, his bilateral upper extremity neuropathy is related to his in-service herbicide (i.e., Agent Orange) exposure.

CONCLUSIONS OF LAW

1. The criteria for service connection for left lower extremity neuropathy of the femoral nerve have been met. 38 U.S.C. §§ 1110, 1131, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303 (2023).

2. The criteria for service connection for left lower extremity neuropathy of the sciatic nerve have been met. 38 U.S.C. §§ 1110, 1131, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303 (2023).

3. The criteria for service connection for right lower extremity neuropathy of the femoral nerve have been met. 38 U.S.C. §§ 1110, 1131, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303 (2023).

4. The criteria for service connection for neuropathy of the left upper extremity have been met. 38 U.S.C. §§ 1110, 1131, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303 (2023).

5. The criteria for service connection for neuropathy of the right upper extremity have been met. 38 U.S.C. §§ 1110, 1131, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303 (2023).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from September 1966 to September 1968, to include service in the Republic of Vietnam.

This matter is being reviewed according to the appellate process set forth under the modernized review system, also known as the Appeals Modernization Act (AMA).

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in January 2025 by the Department of Veterans Affairs (VA). In the August 2025 VA Form 10182 Decision Review Request: Board Appeal (Notice of Disagreement) (associated 9/24/2025), the Veteran elected the Hearing Review docket. The Veteran testified at a Board hearing in January 2026; a transcript of that hearing is of record.

Based on the Veteran's election, the Board may only consider the evidence of record at the time of the agency of original jurisdiction (AOJ) decisions on appeal, as well as any evidence submitted by the Veteran or his representative at the Board hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). Any evidence submitted either (1) during the period after the AOJ issued the January 2025 decision on appeal and prior to the January 2026 Board hearing, or (2) more than 90 days following the Board hearing, was not considered by the Board herein. 38 C.F.R. §§ 20.300, 20.302(a), 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the
jurisdiction (AOJ) decisions on appeal, as well as any evidence submitted by the Veteran or his representative at the Board hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). Any evidence submitted either (1) during the period after the AOJ issued the January 2025 decision on appeal and prior to the January 2026 Board hearing, or (2) more than 90 days following the Board hearing, was not considered by the Board herein. 38 C.F.R. §§ 20.300, 20.302(a), 20.801.

If the Veteran would like VA to consider any evidence that was submitted that 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 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.

1. Service connection for left lower extremity neuropathy of the femoral nerve

2. Service connection for left lower extremity neuropathy of the sciatic nerve

3. Service connection for right lower extremity neuropathy of the femoral nerve

4. Service connection for neuropathy of the left upper extremity

5. Service connection for neuropathy of the right upper extremity

The Veteran asserts that service connection for his lower extremity and upper extremity neuropathies is warranted. The Veteran particularly contends that his neuropathies are attributable to his exposure to Agent Orange while serving in Vietnam. See e.g., VA Form 21-526EZ, Fully Developed Claim, associated 8/14/2024.

Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. See Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a).

With chronic disease shown as such in service (or within the presumptive period under § 3.307), so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. 38 C.F.R. § 3.303(b). To show a chronic disease in service, a combination of manifestations sufficient to identify the disease entity is required, as is sufficient observation to establish chronicity at the time. Id. However, 38 C.F.R. § 3.303(b), applies to only those chronic diseases listed in 38 C.F.R. § 3.309(a). See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013); 38 U.S.C. § 1101.

Service connection may also be granted for a disease first diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. See 38 C.F.R. § 3.303(d).

For Veterans who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38 C.F.R. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307(a), 3.309(a). However, in order for the presumption to apply, the evidence must indicate that the disability became manifest to a compensable (10 percent) degree within one year of separation from service. See 38 C.F.R. § 3.307.

At the outset, the Board notes that the AOJ favorably found in the rating decision on appeal that the Veteran had been diagnosed with the claimed neuropathies, as indicated in the September 2024 VA examination. See also C&P Exam, associated 9/6/2024. The AOJ also favorably found that the Veteran's participation in a toxic exposure risk activity (TERA) is conceded and, as evidence shows that the Veteran performed service in Vietnam from 1967 to 1968, he was exposed to herbicides during military service. See also Military Personnel Record, associated 7/27/2022; VA Memo, associated 10/31/2022. The Board is bound by such favorable findings by the AOJ unless rebutted by evidence that identifies clear and unmistakable evidence with the favorable findings. 38 C.F.R. §§?3.104(c). Finding none, the Board finds that elements (1) and (2) for service connection under Holton have been met.

However, while early-onset peripheral neuropathy is listed as presumptively associated with exposure to herbicide agents, delayed-onset peripheral neuropathy, such as the Veteran has (indicated below), is not listed as presumptively associated with exposure to herbicide agents; therefore, presumptive service connection based on exposure to herbicide agents in service is not warranted. 38 C.F.R. § 3.309(e). Nonetheless, direct service connection may be established if the evidence shows that the Veteran's neuropathies were, in fact, caused by his exposure to herbicide agents, or some other incident of service. See Combee v. Brown, F.3d at 1039, 1042-44 (Fed. Cir. 1994).

In deciding an appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990).

The Board notes that it has thoroughly reviewed the record in conjunction with this case. However, the Board has limited its discussion below to the relevant evidence required to support its finding of fact and conclusion of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008).

When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102 (reasonable doubt to be resolved in Veteran's favor); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (the benefit-of-the-doubt rule applies if the competing evidence is in approximate balance).

Given elements (1) and (2) for service connection under Holton have been met, the remaining question is one of nexus - whether a causal relationship exists between the Veteran's conceded herbicide exposure and his bilateral neuropathies.

Turning to the record, service treatment records (STRs) show no complaint of, treatment for, or diagnosis of peripheral neuropathy of an extremity.

VA treatment records reflect diagnosis of and treatment for the Veteran's peripheral neuropathies. A December 2019 addendum indicated the Veteran's neuropathies as being "idiopathic neuropathy (meaning to this point, it has no cause)." See e.g., CAPRI records, associated 7/20/2022, 2/11/2023, 8/22/2024. Private treatment records reflect evaluation of his neuropathies. See e.g., Medical Treatment Record-Non-Government Facility (MTR-NGF), associated 9/19/2024, 9/24/2024. Etiology
for, or diagnosis of peripheral neuropathy of an extremity.

The Veteran underwent VA examination in September 2024. The VA examiner, T.S., Nurse Practitioner (NP), confirmed the Veteran's diagnoses of bilateral neuropathy. NP T.S. noted the that the Veteran reported onset in the "2000s" and that he "started to notice numbness through his feet at first and then progressed to having pain as well." The Veteran reported that the VA did EMG testing and put him on gabapentin for pain control but it only provides him with partial relief. He reported that he continues with medication management of his neuropathies which has progressed up his legs into his knees and began to have numbness and pain through his hands as well that make it difficult for him to hold onto objects. On review of the records and in-person examination, NP T.S. provided a negative nexus opinion with regard to bilateral neuropathy of the sciatic nerves, femoral nerves, and the upper extremities. As to rationale, NP T.S. opined that, with regard to the sciatic and femoral nerves, there were no legible STRs to review to suggest treatment of nerve related condition and, with regard to the upper extremities, the Veteran reported his symptoms started in 2000s and that does not meet VA presumptive criteria for "this condition must be at least 10% disabling within 1 year of herbicide exposure." No other rationale was given.

In December 2024, a different VA examiner, C.H., NP, reviewed all available records and opined that the Veteran's bilateral neuropathy of the femoral nerves, sciatic nerves, and the upper extremities were less likely than not caused by the indicated toxic exposure risk activities (TERAs) after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all TERAs of the Veteran. As to rationale, NP C.H. listed the STR service dates, evidence of TERAs, VA diagnosis/treatment of bilateral lower extremity neuropathy with EMG testing in 2019, September 2024 VA examination findings of bilateral neuropathy with decreased sensations/strength in upper and lower extremities, and that there was no medical literature to support that the Veteran's military occupation specialty (MOS) and other TERAs can cause sciatic-related neuropathy or any of the Veteran's neuropathies. NP C.H. also noted, per the medical literature, NAS found that evidence did not support an association between herbicide exposure and delayed-onset peripheral neuropathy, defined as having its onset more than one year after exposure. Medical literature sources cited. No other rationale was given.

In support of his claim, the Veteran submitted a VA Peripheral Nerves Condition Disability Benefits Questionnaire (DBQ) completed in December 2025 by P.C., MD, MBA, a Physical Medicine and Rehabilitation specialist. Dr. P.C. examined and interviewed the Veteran, reviewed all available medical records, and confirmed the diagnoses of neuropathies of the upper and lower extremities. See MTR-NGF, associated 1/20/2026.

In his accompanying narrative report, Dr. J.C. detailed the Veteran's military experience and onset of neuropathy, noting the Veteran reported onset began in his bilateral lower extremities about 20 years ago and the numbness progressed to include his hands, arm, and legs. Dr. J.C. noted the Veteran's current symptoms and medication regime, as described by the Veteran. Dr. J.C. noted relevant medical record reviewed, including excerpts from each, rating decision reviewed, past medical history, and the findings of Dr. J.C.'s physical examination of the Veteran. Dr. J.C. offered a positive nexus opinion, finding that, based on the Veteran's confirmed exposure history, his chronic peripheral neuropathy, and the established association between Agent Orange and peripheral nerve injury in exposed veteran cohorts, it is medically reasonable to conclude that his neuropathy is at least as likely as not related to his herbicide exposure, even though onset occurred many years after service. In so finding, Dr
legs. Dr. J.C. noted the Veteran's current symptoms and medication regime, as described by the Veteran. Dr. J.C. noted relevant medical record reviewed, including excerpts from each, rating decision reviewed, past medical history, and the findings of Dr. J.C.'s physical examination of the Veteran. Dr. J.C. offered a positive nexus opinion, finding that, based on the Veteran's confirmed exposure history, his chronic peripheral neuropathy, and the established association between Agent Orange and peripheral nerve injury in exposed veteran cohorts, it is medically reasonable to conclude that his neuropathy is at least as likely as not related to his herbicide exposure, even though onset occurred many years after service. In so finding, Dr. J.C. included and outlined various studies pertaining to Agent Orange exposure among Vietnam veterans and its role in peripheral neuropathy, of which indicated a clear exposure-response relationship among that group. Dr. J.C. opined that the studies' findings establish biological plausibility and an epidemiologic association between herbicide exposure and peripheral neuropathy independent of diabetes (per VA treatment records, the Veteran tested negative for diabetes) and independent of the timing constraints used for presumptive service connection. See id.

The Board finds the nexus opinion provided by Dr. J.C. to be highly persuasive and assigns it significant probative weight. The nexus opinion is supported by a detailed rationale that includes a thorough review of the Veteran's relevant medical history, comprehensive consideration of the role herbicide/Agent Orange exposure plays in the development of peripheral neuropathies, clear and well-reasoned medical explanations, and citation to pertinent medical literature that support the conclusions. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A] medical opinion must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions").

Based on the body of evidence, and resolving any reasonable doubt in the favor of the Veteran, the Board finds that a causal relationship between his bilateral lower and upper extremity neuropathies and his in-service herbicide exposure has been established. Therefore, the third element of service connection under Holton, a nexus, has been met and service connection is warranted.

The Board acknowledges the negative nexus opinions provided by VA examiners, but affords greater probative weight to medical opinion of Dr J.C. The Board finds that Dr. J.C. provided a more detailed, fully articulated, and medically sound rationale than the VA examiners, with more extensive medical literature to corroborate his opinion as well. See Owens v. Brown, 7 Vet. App. 429, 433 (the Board may favor one medical opinion over another); see also Wray v. Brown, 7 Vet. App. 488 (1995) (the Board may adopt a particular medical expert's opinion for its reasons and bases where the expert has fairly considered the material evidence of record).

In sum, the most probative evidence of record supports finding that the Veteran's peripheral neuropathy of the lower extremities (sciatic nerves, femoral nerves) and upper extremities are related to in-service herbicide (i.e., Agent Orange) exposure. Accordingly, entitlement to service connection is GRANTED. 38 C.F.R. §§3.102; 3.303.

B. D. WATSON

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board M. Picard

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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