PERIPHERAL NERVE CONDITIONS

Summary

The Veteran, a Veteran who served from April 1968 to November 1969, including service in Vietnam, appeals the denial of service connection for bilateral upper and lower extremity peripheral neuropathy. The Veteran contends these conditions are due to in-service herbicide exposure. The Board noted favorable findings from the September 2025 rating decision, including conceded Agent Orange exposure and a current diagnosis of peripheral neuropathy. The Board reviewed multiple medical opinions. An initial February 2021 VA examination was deemed inadequate due to reliance on an inaccurate diagnosis of neurofibromatosis. The October 2022 VA examination provided a positive nexus opinion but was considered conclusory and lacking sufficient rationale. The November 2023 VA examination provided an adequate negative nexus opinion, finding the neuropathy idiopathic and unlikely caused by Agent Orange. However, a January 2025 private medical opinion found it reasonable to consider Agent Orange exposure a potential contributing factor given the timing of symptoms and lack of alternative explanations. The Board found the November 2023 VA opinion adequate but afforded great probative value to the private opinion. Weighing the evidence, the Board found the opinions in approximate balance, resolving reasonable doubt in the Veteran's favor. Service connection for bilateral upper and lower extremity peripheral neuropathy was granted.

Rationale

Conceded herbicide exposure in Vietnam; Conflicting medical opinions weighed; Reasonable doubt resolved in Veteran's favor

Full Decision Text

Citation Nr: A26040888
Decision Date: 04/30/26	Archive Date: 04/30/26

DOCKET NO. 260303-634754
DATE: April 30, 2026

ORDER

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

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

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

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

FINDINGS OF FACT

1. The Veteran is presumed to have been exposed to an herbicide agent during service in the Republic of Vietnam (RVN).

2. Resolving reasonable doubt in favor of the Veteran, the Veteran's bilateral upper extremity peripheral neuropathy is shown to be etiologically related to his exposure to herbicide agents

3. Resolving reasonable doubt in favor of the Veteran, the Veteran's bilateral lower extremity peripheral neuropathy is shown to be etiologically related to his exposure to herbicide agents.

CONCLUSIONS OF LAW

1. The criteria for service connection for left upper extremity neuropathy have been met. 38 U.S.C. §§ 1110, 1132, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.303, 3.304, 3.309.

2. The criteria for service connection for left lower extremity neuropathy have been met. 38 U.S.C. §§ 1110, 1132, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.303, 3.304, 3.309.

3. The criteria for service connection for right lower extremity neuropathy have been met. 38 U.S.C. §§ 1110, 1132, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.303, 3.304, 3.309.

4. The criteria for service connection for right upper extremity neuropathy have been met. 38 U.S.C. §§ 1110, 1132, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.303, 3.304, 3.309.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from April 1968 to November 1969.

These matters come before the Board of Veterans' Appeals (Board) on appeal from a September 2025 rating decision issued by a Department of Veterans Affairs (VA) agency of original jurisdiction (AOJ). In the March 2026 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.

Therefore, the Board may only consider the evidence of record at the time of the April 2025 AOJ decision, which was subsequently subject to higher-level review. 38 C.F.R. § 20.301. If evidence was submitted during the period after the AOJ issued the decision, which was subsequently subject to higher-level review the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.301, 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 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. 

At the onset, the Board recognizes the Court's decision in Williams v. McDonough, requiring the Board to afford the Veteran the opportunity to modify his docket election in the absence of a waiver of this right. 37 Vet. App. 305, 310 (2024) ("Putting all this together, we agree with Mr. Williams that the Board cannot issue a decision until the time to modify an NOD under § 20.202(c)(2) has run."). However, as the Veteran's appeal is advanced on the docket, the Board finds that this is an implicit waiver, and the Veteran is not prejudiced by the Board's expedient disposition prior to expiration of the time to request a docket switch.

Service Connection

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. §
 a waiver of this right. 37 Vet. App. 305, 310 (2024) ("Putting all this together, we agree with Mr. Williams that the Board cannot issue a decision until the time to modify an NOD under § 20.202(c)(2) has run."). However, as the Veteran's appeal is advanced on the docket, the Board finds that this is an implicit waiver, and the Veteran is not prejudiced by the Board's expedient disposition prior to expiration of the time to request a docket switch.

Service Connection

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; 38 C.F.R. § 3.303(a)

To establish a right to compensation for a present disability, a Veteran must show: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service." Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

VA laws and regulations provide that a Veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the Vietnam war era (i.e., from January 9, 1962, to May 7, 1975) shall be presumed to have been exposed to an herbicide agent, unless there is affirmative evidence to the contrary. 38 U.S.C. § 1116(a)(3); 38 C.F.R. § 3.307(a)(6)(iii). Service in the Republic of Vietnam includes service in the waters offshore and service in other locations if the conditions of service involved duty or visitation in the Republic of Vietnam. 38 U.S.C. § 1116(f); 38 C.F.R. § 3.307(a)(6)(iii).

If a veteran was exposed to an herbicide agent during service, certain specified diseases shall be service connected if the requirements of 38 C.F.R. § 3.307(a)(6) are met, even though there was no record of such disease during service, provided further that the rebuttable presumption provisions of 38 C.F.R. § 3.307(d) are also satisfied.

The list of diseases presumptively associated with exposure to herbicide agents, however, only includes early onset peripheral neuropathy, that is, if it manifests to a degree of 10 percent or more within one year after the last date on which the veteran was exposed to an herbicide agent in service. 38 U.S.C. §§ 1110, 1116(a)(2); 38 C.F.R. §§ 3.307(a)(6), (d), 3.309(e).

Even if a Veteran is not entitled to presumptive service connection for a disease claimed as secondary to herbicide exposure, VA must also consider the claim on a direct service-connection basis. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). 

In relevant part, 38 U.S.C. § 1154(a) requires that the VA give "due consideration" to "all pertinent medical and lay evidence" in evaluating a claim to disability or death benefits. Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional." Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed.Cir.2007). In fact, competent medical evidence is not necessarily required when the determinative issue involves either medical etiology or a medical diagnosis. Id. at 1376-77; see also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006); Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009).

Once evidence is determined to be competent, the Board must determine whether such evidence is also credible. See Layno, supra (distinguishing between competency ("a legal concept determining whether testimony may be heard and considered") and credibility ("a factual determination going to the probative value of the evidence to be made after the evidence has been admitted").

When there is an
 when the determinative issue involves either medical etiology or a medical diagnosis. Id. at 1376-77; see also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006); Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009).

Once evidence is determined to be competent, the Board must determine whether such evidence is also credible. See Layno, supra (distinguishing between competency ("a legal concept determining whether testimony may be heard and considered") and credibility ("a factual determination going to the probative value of the evidence to be made after the evidence has been admitted").

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b).

1. Entitlement to service connection for left upper extremity neuropathy

2. Entitlement to service connection for left lower extremity neuropathy

3. Entitlement to service connection for right lower extremity neuropathy

4. Entitlement to service connection for right upper extremity neuropathy

The Veteran contends that he has bilateral upper and bilateral lower extremity peripheral neuropathy as a result of in-service herbicide exposure while serving in Vietnam. See September 2020 VA Form 21-526EZ; March 2026 VA Form 10182. 

As an initial matter, the Board notes that the September 2025 rating decision  conceded the following favorable findings concerning the Veteran's claim: (1) the Veteran performed service in Da Nang Republic of Vietnam from November 1968 to November 1969; (2) Agent Orange exposure is conceded; (3) the Veteran has sufficient service to meet minimum for presumptive service connection; (4) the claimed disability, peripheral neuropathy, is a chronic disease which may be presumptively linked to military service if diagnosed to a compensable degree within one year of discharge; and (5) the Veteran has a current diagnosis of bilateral upper and lower extremity neuropathy. No clear and unmistakable error has been shown by the evidence of record to rebut these favorable findings. See 38 C.F.R. § 3.104(c). 

The question before the Board is whether the Veteran's bilateral upper and lower extremity peripheral neuropathy is due to his exposure to Agent Orange.

As a preliminary matter, the Board notes that the record contains contradicting medical nexus opinions which must be considered and weighed. See Hayes v. Brown, 5 Vet. App. 60, 69-70 (1993) (citing Wood v. Derwinski, 1 Vet. App. 190, 192-93 (1992)); see also Guerrieri v. Brown, 4 Vet. App. 467, 470-471 (1993) (stating that the probative value of medical evidence is based on the physician's knowledge and skill in analyzing the data, and the medical conclusion the physician reaches; as is true of any evidence, the credibility and weight to be attached to medical opinions are within the province of the Board). When faced with conflicting medical opinions, the Board may favor one medical opinion over the other. See Evans v. West, 12 Vet. App. 22, 30 (1998), citing Owens v. Brown, 7 Vet. App. 429, 433 (1995). The Board will consider each of the opinions below.

Upon review of the record and after resolving reasonable doubt in favor of the Veteran, the Board finds that service connection for bilateral upper and lower extremity peripheral neuropathy is warranted, as supported by the analysis below.

The Veteran's service treatment records (STRs) show no treatment for or diagnosis of this condition during service, and a November 1969 report of medical examination shows that the Veteran's upper and lower extremities and neurological system were normal upon his discharge from active duty. See October 2020 STR - Medical (11 pgs.) at 4. 

In A February 2021 statement, the Veteran, in relevant part, reported that he began having numbness in his toes and tops of feet after he returned home from service in 1970 and later the symptoms "progressed" and he began having similar pain in his hands. See February 2021 VA Form 21-4138 at 3-4. Additionally, the Veteran added that a few years later he had a neurofibroma removed from his leg. Id. 

During a February 2021 VA examination for peripheral nerves conditions, the Veteran reported that his symptoms began in 1970. See August 2021 C&P Exam: Peripheral Nerves Conditions DBQ at 2 (the examination was conducted in February
 

In A February 2021 statement, the Veteran, in relevant part, reported that he began having numbness in his toes and tops of feet after he returned home from service in 1970 and later the symptoms "progressed" and he began having similar pain in his hands. See February 2021 VA Form 21-4138 at 3-4. Additionally, the Veteran added that a few years later he had a neurofibroma removed from his leg. Id. 

During a February 2021 VA examination for peripheral nerves conditions, the Veteran reported that his symptoms began in 1970. See August 2021 C&P Exam: Peripheral Nerves Conditions DBQ at 2 (the examination was conducted in February 2021). The examiner noted that the Veteran reported a diagnosis of spinal neurofibromatosis; however, the examiner found that the Veteran did not have a peripheral nerve condition. Id. at 2-3. The examiner noted that there was no documentation in the file to support a diagnosis of neurofibromatosis of the spine. Id. at 12. The examiner rendered a negative nexus opinion explaining that "Examiner reviewed veteran's c-file and opines that his claimed numbness of lower extremities neuropathy is less likely incurred in/caused by the exposure to Agent Orange based on the following: (1) Veteran states he was diagnosed with neurofibromatosis of the spine which is causing his BLE neuropathy however this information is not noted in c-file. (2) In addition, this is related to benign tumors of the spine." See August 2021 C&P Exam: Medical Opinion. 

A November 2021 private medical record noted that the Veteran's symptoms began 50 years ago with numbness in his toes at a young age and the Veteran saw a neurologist 20 years ago and was told that he has polyneuropathy. See September 2022 Medical Treatment Record - Non-Government Facility (69 pgs.) at 1. 

In September 2022, the Veteran submitted as statement, again detailing his symptoms that began in 1970 and that he would complain to his doctor for years, which "fell on deaf ears" for several years. See September 2022 Buddy/Lay Statement at 8. The Veteran reported that eventually he was referred to a neurologist and told that he has peripheral neuropathy. Id. The Veteran underwent testing, which ruled out a diagnosis of diabetes and thus was not the cause of his peripheral neuropathy. Id. The Veteran also detailed how the condition and symptoms have progressed over the years. Id.  

In October 2022, the Veteran underwent a peripheral nerves conditions VA medical examination. See October 2022 C&P Exam: Peripheral Nerves Conditions DBQ. The examiner noted diagnoses of peripheral neuropathy, bilateral upper and lower extremities. Id. at 2. It was noted that the Veteran began having numbness, pain, and tingling in his feet around 1970 and similar symptoms in his hands around 2010, which have progressed/worsened since onset. Id. After examining the Veteran, the examiner rendered a positive nexus opinion, noting that the "Veteran has developed peripheral neuropathy secondary to agent orange while active in the service. See October 2022 C&P Exam: Medical Opinion. 

In December 2022, the Veteran underwent a peripheral nerves conditions VA medical examination. See December 2022 Peripheral Nerves Conditions DBQ. The examiner noted diagnoses of peripheral neuropathy, bilateral upper and lower extremities. Id. at 2. It was noted that the Veteran began having numbness and tingling in his feet and legs in 1970 and a few years later he began having shooting pain in his arms and hands. Id. His current symptoms were noted as numbness, tingling, and shooting pain in arms, hands, legs, and feet, which he treats with Gabapentin. Id. No nexus opinion was provided after the examination of the Veteran.

The Veteran underwent another peripheral nerves conditions VA examination in November 2023. See November 2023 Peripheral Nerves Conditions DBQ. The examiner noted diagnoses of idiopathic sensorimotor polyneuropathy, with a diagnosis date of 2003. Id. at 2. Regarding the medical history of the condition, the examiner noted that "The veteran reports that he had the initial onset bilateral numbness and tingling within a year of getting back from Vietnam about 50 years ago. He went to a chiropractor initially and was told that it was a pinched nerve. The numbness and tingling slowly progressed over time. In 1976 he had removal of a neurofibroma from his sciatic nerve. He denies any real workup or treatment for many years since that time. Eventually he was sent to a neurologist at which time he believes
. The examiner noted diagnoses of idiopathic sensorimotor polyneuropathy, with a diagnosis date of 2003. Id. at 2. Regarding the medical history of the condition, the examiner noted that "The veteran reports that he had the initial onset bilateral numbness and tingling within a year of getting back from Vietnam about 50 years ago. He went to a chiropractor initially and was told that it was a pinched nerve. The numbness and tingling slowly progressed over time. In 1976 he had removal of a neurofibroma from his sciatic nerve. He denies any real workup or treatment for many years since that time. Eventually he was sent to a neurologist at which time he believes he was diagnosed with neuropathy about 20 years ago. He recalls difficulty with his balance and progressive weakness that had affected him to the point where he stopped working around 2001. In 2021 he saw a neurologist who found that he had idiopathic slowly progressive length dependent axonal sensorimotor polyneuropathy." Id. The examiner noted that the Veteran's condition has stayed the same since onset. Id. at 2-3. After a full examination, the examiner rendered a negative nexus opinion. See November 2023 C&P Exam: Medical Opinion. After summarizing medical evidence and relevant medical literature, the examiner explained that "the veteran has been diagnosed with idiopathic peripheral neuropathy. There is no objective evidence of the symptom onset being within a year of presumed exposure in Vietnam. The source of his neuropathy is currently unknown, but scientific literature indicates that Herbicide Agent - 2,3,7,8 - Tetrachlorodibenzodioxin (TCDD) is unlikely to be the cause of his condition. Therefore, no nexus to service can be established and the claimed condition was less likely than not (likelihood is less than approximately balanced or nearly equal) caused by the indicated toxic exposure risk activity(ies), after considering the total potential exposure through all applicable military deployments of the Veteran[.]" Id. 

In January 2025, the Veteran submitted a private positive nexus medical opinion. See January 2025 Medical Treatment Record - Non-Government Facility. The physician found that "it is reasonable to conclude that [the Veteran's] reported symptoms of numbness in his lower extremities in 1970 were consistent with the early signs of peripheral neuropathy, especially considering the typical presentation. His current clinical examination, along with electrodiagnostic testing, unequivocally confirms the diagnosis of peripheral polyneuropathy." Id. In providing the nexus opinion, the physician noted that "[a]n extensive neuropathic workup has been performed to determine a potential etiology, especially considering the absence of known risk factors such as diabetes or alcohol abuse. The results of this workup were unremarkable. Notably, [the Veteran] reported exposure to Agent Orange, and while I have explained that I cannot definitively establish a causal relationship between Agent Orange and his peripheral neuropathy, there is evidence suggesting that Agent Orange exposure may increase the risk of peripheral polyneuropathy, particularly when symptoms onset occur[] shortly after exposure. Given the timing of [the Veteran's] reported symptoms and the lack of alternative explanations, it is reasonable to consider Agent Orange exposure as a potential contributing factor, if not the sole cause, of his condition." Id. 

The Board has also reviewed the lay statements from the Veteran's wife detailing her observation of the Veteran's neuropathy symptoms when they began living together around 1972. See e.g., February 2021 Buddy/Lay Statement; January 2025 Buddy/Lay Statement. Additionally, in the February 2021 statement, she recalled that the Veteran had a neurofibroma removed from his leg sometime around 1974. February 2021 Buddy/Lay Statement at 1. 

The Board has also reviewed the Veteran's lay statements and contentions, including challenging the adequacy of the VA medical examination reports. See generally, January 2025 Buddy/Lay Statement. Additionally, the Veteran noted that he does not have and has never been diagnosed with neurofibromatosis. Id. at 2. Further, the Veteran explained that he inquired and his private medical records prior to 2010 were no longer available. Id. at 10. The Veteran also detailed his symptoms that began in 1970. Id. at 11. The Veteran added that when he returned home his feet were "a mess" from his worn socks and boots and stated that "[i]f there was any neuropathy symptoms during the last months I was In Vietnam or the first three months after I returned home I would not have been able to discern that it was separate from the pain I was feeling because of the open sores on my feet." Id. at 10. Further, he
 with neurofibromatosis. Id. at 2. Further, the Veteran explained that he inquired and his private medical records prior to 2010 were no longer available. Id. at 10. The Veteran also detailed his symptoms that began in 1970. Id. at 11. The Veteran added that when he returned home his feet were "a mess" from his worn socks and boots and stated that "[i]f there was any neuropathy symptoms during the last months I was In Vietnam or the first three months after I returned home I would not have been able to discern that it was separate from the pain I was feeling because of the open sores on my feet." Id. at 10. Further, he initially believed that the foot tingling and numbness was caused by a pinched nerve in his lower back and sought chiropractic care. Id. 

In weighing the probative value of these opinions, the Board finds that the February 2021 VA opinion (which was signed and received by VA in August 2021) is inadequate for adjudication purposes. Specifically, the VA examiner relied on an inaccurate factual premise that the Veteran has been diagnosed with neurofibromatosis based on the Veteran's statements; however, the Veteran has reported that he has never been diagnosed with that condition and the examiner noted that the claims file does not contain any such diagnosis. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (It is well-established an opinion based on an inaccurate factual premise has no probative value). 

Additionally, the Board finds that the October 2022 positive nexus VA opinion is inadequate for adjudication purposes as it is conclusory and lacks sufficient rationale to assist the Board in adjudicating the claim. See Nieves-Rodriguez v. Peak, 22 Vet. App. At 304 (2008) ("It is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes probative value to a medical opinion.").

The Board finds that the November 2023 VA medical nexus opinion is adequate for adjudication purposes and affords it great probative value as it is based on correct facts to reach a reasoned conclusion, with full explanation. Id. 

The Board acknowledges that the private medical opinion, received by VA in January 2025, is not as strongly written; however, the Board interprets the opinion as finding that it is as least as likely as not that the Veteran's claimed conditions are directly related to his conceded herbicide exposure. See Parrish v. Shinseki, 24 Vet. App. 391, 401 (2011) (recognizing that poorly drafted medical opinion not necessarily inadequate if it can otherwise be understood). As such, the Board finds it adequate for adjudication purposes and affords it great probative value.

Accordingly, after careful consideration of the opinions of record, the Board finds that the weight of competent and probative evidence is in at least approximate balance as to whether the Veteran's bilateral upper and lower extremity neuropathy conditions are directly related to his conceded in-service herbicide exposure. The Board finds no adequate reason to favor the negative opinion over the positive opinion that is favorable to the Veteran's claim. The Board also notes that it is prohibited from developing additional evidence for the purpose of obtaining evidence against a claimant's case. See Mariano v. Principi, 17 Vet. App. 305, 312 (2003) (noting that, because it is not permissible for VA to undertake additional development to obtain evidence against an appellant's case, VA must provide an adequate statement of reasons or bases for its decision to pursue such development where such development could be reasonably construed as obtaining additional evidence for that purpose).

As the Board has found that the evidence for and against the claims is at least in approximate balance, reasonable doubt must be resolved in favor of the Veteran and entitlement to service connection for his bilateral upper and lower extremity neuropathy is warranted. 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

 

R. Bisignani

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Lewis, Aliece M.

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.