Citation Nr: 9820509 Decision Date: 07/02/98 Archive Date: 07/13/98 DOCKET NO. 94-28 476 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office and Insurance Center in Philadelphia, Pennsylvania THE ISSUE Entitlement to service connection for a fungus infection of the toenails, diagnosed as onychomycosis. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD C. Fetty, Associate Counsel INTRODUCTION The veteran had active service from November 1969 to January 1973. He served in combat in Vietnam and his awards include the Purple Heart. This matter comes before the Board of Veterans' Appeals (Board) on appeal from June 1993 and later decisions of the Department of Veterans Affairs (VA) Regional Office and Insurance Center (RO) in Philadelphia, Pennsylvania, that, in pertinent part, denied a claim for service connection for a fungus infection of the toenails. The veteran has appealed for service connection for this disorder. In May 1996, the Board remanded the case to the RO for additional development. Subsequently, the claim for service connection for PTSD was granted and that issue is no longer on appeal. However, as the development on the remaining issue was accomplished, but the denial of the claim continued, that issue is before the Board for further review. In an April 1993 VA examination report, the examiner noted evidence of tinea versicolor and onychomycosis and indicated service connection was in order for both conditions. Although the veteran has not filed a specific claim for service connection for tinea versicolor, this informal claim is referred to the RO for appropriate action. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that a current fungus infection of the toenails, diagnosed as onychomycosis, began during active service; he requests service connection for that condition. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991 & Supp. 1998), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that, with resolution of all reasonable doubt in the veteran’s favor, the evidence supports a grant of service connection for a fungus infection of the toenails. FINDING OF FACT Although there is no medical evidence of treatment for fungus infection of the toenails or of continuity of symptomatology since service, the veteran currently has a fungus infection of the toenails, diagnosed as onychomycosis, which has been linked by competent medical to active service. CONCLUSION OF LAW Onychomycosis of the toenails was incurred during active service. 38 U.S.C.A. §§ 1110, 1154, 5107 (West 1991); 38 C.F.R. §§ 3.102, 3.303 (1997). REASONS AND BASES FOR FINDING AND CONCLUSION I. Factual Background According to the veteran's service medical records, he underwent an enlistment examination in October 1969. The report is negative for relevant abnormalities. He was treated in April 1970 for an ingrown toenail. The report notes that he received warm soaks and that there was no evidence of inflammation or infection. In November 1972 he underwent a separation examination. On the Report of Medical History he filed out in connection with that examination, he checked "no" to a history of foot trouble and to skin diseases. He then stated "my present state of health is excellent." In March 1993, the veteran underwent a VA Agent Orange examination. Pertinent parts of the examiner's report note numerous areas of hypopigmentation on the back and chest and onychomycosis of the toenails. The examiner noted that the veteran was advised to file a claim to establish service connection. In April 1993, the veteran underwent a VA skin examination. He reported episodes of intense itching, possibly associated with excessive sweating in service, but that he never sought medical attention for this. He also reported that he noticed thickening and discoloration of the toenails that worsened over the years. The examiner diagnosed tinea versicolor of the shoulders and flanks, onychomycosis pedis of all of the nails, and a keratotic patch of skin on the left fifth finger adjacent to a large wedding ring. The examiner indicated that service connection was warranted for tinea versicolor and for onychomycosis pedis of all nails. An April 1993, letter to the veteran from his Agent Orange examiner indicates that Tinea Versicolor of the skin and nails was found but was not related to exposure to Agent Orange. No other etiology was supplied. In July 1993, the veteran reported that two doctors had told him that fungi of the skin and nails were caused by service in Southeast Asia. In July 1995, the veteran testified before the undersigned Member of the Board that he performed foot patrol and reconnaissance in Vietnam. He indicated that he saw medics for foot problems weekly, and received creams for his feet; he also used foot powder to control the fungus after active service.. He reported that he discontinued wearing socks in his boots because of "jungle rot" and "dry rot." He testified that, later, while stationed in Ft Carson, Colorado, he was treated for an ingrown toenail, but did not see fungus of the toenails. He indicated that in 1985, his toenails were removed at Columbia Hospital in York, but that, after his operation, the toenails grew back and the fungi returned. He testified that the foot conditions produced current impairment in his job as a house painter. In May 1996, the Board remanded the case to the RO for additional development. Subsequently, additional treatment records were received. One of the reports received indicates that the veteran underwent private hospitalization during March and April 1986 at Columbia Hospital. The report notes that his extremities showed no evidence of rashes, ulceration, clubbing, edema or cyanosis. A letter from a private podiatrist dated in June 1997 notes that he did not have files dating back to 1986 and he did not remember the veteran. II. Legal Analysis The Board finds that the veteran's claim is well-grounded within the meaning of 38 U.S.C.A. § 5107(a) (1997). That is, the claim is inherently plausible. The Board finds that all relevant facts have been properly developed and all evidence necessary for an equitable resolution of the issue on appeal has been obtained. Service connection may be granted for disability due to disease or injury incurred in or aggravated by service. See 38 U.S.C.A. § 1131 (West 1991); 38 C.F.R. § 3.303 (1997). The evidence in this case demonstrates that the veteran currently has a fungus infection of the toenails. There are no service medical records to document his purported treatment for problems with his feet during Vietnam, and the veteran has not claimed that such condition was present during subsequent active service at Ft. Carson, Colorado, and the veteran's separation examination report was negative for a foot condition. Efforts to obtain purported treatment records of surgical removal of the veteran’s toenails in 1985 were unsuccessful, and a 1986 private hospitalization report are negative for any foot conditions. The first evidence of a diagnosis concerning fungus of the toenails was made in March 1993, several years after discharge from service. Notwithstanding the above, the Board notes that the veteran served in combat during Vietnam, as evidenced by his receipt of various medals, including the Purple Heart. The Board thus finds that the veteran’s testimony that he received treatment for fungus of the toenails during combat in Vietnam, but the absence of medical records to document such treatment, is “consistent with the circumstances of his service.” 38 U.S.C.A. § 1154 (West 1991). See also Collette v. Brown, 82 F.3d 389, 392-3 (Fed. Cir. 1996) (emphasizing the lighter burden of proof required where veteran’s are seeking service connection for conditions related to combat service). Additionally, although continuity of symptomatology since service has not been demonstrated, it is significant that VA examiners, apparently based on the veteran’s reported history, have indicated that service connection for onychomycosis of the toenails was warranted. Finally, there is no medical evidence to suggest that the veteran’s current fungus condition affecting the feet is from any source other than his a Therefore, given the credible testimony of a foot condition in service, competent medical evidence of a nexus between current fungus infection of the toenails, diagnosed as onychomycosis, and resolution of all reasonable doubt in the veteran’s favor, the Board finds that service connection for such condition is warranted. See 38 U.S.C.A. § 5107(b) (West 1919); 38 C.F.R. § 3.102 (1997). ORDER Service connection for a fungus infection of the toenails, diagnosed as onychomicosis, is granted. JACQUELINE E. MONROE Member, Board of Veterans' Appeals NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991 & Supp. 1998), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402, 102 Stat. 4105, 4122 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals. - 2 -