Citation Nr: 9826012 Decision Date: 08/28/98 Archive Date: 07/27/01 DOCKET NO. 96-38 882 ) DATE ) ) On appeal from the Department of Veterans Affairs Medical and Regional Office Center in Wichita, Kansas THE ISSUE Entitlement to service connection for residuals of right peroneal nerve palsy with right foot drop. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD J. W. Loeb INTRODUCTION The veteran served on active duty from July 1974 to June 1995. This case was remanded by the Board of Veterans' Appeals (Board) in September 1997 to the Department of Veterans Affairs (VA) Medical and Regional Office Center (M&ROC) in Wichita, Kansas, for additional development. The issue of entitlement to service connection for right ankle disability was withdraw by the veteran in a May 1998 statement and is not a part of this appeal. CONTENTIONS OF APPELLANT ON APPEAL The veteran has contended, including at his personal hearing at the M&ROC in September 1996, that he began to have problems with right foot numbness and right foot drop due to peroneal nerve palsy beginning in service and that these problems have continued since service. 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 the preponderance of the evidence supports the veteran's claim for service connection for residuals of right peroneal nerve palsy with right foot drop. FINDINGS OF FACT 1. All available evidence necessary for an equitable determination of the veteran's claim for service connection for residuals of right peroneal nerve palsy with right foot drop has been obtained. 2. Right peroneal nerve palsy with right foot drop originated in service, and residuals thereof continue to be present. CONCLUSION OF LAW Residuals of right peroneal nerve palsy with right foot drop were incurred in service. 38 U.S.C.A. §§ 1110, 1131, 5107(a) (West 1991); 38 C.F.R. § 3.303 (1997). REASONS AND BASES FOR FINDINGS AND CONCLUSION The veteran's claim for service connection for residuals of right peroneal nerve palsy with right foot drop is well grounded within the meaning of 38 U.S.C.A. § 5107(a). Additionally, the facts relevant to the issue have been properly developed and the statutory obligation of VA to assist the veteran in the development of his claim has been satisfied. 38 U.S.C.A. § 5107(a). Service connection is granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131. The veteran's service medical records reveal multiple complaints of recurrent right foot numbness and right foot drop since 1984, with peroneal nerve disorder sometimes diagnosed. The veteran complained on his retirement medical history report in January 1995 of numbness between the toes of the right foot and noted a nerve disorder of the foot; his feet were normal on discharge physical examination in January 1995. On VA examination in November 1996, the veteran noted a history of foot drop and residual numbness of the toes, which started in 1984 and had been recurring intermittently since then. His current complaints included foot drop with walking more than one mile on the right foot. Examination revealed decreased dorsiflexion in the right foot; it was noted that this was patient dependent. No foot drop was found and sensation was intact. The diagnoses included foot drop, not present on examination. On VA neurological examination in November 1996, the veteran complained of difficulty with dorsiflexion of the right foot and of foot drop with increased activity. There was no numbness on neurological examination and no palpable mass of peroneal nerve at the fibular head. The diagnosis was foot drop, by history, with the only abnormality on examination being decreased strength with dorsiflexion, which was noted to be dependent on the veteran's effort. The examiner noted that most people with peroneal nerve damage have resolution of symptoms over time and that the veteran said that his symptoms were intermittent, which was inconsistent with nerve damage. X-rays of the feet in November 1996 did not show any definite pathology. X-rays of the right ankle revealed mild degenerative joint disease, which was thought by the examiner who performed the general evaluation to be probably secondary to fracture prior to entering service. On VA neurological examination in December 1997, the veteran complained that, on long walks, he sometimes got numbness in the first and second right toes and weakness in the right foot, with the foot slapping on the ground. The veteran's gait was considered normal. Motor strength in the right lower extremity was, at least 4+/5. On sensation examination of the right foot, the veteran described some increased sensitivity to pin prick over the first and second toes; no sensory abnormality was found. The examiner noted that a December 1996 nerve conduction velocity (NCV) study revealed findings consistent with bilateral right greater than left peroneal neuropathy, with involvement distal to the femoral head. The impression was history of right peroneal nerve palsy with associated foot drop, which had improved remarkably with very minimal weakness of the right extensor hallucis longus muscle. The examiner concluded that the cause was unclear but was most probably related to some form of compression neuropathy that occurred in 1985. VA orthopedic examination in December 1997 revealed complaints of tingling numbness in the first dorsal interspace, which was noted to be suggestive of deep peroneal neuropathy, and fatigue weakness and wearing out of the anterior aspect of his shoe with slapping gait when he walked very long distances. Physical examination revealed a normal gait with no foot deformity. Neurologically, there was decreased sensation in the first dorsal inner space of the right foot. The examiner indicated that electromyogram (EMG) and NCV studies in December 1996 showed chronic denervation changes in the muscle enervated by the right peroneal nerve, which appeared to be residuals of a frank peroneal neuropathy from the knee distally. The assessments were minimal right traumatic ankle arthrosis secondary to high school ankle fractures and multiple sprains, with no functional disability; and history of idiopathic right peroneal neuropathy. The examiner noted that although he had difficulty determining the etiology of the peroneal neuropathy, there was no question that the veteran had developed the neuropathy during military service, that it had been a very serious problem for him over the years, and that he still had the residuals of right ankle fatigue weakness and numbness in the distribution of the deep peroneal nerve. The veteran's service medical records reveal complaints of right foot numbness and foot drop, including on his January 1995 retirement medical history report, and right peroneal nerve impairment was sometimes diagnosed although no pertinent abnormality was noted on discharge physical examination in January 1995. The veteran continued to complain of right foot problems on examinations after service discharge, especially numbness and intermittent foot drop. While VA examinations in November 1996 did not find any right foot abnormality, they did not have the benefit of EMG and NCV studies done in December 1996, which were noted by VA examiners in December 1997 to show findings consistent with right peroneal neuropathy. The two VA examiners who examined the veteran in December 1997 indicated that the veteran had had service related right peroneal neuropathy, and one of them noted current neuropathy residuals of right ankle fatigue weakness and numbness. Consequently, the Board finds that the preponderance of the evidence warrants the allowance of service connection for residuals of right peroneal nerve palsy with foot drop. ORDER Service connection for residuals of right peroneal nerve palsy with right foot drop is granted. SHANE A. DURKIN 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). 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