Citation Nr: 1237697 Decision Date: 11/02/12 Archive Date: 11/09/12 DOCKET NO. 09-18 222 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Lincoln, Nebraska THE ISSUES 1. Entitlement to service connection for a lumbar spine disability. 2. Entitlement to service connection for a bilateral hip disability, to include as secondary to lumbar spine disability. 3. Entitlement to service connection for a left knee disability, to include as secondary to a lumbar spine disability or hip disability. 4. Entitlement to service connection for a bilateral foot disability, to include as secondary to a lumbar spine disability or cold injury residuals. 5. Entitlement to service connection for a bilateral hand disability, to include as due to cold injury residuals. REPRESENTATION Appellant represented by: Nebraska Dept. of Veterans Affairs WITNESSES AT HEARING ON APPEAL Appellant and his brother ATTORNEY FOR THE BOARD J. Juliano, Associate Counsel INTRODUCTION The Veteran served on active duty from January 1951 to April 1953. These matters come before the Board of Veterans' Appeals (Board) on appeal from July 2008 and February 2009 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) located in Lincoln, Nebraska. In March 2011, the Veteran testified before the undersigned Veterans Law Judge at a Travel Board hearing held at the RO in Lincoln, Nebraska. A transcript of the proceeding has been associated with the claims file. In May 2011, the Board remanded the Veteran's claims for further development. Such development has been completed and associated with the claims file, and these matters are returned to the Board for further review. Please note this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). 38 U.S.C.A. § 7107(a)(2) (West 2002). FINDINGS OF FACT 1. The Veteran is shown by a preponderance of the evidence to have a lumbar spine disability that is etiologically related to an in-service injury. 2. The Veteran is shown by a preponderance of the evidence to have a right hip disability that was caused by his lumbar spine disability. 3. The preponderance of the evidence of record is against a finding that the Veteran has a current left hip disability. 4. The Veteran is shown by a preponderance of the evidence to have a left knee disability that was caused by his lumbar spine disability and right hip disability. 5. The Veteran is shown by a preponderance of the evidence to have residuals of a cold injury of the feet, including decreased sensitivity, hyperhidrosis, and brittle nail plates, that is etiologically related to an in-service cold injury. 6. The Veteran is shown by a preponderance of the evidence to have a right foot drop disability that was caused by his lumbar spine disability. 7. The Veteran is shown by a preponderance of the evidence to have residuals of a cold injury of the hands, including decreased sensitivity, that is etiologically related to an in-service cold injury. CONCLUSIONS OF LAW 1. Service connection for a lumbar spine disability is warranted. 38 U.S.C.A. §§ 1110, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303 (2012). 2. Service connection for a right hip disability is warranted. 38 U.S.C.A. §§ 1110, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.310 (2012). 3. Service connection for a left hip disability is denied. 38 U.S.C.A. §§ 1110, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303 (2012). 4. Service connection for a left knee disability is warranted. 38 U.S.C.A. §§ 1110, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.310 (2012). 5. Service connection for residuals of a cold injury of the feet, including decreased sensitivity, hyperhidrosis, and brittle nail plates, is warranted. 38 U.S.C.A. §§ 1110, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303 (2012). 6. Service connection for a right foot drop disability is warranted. 38 U.S.C.A. §§ 1110, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.310 (2012). 7. Service connection for residuals of a cold injury of the hands, including decreased sensitivity, hyperhidrosis, and brittle nail plates, is warranted. 38 U.S.C.A. §§ 1110, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Veterans Claims Assistance Act of 2000 (VCAA) The Veteran's claims of entitlement to service connection for lumbar spine, right hip, left knee, bilateral feet, and bilateral hand disabilities are all granted, as explained below. As such, the Board finds that any error under the VCAA with regard to these claims is moot. See 38 U.S.C.A. §§ 5103, 5103A (West 2002); 38 C.F.R. § 3.159 (2012); Mayfield v. Nicholson, 19 Vet. App. 103 (2005), rev'd on other grounds, Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006). The Board acknowledges, however, that the Veteran originally claimed entitlement to service connection for a bilateral hip disability, and only service connection for a right hip disability is granted herein. Therefore, with regard to the Veteran's claim as it relates to his left hip, VA has met all statutory and regulatory notice and duty to assist provisions. See 38 U.S.C.A. §§ 5102, 5103(a), 5103A, 5106 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.159, 3.326(a) (2012). Under the VCAA, when VA receives a complete or substantially complete application for benefits, it is generally required to "notify the claimant and the claimant's representative, if any, of any information and any medical or lay evidence not previously provided . . . that is necessary to substantiate the claim." 38 U.S.C.A. § 5103(a)(1) (West Supp. 2012). As part of that notice, VA must "indicate which portion of that information and evidence, if any, is to be provided by the claimant and which portion, if any, the Secretary . . will attempt to obtain on behalf of the claimant." 38 U.S.C.A. § 5103(a)(1) (West Supp. 2012). The requirements apply to all five elements of a service connection claim: veteran status, existence of a disability, a connection between the veteran's service and the disability, degree of disability, and effective date of the disability. See Dingess v. Nicholson, 19 Vet. App. 473 (2006), aff'd sub nom. Hartman v. Nicholson, 483 F.3d 1311 (Fed. Cir. 2007). The Board finds that a VCAA letter dated in May 2008 fully satisfied the duty to notify provisions. See 38 U.S.C.A. § 5103(a) (West Supp. 2012); 38 C.F.R. § 3.159(b)(1) (2012). The VCAA letter informed the Veteran of what information or evidence was needed to support his claim, including claims for secondary service connection, what types of evidence the Veteran was responsible for obtaining and submitting to VA, and which evidence VA would obtain. The May 2008 notice also explained how VA assigns disability ratings and effective dates. See Dingess, supra. The Board also concludes that VA's duty to assist has been satisfied. See 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159(c) (2012). All of the Veteran's VA and private treatment records have been associated with the claims file, and the Veteran has not identified any outstanding post-service treatment records for VA to obtain. With regard to the Veteran's service treatment records, the Board notes that a July 2003 response from the National Personnel Records Center (NPRC) reflects that the Veteran's service treatment records are fire-related and have been destroyed. The Board acknowledges that the RO requested copies of the records from the Veteran, and also obtained copies of the morning reports (which reports are in the claims file but do not reflect any medical complaints or treatment). In light of all of the above, the Board finds that it has satisfied its duty to assist with regard to obtaining evidence in support of the Veteran's claim. The Board further acknowledges that in cases where service records have been lost or destroyed through no fault of a veteran, the Court has held that there is a heightened obligation on the part of VA to explain findings and conclusions and to consider carefully the benefit-of-the-doubt rule. See Cuevas v. Principi, 3 Vet. App. 542, 548 (1992); O'Hare v. Derwinski, 1 Vet. App. 365, 367 (1991). The Board's analysis has been undertaken with the heightened obligation set forth in Cuevas and O'Hare in mind. It is noted, however, that the case law does not lower the legal standard for proving a claim for service connection, but rather increases the Board's obligation to evaluate and discuss in its decision all of the evidence that may be favorable to the claimant. See Russo v. Brown, 9 Vet. App. 46 (1996). VA's duty to assist also includes the duty to provide a VA examination when the record lacks evidence to decide a veteran's claim and there is evidence of (1) a current disability, (2) an in-service event, injury, or disease, and (3) some indication that the claimed disability may be associated with the established in-service event, injury, or disease, but (4) insufficient competent medical evidence on file for the Secretary to make a decision on the claim. See 38 C.F.R. § 3.159(c)(4) (2012); McLendon v. Nicholson, 20 Vet. App. 79 (2006). In May 2011, the Veteran's claim was remanded by the Board so that he could be afforded a VA examination relating to his claim. Based thereon, the Veteran was provided with a VA examination relating to his claim in September 2011. The September 2011 VA examination report reflects that the examiner reviewed the claims file, interviewed the Veteran, examined him, addressed the questions posed by the Board, and provided an adequate rationale for the conclusions provided. Therefore, the Board finds the September 2011 VA examination report to be adequate upon which to base a decision with regard to the Veteran's claim as it relates to his left hip, and that there has been substantial compliance with the Board's remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). As there is no indication that any failure on the part of VA to provide additional notice or assistance reasonably affects the outcome of this case, the Board finds that any such failure is harmless. See Mayfield v. Nicholson, 19 Vet. App. 103 (2005), reversed on other grounds, Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006). Legal Analysis The Board must assess the credibility and weight of all evidence, including the medical evidence, to determine its probative value, accounting for evidence that it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case, the claim is denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Service connection may be established for a disability resulting from personal injury suffered or disease contracted in the line of duty in the active military, naval, or air service. 38 U.S.C.A. § 1110 (West 2002). That an injury or disease occurred in service is not enough; there must be chronic disability resulting from that injury or disease. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303(b) (2012). Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d) (2012). 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" - the so-called "nexus" requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). A "disability which is proximately due to or the result of a service-connected disease or injury shall be service connected." 38 C.F.R. § 3.310(a) (2012). "Any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease, will be service connected. VA will not concede that a nonservice-connected disease or injury was aggravated by a service-connected disease or injury unless the baseline level of severity of the nonservice-connected disease or injury is established by medical evidence." 38 C.F.R. § 3.310(b) (2012); Allen v. Brown, 7 Vet. App. 439 (1995). Lumbar spine disability and foot drop The Veteran served on active duty from January 1951 to April 1953. He claims that he incurred lumbar spine disability as a result of a slipping and falling in service. Specifically, he claims that he worked guard duty in a tower in a prisoner of war (POW) camp in Chejudo, Korea, and that he slipped on ice walking down a ramp and landed on his buttocks. See Board Hearing Transcript at 8-10; DRO Hearing Transcript, 4-5; Claim, July 2008. The Veteran testified that around the time of his separation from service, his back was x-rayed because of his back complaints due to the slipping injury and that he was told that the x-ray showed a prior back injury. See also Claim, July 2008. As noted above, the Veteran's service treatment records were destroyed in the NPRC fire. The Board also acknowledges that the Veteran asserts that there were in existence two separate sets of medical records, one of which had been destroyed in a typhoon during service, and another prepared thereafter that was apparently destroyed in the NPRC fire. See Board Hearing Transcript at 23; Claim, July 2008. The Board does, however, acknowledge certain morning reports associated with the claims file reflecting certain periods of TDY, as well as the Veteran's separation record which reflects that he had 12 weeks of training in Korea in security of war prisoners and that his main military occupation was MP security of POWs for 11 months. The Veteran testified at the Board hearing that, post-service, he received chiropractic treatment for his back for approximately 40 years, since the 1960s, but that the chiropractor had recently passed away (and the records are presumably unavailable). See Board Hearing Transcript at 28. In a May 2008 letter, Mr. J.M., another chiropractor, wrote that he had been treating the Veteran since March 2008, and that although the Veteran initially presented complaining of hip and knee pain, during the initial consultation, the Veteran described a fall he incurred in service (that he believed related to his hip and knee problems). Mr. M. noted that spine x-rays revealed phase III degenerative changes at L3 to S1, which indicated that the age of the injury was 40 to 65 years. He noted that the Veteran was diagnosed with lumbar subluxation, lumbo-sacral radiculitis, and lumbar disc degeneration. Mr. J.M. opined that it is at least as likely as not that the Veteran's lumbar spine condition was related to his in-service back injury, noting that, as previously stated, it takes several years for his type of injury to reach his level of degeneration. In another May 2008 letter, Dr. W. of the Grand Island Clinic wrote that the Veteran described his history of guard duty on an island in Korea and falling 15-20 feet from a tower and landing on his back. Dr. W. noted that he reviewed Mr. J.M.'s films and agreed with Mr. M's opinion. In an August 2008 letter, Dr. K.S. of the Mayo Clinic wrote that she evaluated the Veteran for back and hip pain, and also noted that the Veteran has a right foot drop. Dr. K.S. noted the Veteran's reported history of injury to in service. Dr. K.S. noted that although x-rays showed significant degenerative changes that could be present with age-related arthritis, the Veteran had prominent osteophytes that are much more dramatic than are typically seen in people with osteoarthritis, which strongly speaks to prior trauma. Based thereon, Dr. K.S. opined that it is possible that the reported trauma to the Veteran's spine in service led to the degree of degenerative changes and subsequent foot drop. While the Board also acknowledges that her opinion is a bit speculative, the Board notes that the underlying August 2008 treatment records from Dr. K.S. reflect, among other things, findings of significant degeneration of the spine and osteophytes, diagnosed low back pain and lumbar radiculopathy, more prominent on the right than left based on EMG studies, and a foot drop, and her unequivocal opinion that the findings were likely due to a past spinal injury from falling when the Veteran was serving in Korea. With regard to the Veteran's right foot drop in particular, the August 2008 private treatment record from Dr. K.S. also reflects that she opined that it was likely secondary to L5 radiculopathy. The Veteran was provided with a VA examination in September 2011. The VA examination report reflects that the Veteran reported that in service he fell on ice in a guard tower and landed on his back. The Veteran reported that prior to his separation from service, he was seen by a physician who noted wedging of his vertebrae due to previous trauma, and he reported that he sought medical treatment over the years post-service, including physical therapy. The Veteran reported experiencing back pain, stiffness, tightness, achiness, and limitation of motion, and radiculopathy radiating into his right lower extremity. The examiner noted that the Veteran developed a right foot drop with the right lower extremity radiculopathy. The examiner also noted that the Veteran had decreased sensation as well as weakness to the dorsiflexion of the right foot in conjunction with his radiculopathy symptoms of the right lower extremity associated with his lumbar spine condition. Physical examination of the spine revealed painful motion and tenderness. The examiner noted that there was muscle spasm, localized tenderness or guarding severe enough to be responsible for an abnormal gait or abnormal spine contour. An x-ray report reflects findings of advanced degenerative disc and facet disease, and an impression of advanced general lumbar spondylosis. The examiner recorded a diagnosis of lumbar spine DDD and facet DJD with right lower extremity radiculopathy and right foot drop. The examiner opined that it was at least as likely as not that the Veteran did sustain an injury to the low back as a result of the falling incident in the guard tower, and that his lumbar spine condition with radiculopathy to the right lower extremity is due to the in-service fall. The examiner reasoned that his testimony and his description of the incident was consistent with his current back condition. In light of all of the above, the Board finds that the Veteran is shown by a preponderance of the evidence to have a lumbar spine disability that is related to his in-service falling injury. As shown above, there is no medical opinion of record that contradicts the opinions of the September 2011 VA examiner, Mr. J.M., and Dr. K.S. The Board acknowledges that, as noted by the RO, some of the above medical opinions are based to some extent on a history provided by the Veteran of his in-service injury, as there are no service treatment records available documenting the injury. At the same time, however, the Board notes that the Veteran is competent to report having fallen and injuring his back in service, and the Board finds his reported history of the injury to be credible. Furthermore, as shown above, Dr. K.S. reasoned that although some of the Veteran's degenerative changes could be age-related, the prominent osteophytes shown in the x-rays indicated prior trauma and, likewise, J.M. reasoned that the phase III degenerative changes shown in the spine x-rays were typical of prior trauma. Also, the VA examiner noted that the Veteran's current back condition was consistent with the Veteran's reported history of injury. Therefore, the Board finds that the preponderance of the evidence is in favor of granting the Veteran's claim for service connection for a lumbar spine disability. In addition, as noted above, in her August 2008 letter, Dr. K.S. of the Mayo Clinic noted that the Veteran has a right foot drop and opined that that the degenerative changes in the Veteran's spine led to the Veteran's foot drop. Similarly, in her August 2008 private treatment record, she opined that it "was likely secondary" to L5 radiculopathy. Likewise, the September 2011 VA examination report reflects that the examiner noted that the Veteran developed a right foot drop, including decreased sensation and weakness of dorsiflexion of the right foot, in connection with right lower extremity radiculopathy related to his lumbar spine disability. Based thereon, because the Veteran has claimed service connection for a bilateral foot condition, and because service connection for the Veteran's lumbar spine disability is being granted herein, the Board finds that the preponderance of the evidence is also in favor of granting service connection for a right foot drop as secondary to a lumbar spine disability. Bilateral Hip The Veteran claims that he has a bilateral hip disability as a result of the in-service falling accident in Korea. See Claim, March 2008. In the alternative, the Veteran claims that it is secondary to his service-connected lumbar spine disability. See Board Hearing Transcript at 48. An August 2008 treatment record from Dr. K.S. of the Mayo Clinic reflects that she wrote that the Veteran reported experiencing right hip pain due to the falling accident in service. She noted that his pain in service was so bad that at the time of the injury, he had to wear a sponge cut-out to accommodate his right hip bone because he was told he had a "bone pointer" and it was the only way that he could get comfort laying on his right side. He reported an exacerbation of pain in recent years. X-rays of the Veteran's hips showed mild degenerative changes in the hips. A diagnosis of right greater trochanteric bursitis was recorded. The Board also acknowledges July 2000 and May 2008 private treatment records from Dr. W. that reflect that the Veteran complained of right hip pain and a diagnosis of trochanteric bursitis was recorded. A September 2011 VA examination report reflects that the Veteran reported his history of falling on ice in service. He reported experiencing right hip pain over the past 15 years. See report at 10. The examiner emphasized that while the examination was requested for a bilateral hip disability, the Veteran only claimed to have a right hip condition, and did not describe any left hip problems at the examination. See id. at 11. Limitation of motion was noted, including abduction to 30 degrees (of 45) and adduction to 20 degrees. An x-ray of the Veteran's hips, however, was negative. The examiner recorded a diagnosis of right hip tendonitis and bursitis. As noted above, no disability of the left hip was found on examination. With regard to the Veteran's right hip, the examiner opined that the Veteran demonstrated trochanteric bursitis as well as some tendonitis of the right hip that is the result of altered biomechanics and change in gait due to his low back condition. In light of all of the above, the Board finds that the Veteran is shown by a preponderance of the evidence to have a right hip disability secondary to his lumbar spine disability. The Board notes that there is no medical opinion of record that contradicts the opinion of the September 2011 VA examiner. The Board acknowledges that the RO notes that the examiner's opinion, to some extent, relies on a history provided by the Veteran of an in-service injury (to his back). Because, however, service connection has been granted herein for the Veteran's lumbar spine disability, and because the uncontradicted, thorough medical opinion of the September 2011 VA examiner relates the Veteran's right hip disability to his service-connected lumbar spine, the Board nevertheless finds that service connection is warranted on a secondary basis. See 38 C.F.R. § 3.310 (2012). However, with regard to the Veteran's bilateral hip disability claim as it relates to his left hip, the Board finds that a left hip disability has not been established by the competent medical evidence of record. As shown above, while the Board acknowledges some general notations in private treatment records of "hip" complaints, there is no medical record of any diagnosed left hip condition. Rather, the only specific notations of diagnoses relate to the Veteran's right hip. Furthermore, as noted above, the September 2011 VA examiner emphasized that while the examination had been ordered for a bilateral hip disability, the Veteran had no left hip complaints, and all of his reported symptoms related to his right hip only. The threshold requirement for service connection to be granted is competent medical evidence of the current existence of a claimed disorder. See Degmetich v. Brown, 104 F.3d 1328 (1997); Brammer v. Derwinski, 3 Vet. App. 223 (1992). Without a current diagnosis of a left hip disability, the Veteran's claim for service connection for such may not be granted. See id. Therefore, the Board finds that a preponderance of the evidence is against granting service connection for a left hip disability. There is not an approximate balance of evidence, and the benefit of the doubt rule is not for application. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001). Left Knee The Board acknowledges May 2006 private treatment records from Dr. W. reflecting that the Veteran reported that his left knee buckled and he fell (but caught himself). X-rays showed minimal osteoarthritic changes. Examination revealed a positive pivot shift for the medial meniscus, a reproducible click, and an impression of a Baker's cyst. A diagnosis of a probable left knee meniscal tear was noted. A subsequent May 2006 record from Dr. W. reflects a diagnosis of internal derangement of the left knee with good interval healing. A September 2011 VA examination report reflects that the Veteran reported left knee pain, instability, and swelling that he attributed to his back pain and gait alteration due to his right hip pain and right lower extremity radiculopathy. See id. at 10. He reported that sometimes his left knee will give out and cause him to fall. See id. at 10. Limitation of motion was noted, with flexion to 110 degrees and extension to 15 degrees. Objective findings of crepitus, snapping/popping, and grinding were also noted on examination, as well as tenderness to palpation and mild-to-moderate medial compartment ligament laxity. An x-ray revealed mild left medial and patellofemoral compartment degenerative joint disease. The examiner recorded a diagnosis of left knee DJD, and opined that it is at least as likely as not due to or the result of the Veteran's back condition and resultant right hip condition that led to altered biomechanics, thus increasing load bearing, altered biomechanics, and gait alteration, all of which contributed to the development of his current left knee condition. In light of the above, the Board finds that the Veteran is shown by a preponderance of the evidence to have a left knee disability secondary to his service-connected lumbar spine and right hip disabilities. See 38 C.F.R. § 3.310 (2012). The Board notes that there is no medical opinion of record that contradicts the opinion of the September 2011 VA examiner, and the Board finds that the VA examiner's opinion is thorough and adequate upon which to base a decision with regard to the Veteran's claim. Therefore, the Board will grant the claim for service connection for a left knee disability. Bilateral Foot and Hand Disabilities The Veteran claims that he has a bilateral foot disability secondary to his lumbar spine disability. In the alternative, he claims that his bilateral foot disability is due to residuals of a cold injury while serving in the cold weather in Korea in the tower. See Transcript at 8, 34-37. He also claims that he has a bilateral hand disability due to in-service cold injury residuals. At the Board hearing, the Veteran reported symptoms of tingling and sensory problems with his feet and hands, and some pain in his feet that he attributed to his in-service cold injuries or "frostbite." See Transcript at 40. The Veteran was provided with a VA examination in September 2011. The VA examiner noted the Veteran's reported history of cold injuries to his hands and feet in service in Korea during the winter months while on guard duty. The Veteran reported that the weather included ice, snow, and windy and cold weather at temperatures below zero. He reported that his hands became red and blistery. The Veteran said that he did not seek any treatment. He described experiencing over the years hyperhidrosis and brittle nails of the feet and hands. He also described some significant pain and cramping at night, as well as overall decreased sensation and cold sensitivity. He reported taking precautions post-service to protect his hands and feet from the cold. Physical examination of the Veteran's feet revealed brittle nail plates and decreased sensation to light touch testing of the toes and feet. X-rays of the Veteran's feet revealed no acute abnormality. Physical examination of the Veteran's hands revealed brittle nail plates and decreased sensation to light touch testing to the fingers and hands bilaterally. A diagnosis of decreased sensation, hyperhidrosis, brittle nail plates, and cold sensitivity of the hands and feet bilaterally was recorded. The examiner opined that the Veteran's bilateral hand and foot conditions are at least as likely as not related to his in-service cold exposure. The examiner reasoned that the Veteran's foot and hand conditions were consistent with cold exposure injury residuals, and that the Veteran continues to experience significant cold sensitivity, which is not an uncommon symptom of previous cold injury. In light of the above, the Board finds that the Veteran is shown by a preponderance of the evidence to have residuals of in-service cold injuries of the feet and hands, including decreased sensitivity, hyperhidrosis, and brittle nail plates. The Board notes that there is no medical opinion of record that contradicts the above opinions of the September 2011 VA examiner, and the Board finds that the VA examiner's opinion is thorough and adequate upon which to base a decision with regard to the Veteran's claims. Therefore, the Board will grant the claims for service connection for residuals of cold injuries of the feet and hands, including decreased sensitivity, hyperhidrosis, and brittle nail plates. The Board acknowledges that Dr. W., in a May 2008 letter, noted that his suspicion was that the Veteran's foot symptoms are related more to his back condition than cold injury residuals, but that further evaluation was needed. The Board notes, however, that this opinion is merely speculative by its own terms, and it therefore has significantly less probative value than the opinion of the VA examiner. In any event, service connection for the Veteran's back condition has been granted herein. ORDER Service connection for a lumbar spine disability is granted. Service connection for a right hip disability is granted. Service connection for a left hip disability is denied. Service connection for a left knee disability is granted. Service connection for residuals of a cold injury of the feet, including decreased sensitivity, hyperhidrosis, and brittle nail plates, is granted. Service connection for a right foot drop disability is granted. Service connection for residuals of a cold injury of the hands, including decreased sensitivity, is granted. ____________________________________________ DAVID L. WIGHT Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs