Citation Nr: 1306202 Decision Date: 02/22/13 Archive Date: 02/27/13 DOCKET NO. 11-34 197 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUE Entitlement to service connection for residuals of cold injury to the bilateral upper and lower extremities. REPRESENTATION Veteran represented by: Veterans of Foreign Wars of the United States ATTORNEY FOR THE BOARD David A. Brenningmeyer, Counsel INTRODUCTION The Veteran served on active duty from February 1951 to February 1953, to include more than eight months of service in Korea. His awards and decorations include the Combat Infantry Badge. This matter comes to the Board of Veterans' Appeals (Board) on appeal from an August 2010 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri. The Board notes that, in addition to the paper claims file, there is a Virtual VA paperless claims file. A review of the documents in such file reveals that they are either duplicative of the evidence in the paper claims file or are irrelevant to the issue on appeal. 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 served in combat in Korea. 2. The Veteran's service treatment records were lost in a fire and are unavailable for review, with the exception of his service separation examination. 3. The Veteran's allegations with respect to cold injury in service are consistent with the circumstances, conditions, and hardships of his combat service. 4. It is at least as likely as not that the Veteran currently suffers from residuals of in-service cold injury to the bilateral upper and lower extremities. CONCLUSION OF LAW Resolving reasonable doubt in the Veteran's favor, service connection for residuals of cold injury to the bilateral upper and lower extremities is established. 38 U.S.C.A. §§ 1110, 1154, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran seeks to establish service connection for residuals of in-service cold injury to the bilateral upper and lower extremities.. More specifically, he maintains that he exposed to cold weather during active service in Korea, and that he has current disabilities of his hands and feet that can be attributed to such exposure. As set forth below, the Board is granting the Veteran's claim for service connection for residuals of cold injury to the bilateral upper and lower extremities. As the Board's decision constitutes a complete grant of the benefits sought on appeal, no further action is required to comply with the Veterans Claims Assistance Act of 2000 and implementing regulations. Service connection may be established for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303. Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). In the case of any Veteran who engaged in combat with the enemy in active service during a period of war, campaign, or expedition, VA shall accept as sufficient proof of service connection of any disease or injury alleged to have been incurred in or aggravated by such service satisfactory lay or other evidence of service incurrence or aggravation of such injury or disease, if consistent with the circumstances, conditions, or hardships of such service, notwithstanding the fact that there is no official record of such incurrence or aggravation in such service. 38 U.S.C.A. § 1154(b); 38 C.F.R. § 3.304(d). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). In the present case, the evidence shows that the Veteran's service treatment records were lost in a fire and are unavailable for review, with the exception of his service separation examination. The Board is mindful that, in a case such as this, VA has a heightened duty to explain its findings and conclusions and to consider carefully the benefit of the doubt rule. Pruitt v. Derwinski, 2 Vet. App. 83, 85 (1992); O'Hare v. Derwinski, 1 Vet. App. 365, 367 (1991). As previously noted, the evidence shows that Veteran had active service from February 1951 to February 1953, to include more than eight months of service in Korea. His awards and decorations include the Combat Infantry Badge. Thus, his participation in combat is conceded. His allegations with respect to cold injury in service are also conceded, inasmuch as they are consistent with the circumstances, conditions, and hardships of his combat service. The Veteran's service separation examination is silent on the subject of cold injury residuals. After service, in July 1979, he was diagnosed with Guillain-Barre syndrome and polyradiculopathy. Treatment records for the ensuing hospitalization and treatment are associated with the claims file, and are dated through December 1979, when it was noted that the Veteran was able to return to work. The Veteran underwent a VA examination in July 2010 in order to determine the nature and etiology of any cold injury residuals found to be present. He reported symptoms of numbness and tingling of the hands and feet, toenail fungus, and stiffness and cold sensitization of the feet. Following a physical examination, the examiner diagnosed minimal degenerative joint disease (DJD) of the bilateral hands, and mild hammer toes with plantar calcaneal spurs of the feet, bilaterally. It was also noted that he had toenail fungus of the nails, bilaterally. In a November 2011 addendum, the examiner opined that the Veteran's symptoms of numbness and tingling were most likely due to his polyradiculopathy, and less likely due to service. The examiner did not provide an opinion regarding whether the DJD, hammer toes, cold sensitization, plantar calcaneal spurs, or toenail fungus were related to cold exposure during service. Moreover, the examiner appears to have questioned the Veteran's in-service exposure to cold, which, as noted above, is conceded as consistent with the circumstances of his combat service. In November 2012, the Board referred the Veteran's case to an outside medical expert (a VA neurologist) for an opinion as to whether it was at least as likely as not (i.e., whether it was 50 percent or more probable) that pain, tingling, numbness, toenail fungus, cold sensitization of the feet, DJD of the bilateral hands, and/or mild hammer toes with plantar calcaneal spurs of the bilateral feet were related to the Veteran's acknowledged in-service exposure to cold weather while serving in Korea. In providing the opinion, the neurologist was asked to comment on the significance, if any, of the Veteran's diagnosis of Guillain-Barre syndrome and polyradiculopathy in 1979. The requested opinion was received in February 2013. After reviewing the claims file, and taking into account the fact that the Veteran's in-service exposure to cold weather had been conceded, the neurologist opined that it was at least as likely as not that the Veteran suffered from residuals of in-service cold injury, including pain, tingling, and cold sensitization of the feet, and that it was less likely (i.e., less than 50 percent probability) that he had any functional impairment, including pain and tingling in his hands and feet, from Guillain-Barre syndrome. The neurologist noted that a delayed/residual effect of cold injuries had been reported in Veterans of the Korean War, and that such effects included hyperhydrosis, recurrent nail loss, susceptibility to fungal infections, persistent sensory disturbance, causalgia, allodynia, and chronic alteration of gait leading, in turn, to foot, knee, hip, and back problems. The neurologist also noted that it was known that cold sensitivity/intolerance could be a long-term and permanent sequel of nerve injuries, and that recognized long-term and delayed sequelae of cold injuries included peripheral neuropathy, skin cancer in frostbite scars (which may occur in such locations as the heels and earlobes), arthritis in involved areas, chronic tinea pedis, fallen arches and stiff toes, nocturnal pain, and cold sensitization. The neurologist explained, further, that Veterans' cold-related problems could worsen as they grow older and develop complicating conditions such as diabetes and peripheral vascular disease, which place them at higher risk for late amputations. The neurologist also noted that it was common for service treatment records to contain no information regarding a cold injury, and that service discharge examinations commonly show no residuals of such injury because the acute injury has healed and the late residuals have not yet appeared. As for the Veteran's Guillain-Barre syndrome, the neurologist noted, in part, that the Veteran continued to work in a variety of jobs after his 1979 diagnosis, that records from December 1979 did not document any sensory loss or symptoms, and that the available records otherwise contained no evidence of associated, ongoing physical or occupational disability. Following a review of the record in this case, and the applicable laws and regulations, the Board finds that the evidence supports the Veteran's claim for service connection for residuals of cold injury to the bilateral upper and lower extremities. The favorable opinion from the February 2013 VA neurologist was based on a review of the claims file. The opinion is factually accurate, properly acknowledges the Veteran's conceded in-service exposure to cold weather, and contains a fully articulated rationale for the conclusions offered, to include an ample discussion of the medical principles underlying the natural history of cold injuries and the likelihood of late residuals. As such, it is at least as probative as the contrary opinion obtained from the July 2010/November 2011 VA examiner. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008) (holding that it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion). Accordingly, and resolving all reasonable doubt in the Veteran's favor, service connection for residuals of cold injury to the bilateral upper and lower extremities is established. ORDER Service connection for residuals of cold injury to the bilateral upper and lower extremities is granted. ____________________________________________ A. JAEGER Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs