Citation Nr: 18148531 Decision Date: 11/08/18 Archive Date: 11/07/18 DOCKET NO. 17-13 649 DATE: November 8, 2018 ORDER Service connection for frostbite to feet, ankles, and legs is granted, subject to the laws and regulations governing the payment of monetary awards. FINDING OF FACT Resolving reasonable doubt in favor of the Veteran, the Veteran suffered from frostbite during active service and his current diagnoses of peroneal tendonitis, edema, drop foot, onychomycosis, and peripheral vascular disease are directly related to this inservice injury. CONCLUSION OF LAW The criteria for service connection for frostbite to feet, ankles, and legs have been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from October 1950 to October 1952. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2015 rating decision. In October 2017, the Veteran withdrew his request for a Board hearing. 38 C.F.R. § 20.704(e). Service Connection In general, service connection may be granted for a disability or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. To prevail on a direct service connection claim, there must be competent evidence of (1) a current disability, (2) an in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). The Board takes notice that a July 1973 fire at the National Personnel Records Center in St. Louis, Missouri, is estimated to have destroyed the records of 80 percent of Army personnel discharged between November 1912 and January 1960. See www.archives.gov/st-louis/military-personnel/fire-1973.html. Where records once in the hands of the government are lost, the Board has a heightened obligation to explain its findings and conclusions and to consider carefully the benefit-of-the doubt rule. See O’Hare v. Derwinski, 1 Vet. App. 365 (1991). The Board’s analysis of the Veteran’s claim has been undertaken with this heightened duty in mind. Here, in an April 2015 letter, VA notified the Veteran that it had made a formal finding that his military records were unavailable for review, in part due to the 1973 fire. The claimant bears the burden of presenting and supporting a claim for benefits. 38 U.S.C. § 5107(a); Fagan v. Shinseki, 573 F.3d 1282, 1286–88 (Fed. Cir. 2009). In making determinations, VA is responsible for ascertaining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether the preponderance of the evidence is against the claim, in which case the claim is denied. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 54 (1990). Here, the Board reviewed all evidence in the claims file, with an emphasis on that which is relevant to this appeal. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380–81 (Fed. Cir. 2000) (holding that the Board must review the entire record but does not have to discuss each piece of evidence). Therefore, the Board will summarize the relevant evidence where appropriate, and the Board’s analysis will focus specifically on what the evidence shows, or fails to show, as it relates to the Veteran’s claim. The Veteran seeks service connection for frostbite to his feet, ankles, and legs, contending that while stationed at Inchon, Korea, during the Korean War, he slept in a tent on frozen ground, ate frozen food, had to walk a mile each way to work, and often had to “fall out” at night and sleep in a trench due to anti-personnel bombs being dropped. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an inservice injury, event, or disease. Resolving reasonable doubt in favor of the Veteran, the Board concludes that the Veteran’s current diagnoses of peroneal tendonitis, edema, drop foot, onychomycosis, and peripheral vascular disease are a direct result of frostbite injuries sustained while serving in Korea during the Korean War. 38 U.S.C. § 1110, 5107(b); 38 C.F.R. § 3.303(a); Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009). Medical records from a surgical clinic show that beginning in May 2012 the Veteran was treated for right lower extremity lymphedema. It was noted that he had suffered frostbite during the Korean War. Medical records from a foot and ankle practice from July 2015 show an ongoing medical problem of frostbite to both legs and feet with lymphedema of feet/legs. It was recorded that the Veteran complained of pain and swelling in right foot, explaining that swelling and drop foot started after frostbite in the Korean War. It was recorded that bilaterally dorsalis pedis and posterior tibial pulses were not palpable. Moderate swelling of the right lower extremity and the absence of pedal and leg hair were noted. The Board finds, accordingly, that the first Holton element, current disability, is met. The Veteran’s DD Form 214 shows that he is in receipt of the Korean Service Medal with Bronze Service Star. In fact, military personnel records that were associated with the Veteran’s claims file in August 1953 in connection to a dental claim show that he reported receiving medical treatment in Inchon, Korea, in 1952. A search of medical records by VAMC Fayetteville produced a locator card showing that the Veteran was an in-patient from January to February 1953, totaling 29 days. In a March 2017 letter, a member of the Veteran’s treating family health clinic, Ms. C.L.T., FNP-C, stated that this hospitalization occurred at an overflow facility constructed specifically to treat servicemembers returning from Korea with frostbite. It was explained that there were two treatment protocols, and the length of the Veteran’s hospitalization corresponded to the protocol for moderate-to-severe frostbite. In a September 2015 letter, Ms. C.L.T., stated that the Veteran did not have any other medical history, such as extensive trauma or illness, that would warrant such an extended stay beside a history of frostbite. The Veteran presented a print out of the webpages of the Korean War Educator on the topic of Weather Report. The site included a hyperlink to the temperatures recorded at Station 112 in Incheon, Korean, between 1950 to 1953, which centered around freezing during the winter. Resolving reasonable doubt in favor of the Veteran, the Board finds that the evidence places the Veteran in Inchon, Korea, during the Korean War, which included serving in a combat zone during freezing winter weather, such that the Veteran’s claim of suffering frostbite is consistent with the place, type, and circumstances of his service. Furthermore, there is evidence that he received medical treatment immediately following separation from service that is consistent with treatment for frostbite. Accordingly, the second Holton element, inservice incurrence of disease or injury, is met. The Board notes that the Veteran, while entirely competent to report the nature of his service and his symptoms, is not competent to proffer an opinion as to diagnoses or the etiologies of his disabilities. Such opinions require specific medical training and are beyond the competency of a lay person. In the absence of evidence indicating that the Veteran has the medical training to render medical opinions, the Board must find that his contentions in these regards to be of no probative value. See 38 C.F.R. § 3.159(a)(1)–(2) (defining competent medical evidence and competent lay evidence); Charles v. Principi, 16 Vet. App. 370 (2002) (finding the veteran competent to testify to symptomatology capable of lay observation); Layno v. Brown, 6 Vet. App. 465, 469–70 (1994) (noting that competent lay evidence requires facts perceived through the use of the five senses); Barr v. Nicholson, 21 Vet. App. 303, 307 (2007) (stating that “lay persons are not competent to opine on medical etiology or render medical opinions.”). Accordingly, the statements offered by the Veteran in support of his claims are not competent evidence to support any specific diagnosis or etiology of a disability. In her September 2015 letter, Ms. C.L.T., stated that the Veteran had an extensive medical history of conditions associated with the long-term effects of frostbite, and VA had not determined an alternative origin of the Veteran’s medical conditions. Based upon her medical research, citations to which were provided, she stated that a body part seldom recovers completely from frostbite. Cited residuals include hyperhidrosis, neuropathies, decreased nail and hair growth, and lymphedema. She explained that the most injurious aspect of frostbite was the cycles of freezing and thawing of the affected body parts and ambulation on the effected extremities, which was the norm in a combat zone. She related, furthermore, that reports show that the Korean War servicemembers were not adequately equipped for cold weather having landed earlier in the year in a more tropical locale in Korea. Ms. C.L.T. stated that the only logical conclusion was that the Veteran’s current medical conditions are most likely the residual effects of being frostbit during his military service. In her March 2017 letter, she reiterated that the Veteran is afflicted with medical conditions that have been scientifically proven to be residual effects of frostbite that the VA cannot attribute to any other cause. Accordingly, the third Holton element, medical nexus, is met, and the claim is granted. JOHN J. CROWLEY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Leanne M. Innet, Associate Attorney