Citation Nr: 20004065 Decision Date: 01/16/20 Archive Date: 01/16/20 DOCKET NO. 19-07 526 DATE: January 16, 2020 ORDER Service connection for left foot nerve damage is granted. Service connection for right foot nerve damage is granted. FINDINGS OF FACT 1. Left foot nerve damage was caused by an in-service cold injury. 2. Right foot nerve damage was caused by an in-service cold injury CONCLUSIONS OF LAW 1. The criteria for service connection for left foot nerve damage have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for right foot nerve damage have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1975 to June 1979. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2017 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). Service Connection 1. Service connection for left foot nerve damage and service connection for right foot nerve damage. The Veteran asserts that he has numbness and tingling in his feet since a cold injury (a.k.a. frostbite) to his feet in service. He describes this numbness and tingling as nerve damage, according to his submissions which include his May 2016 Fully Developed Claim. Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009). The Board concludes that the Veteran has a current disability that is related to his in-service cold injury. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). The issue of whether there is a current disability of nerve damage is the point of contention in this case, and the Board will address it now. A June 2015 private treatment record noted the Veteran had a long history of bilateral forefoot pain, numbness, tingling, and burning since severe frostbite injury in service. Indeed, the Veteran has been awarded service connection for the residuals of the cold injury. An August 7, 2015, VA nerve conduction study (NCS) was normal and without evidence for a generalized polyneuropathy. A September 2015 private NCS revealed findings consistent with moderate bilateral saphenous sensory neuropathy of the feet. A March 2016 private medical opinion held that frostbite, depending on the severity, can cause irreversible nerve damage. This is most likely what caused the Veteran’s neuropathy. An August 2016 VA medical opinion also linked the Veteran’s frostbite to his nerve damage. Nonetheless, a February 2017 VA examiner opined that, while the Veteran does have cold sensitivity residuals due to his in-service injury, his reported numbness and nerve damage is not due to cold injury as the NCS study done by VA shows no evidence of nerve damage. The examiner reasoned that the private NCS was done by nurse practitioner, while the VA NCS was done by Board certified neurologist. She further reasoned that the neurologist is a medical specialist who has more years of professional study in the field of neurology (having done a post-graduate residency and fellowship) and is therefore more qualified than a nurse practitioner to interpret the results of an NCS. It is therefore felt that the report of the NCS done at VA is more accurate and truly reflects the neurological condition of the feet, according to the February 2017 VA examiner. The Board has reviewed both NCS studies, and finds that the private study is much more detailed than the study performed by VA. The study performed by VA does not appear to contain a measurement for the specific nerve noted in the private study. Additionally, the Board surmises that the objective, numeric results from the study do not require a significant amount of subjective interpretation such that a neurologist versus a trained nurse practitioner would make an appreciable difference. Accordingly, at the very least, these studies should be afforded equal weight. Additionally, VA treatment records note that the Veteran has been treated for numbness and tingling in the feet for which Gabapentin was prescribed. Later VA treatment records show the Veteran receiving peripheral nerve blocks on the lower legs and feet. These records further support the finding of a current peripheral nerve disorder. Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran’s current peripheral nerve damage is related to service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for peripheral nerve damage to the feet is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. D. Martz Ames Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Rocktashel, Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.