Citation Nr: 20005442 Decision Date: 01/22/20 Archive Date: 01/22/20 DOCKET NO. 10-44 328A DATE: January 22, 2020 ORDER Entitlement to service connection for a fungal infection of the right great toenail is granted. FINDING OF FACT During the period on appeal, the Veteran had a fungal infection of her right great toenail which was at least as likely as not incurred in and causally related to her active service. CONCLUSION OF LAW The criteria for service connection a fungal infection of the right great toenail have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the Army from December 1977 to January 1998 and from September 2004 to September 2008 This matter is before the Board of Veterans’ Appeals (Board) on appeal of a November 2009 rating decision of a Regional Office (RO) of the Department of Veterans Affairs (VA). In November 2015, the Veteran testified at a Board hearing before the undersigned. The Board subsequently remanded the claim for additional development in May 2016 and February 2018. The issues of entitlement to increased initial ratings for right and left knee disabilities will be addressed in a separate decision. Entitlement to service connection for a right great toenail disability Service connection will be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110; 38 C.F.R. § 3.303. The evidence must show (1) the existence of a current disability, (2) an in-service incurrence or aggravation of a disease or injury, and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Entitlement to service connection can be established if the Veteran has a disability at any point during the course of the appeal, even if such disability subsequently resolves. See McLain v. Nicholson, 21 Vet. App. 319, 321 (2007); see also Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). The Board must consider all the evidence of record and make appropriate determinations of competence, credibility, and weight. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). VA shall give the benefit of the doubt to the claimant when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The Veteran seeks entitlement to service connection for a fungal infection of her right great toenail. The Veteran submitted a November 2010 statement asserting she did not have this infection prior to her September 2004 to September 2008 period of active service. She also stated, during her active service, she reported the condition to her primary care doctor, and he suggested she allow the toenail to heal on its own. Her doctor did not note the conversation in her service medical records. In November 2015, the Veteran testified that her toenail condition had “cleared up,” but she still sometimes felt “stuff walking inside [her] toe.” She also testified the condition began during her second period of active service, it continued after she separated from service, and it later healed up. The condition was noted in a December 2008 VA general medical examination as “right great toe fungal infection. Noted to cover approximately one-fifth of the nail bed of the right great toe. Nontender. No abnormalities other than the change in the nail thickness and color.” The examiner observed the fungal infection was initially diagnosed in January 2007, but it was not associated with any symptoms. He did not give any opinion as to the etiology of the toenail infection. An August 2017 VA skin conditions examination was provided to address the etiology of the toenail condition. The August 2017 examiner found a normal toenail at the time of the examination and opined that the condition was not related to service because it had not continued over the entire appeal period. As noted in the Board’s February 2018 decision, this etiology opinion was inadequate to evaluate the claim because it did not consider whether a toenail condition existed at any point over the appeal period. The opinion is not probative of the issue before the Board. A February 2019 VA skin conditions examination and etiology opinion are also of record. The February 2019 examiner described a diagnosis of onychomycosis from December 2008. He observed the Veteran’s report that the condition was onset in 2007, during active service, around the time the she tried on new boots. He also noted the Veteran had progressive worsening of the toenail discoloration, used bacitracin cream daily, but had no current symptoms on the date of the examination. The February 2019 examiner opined the right great toenail disability was at least as likely as not incurred in or etiologically related to the Veteran’s active service. To support his opinion, he noted the December 2008 diagnosis of a fungal infection and the Veteran’s continuing complaints of the same problem. He found the same condition was present in service and persisted after service. Here, the December 2008 VA examination documents a great right toenail infection within the appeal period. The Veteran, as a layperson, is capable of observing thickening and discoloration in her nails. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). She credibly reported this condition existed during her active service. Finally, the competent and probative February 2019 VA etiology opinion establishes a nexus between the toenail condition and the Veteran’s service. Resolving any reasonable doubt in favor of the Veteran, the Board finds entitlement to service connection for a great right toenail disability is warranted. See Gilbert, supra; see also Shedden, supra. M. HYLAND Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Jeanne Celtnieks 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.