Citation Nr: 21067453 Decision Date: 11/04/21 Archive Date: 11/04/21 DOCKET NO. 17-41 436 DATE: November 4, 2021 REMANDED Entitlement to service connection for left lower extremity nerve palsy is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from November 1987 to May 1989. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2017 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). A Board hearing was held before the undersigned in June 2021. A transcript of the hearing has been associated with the claims file. Entitlement to service connection for left lower extremity nerve palsy is remanded. Remand is warranted for clarification as to whether the Veteran's left lower extremity nerve palsy is a congenital defect or disease and to obtain an opinion that provides adequate rationale. A January1987 report of medical evaluation reflects the Veteran was qualified for service. The Veteran checked the box for "foot trouble" in his report of medical history and the examiner indicated in the notes section that the Veteran had congenital deficiency flexor tendon left foot. The examiner noted "no functional problems so far as applicant knows." Service treatment records from November 1988 reflect the Veteran reported pain and weakness in his left foot. At that time, it was noted he had a chronic foot problem since childhood and a history of wearing a cast and braces on his left foot since childhood. He was assessed with a provisional diagnosis of congenital deficiency flexor tendon. A podiatry consult was requested. A medical board report from March 1989 reflects the Veteran was evaluated at the orthopedic clinic for left foot weakness. As noted in the report, the Veteran reported that as a child he had always had a drop foot on the left side and wasting on the left part of his leg. He was able to run with his leg but had to wear a highly cushioned shoe. He did not have significant problems until induction in the Marine Corps associated with marching with a pack, running and mainly wearing boots. Subsequently, he developed constant problems while in the Marine Corps. The examiner noted wasting of the anterior compartment of the left leg compared to the right, limited range of motion of the left ankle, and a small increase in bone over the navicular and first cuneiform secondary to his shoe wear. A February 1989 EMG revealed loss of function of the interior tibial and peroneal musculature. The final diagnosis noted in the medical board report was chronic peroneal nerve palsy with weakness of the left leg. The medical board report concluded that the Veteran did not meet the minimum standards for enlistment or induction, the Veteran was unfit for further military service by reason of physical disability, and the physical disability was neither incurred in nor aggravated by a period of active military service. The Veteran underwent a VA examination in February 2017. At that time, the examiner indicated a diagnosis from 1989 of left peroneal neuropathy and explained his clinical presentation showed the same left peroneal neuropathy that was documented in his service treatment records. The February 2017 VA examiner recounted the Veteran's history and concluded that the Veteran's left peroneal neuropathy was not aggravated beyond its natural progression by any issues in service. However, he did not provide rationale for this conclusion. He referenced the medical board's determination in his discussion, but the medical board's opinion also does not explain how it reached its conclusion that the Veteran' s disability was not aggravated. The record reflects the Veteran was able to manage with his disability prior to service and started to have more serious concerns after joining the service. As noted in the March 1989 medical board report, the Veteran did not have significant problems until induction in the Marine Corps associated with marching with a pack, running and mainly wearing boots. Subsequently he developed constant problems while in the Marine Corps. The medical board report also explained that the Veteran had a small increase in bone over the navicular and first cuneiform secondary to his shoe wear. The record reflects the Veteran's military service impacted his disability. Therefore, further rationale is needed to explain the examiner's conclusion. Additionally, it is unclear from the record whether the Veteran's disability is a congenital disease or defect. Service treatment records include an assessment of "congenital deficiency flexor tendon," and reference a "chronic foot problem" since childhood. The March 1989 medical board noted it was the impression the Veteran had a "congenital peroneal nerve palsy" and surgery could be done to enhance the function of the left leg. Remand is warranted for clarification. The matter is REMANDED for the following actions: 1. Obtain an addendum opinion from an appropriate clinician. The clinician is asked to provide a response to the following: a. Identify whether the Veteran's left peroneal neuropathy is a congenital defect or disease. [Note: a disease generally refers to a condition that is considered capable of improving or deteriorating while a defect is generally not considered capable of improving or deteriorating. See VAOPGCPREC 82-90 (1990).] b. If the clinician determines the Veteran's left peroneal neuropathy is a congenital defect, opine as to whether it is at least as likely as not (a probability of 50 percent or greater) that there was a superimposed injury or disease in service that resulted in a condition other than the congenital defect during service. c. If the clinician determines the Veteran's left peroneal neuropathy is a congenital disease, opine whether it is at least as likely as not (a probability of 50 percent or greater) that the disability is related to or aggravated by service, to include marching with a pack, running, wearing boots, and an increase in bone over the navicular and first cuneiform secondary to his shoe wear. Did it first manifest in service? If it pre-existed service, did it progress at an abnormally high rate due to service? 2. Readjudicate the claim. L. CHU Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Vemulapalli, Associate 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.