Citation Nr: 21022316 Decision Date: 04/15/21 Archive Date: 04/15/21 DOCKET NO. 20-06 602 DATE: April 15, 2021 ORDER Entitlement to service connection for left lower extremity neuropathy, to include superficial peroneal neuropathy, is granted. FINDING OF FACT Resolving reasonable doubt in the Veteran’s favor, his left lower extremity neuropathy is at least as likely as not related to an in-service gunshot wound to the left lower extremity. CONCLUSION OF LAW The criteria for service connection for left lower extremity neuropathy are 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 United States Army from August 1967 to August 1969. During his period of service, he earned the Purple Heart, National Defense Service Medal, Silver Star, Bronze Star Medal, two (2) Overseas Bars, Vietnam Service Medal, Vietnam Campaign Medal, Combat Service Badge, Sharpshooter Badge (M-16), and Expert Badge (M-16). The United States Court of Appeals for Veterans Claims (Court) has held that the scope of a claim includes any disability that may reasonably be encompassed by the Veteran’s description of the claim, related symptoms, and any other information of record. Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009); Brokowski v. Shinseki, 23 Vet. App. 79 (2009). As such, the issue of service connection for superficial peroneal neuropathy left lower extremity (also claimed as left foot condition, nerve damage) has been recharacterized as service connection for left lower extremity neuropathy, to include superficial peroneal neuropathy. 1. Entitlement to service connection for left lower extremity neuropathy Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. In order to prevail on a claim of service connection, generally, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service occurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). With regard to current disability, the Veteran appeared for a VA peripheral nerves conditions examination in March 2018, at which time the VA examiner diagnosed superficial peroneal neuropathy of the left lower extremity. As such, the first element of Shedden is met. Next, the Board must consider whether the Veteran sustained a disease or injury in service. A review of the Veteran’s service treatment records reveals that the Veteran sustained a penetrating gunshot wound to the left leg in September 1968, while serving on active duty. As such, the second element of service-connection is met. See Shedden, supra. As to the third element of service connection, it must be determined whether the Veteran’s current left lower extremity neuropathy is related to service. The Veteran appeared for a VA foot conditions examination in August 2017. The VA examiner opined that it was less likely than not that the Veteran’s complaints of numbness in the left foot were proximately due to or the result a service-connected condition. In support of the opinion, the VA examiner noted the Veteran’s complains of pain and discomfort on the lateral aspect of the left foot, as well as numbness of the fourth and fifth toes of the left foot. There was also a reduction of the deep tendon reflex (DTR) of the left ankle. Thus, due to the location of the injury to the left calf caused by the in-service gunshot wound, the VA examiner determined that it was possible that some of the sensory nerves of the left leg were involved, causing the current symptoms of numbness on the lateral left foot. The Veteran appeared for a VA peripheral nerves conditions examination in September 2017. The VA examiner opined that it was less likely than not that the Veteran’s neuropathy was incurred in or caused by service. In support of the opinion, the VA examiner determined that the Veteran’s symptoms were subjective only, as the objective examination was normal with no objective evidence of a chronic condition. Accordingly, a nexus could not be established. A private treatment record was associated with the Veteran’s claims file in February 2018. Dr. I. B. noted a diagnosis of severe chronic left peroneal motor neuropathy as a result of injury during the Vietnam War. The physician further noted that the Veteran’s condition had remained unchanged for over 35 years. A private medical opinion was also associated with the Veteran’s treatment record in February 2018. Dr. P. W. noted that electromyography (EMG) studies of the Veteran’s left lower extremity confirmed a diagnosis of severe chronic left peroneal motor neuropathy. The physician indicated that the neuropathy was consistent with the injury scars from his bullet wound in the left lower extremity. As indicated above, the Veteran appeared for a VA peripheral nerves conditions examination in March 2018. The VA examiner opined that it was less likely than not that the Veteran’s neuropathy was incurred in or caused by service. In support of the opinion, the VA examiner concurred with the findings of the August and September 2017 VA examiners, determining that no link could be made between the Veteran’s in-service gunshot wound and his current peroneal neuropathy. The VA examiner disagreed with the opinions of Drs. I. B. and P. W., as he determined the findings on EMG conducted by Dr. P. W. were inconsistent with the physical findings on examination in March 2018. The VA examiner further noted the Veteran’s subjective complaints of pain to the left lower extremity and dysesthesias at the fourth and fifth toe of the left foot were not documented in his medical record until 2017, which is 45 years after sustaining the in-service gunshot wound. The examiner explained that the Veteran had undergone two left knee surgeries post-service, as well as vein stripping of the left lower extremity, which could have caused or contributed to his peroneal nerve damage. Accordingly, the VA examiner determined that the preponderance of the medical evidence did not support any link between the gunshot wound and the current diagnosis. In consideration of the medical evidence of record, the Board finds that the evidence for and against the Veteran’s claim is in a state of relative equipoise. The Board acknowledges the negative nexus opinion provided by the March 2018 VA examiner; however, the Board finds the opinion to be inadequate for adjudication purposes. In this regard, the VA examiner failed to consider the Veteran’s lay contentions of experiencing numbness in the fourth and fifth toes of the left foot immediately after service. Specifically, the Veteran has testified that he initially considered his symptoms an annoyance, so he did not complain; however, his symptoms have progressively worsened since service. The VA examiner instead based his negative opinion on the lack of medical evidence documented in the treatment records, rendering it of little probative value. Dalton v. Nicholson, 21 Vet. App. 23 (2007). Given the Veteran has a current diagnosis of left lower extremity neuropathy, to include superficial peroneal neuropathy; sustaining a gunshot wound to the left lower extremity during service; and the opinions being in relative equipoise as to whether the Veteran’s current left lower extremity neuropathy is related to his period of service, reasonable doubt will be resolved in favor of the Veteran. Accordingly, the Board finds that service connection for left lower extremity neuropathy, to include superficial peroneal neuropathy, is warranted. 38 U.S.C. § 5107(b) (2012); 38 C.F.R. § 3.102 (2020); Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). A. S. CARACCIOLO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Tracy O. Joseph, 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.