Citation Nr: 21022396 Decision Date: 04/15/21 Archive Date: 04/15/21 DOCKET NO. 09-05 450 DATE: April 15, 2021 REMANDED Entitlement to service connection for disabilities of the bilateral feet is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1954 to May 1956. The appellant is his surviving spouse, and has been substituted as the claimant. See 38 U.S.C. § 5121A; 38 C.F.R. §§ 3.1010, 20.1302. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2007 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In a June 2016 decision, the Board reopened the claim and remanded it for further development. The Board remanded it again for additional development in April 2019. The appellant and her daughter testified at hearings in January 2016 and October 2018 before two of the undersigned Veterans Law Judges (VLJ’s) of the Board. Transcripts of the hearings are of record. Because two VLJ’s held hearings in this appeal, it is reviewed by a panel of three VLJ’s, which includes the VLJ’s who conducted the January 2016 and October 2018 hearings. See 38 C.F.R. § 20.707 (2018). In February 2019, a letter was sent to the appellant affording her the opportunity to request a hearing before a third VLJ who would participate in this decision. See Arneson v. Shinseki, 24 Vet. App. 379 (2011). The appellant was provided 30 days to respond to the letter. A response has not been received. Accordingly, the Board will proceed with appellate review. Entitlement to service connection for disabilities of the bilateral feet is remanded. The Board sincerely regrets the delay in issuing a decision in this matter, but finds that another remand is necessary to ensure substantial compliance with its prior remand directives, as explained below. The issue is whether the Veteran had a foot condition related to cold exposure and possible frostbite while serving in Germany during the winter. See March 2005 VA Form 21-526. In its April 2019 remand for a new medical opinion, the Board instructed that the opinion should assume that the Veteran had in-service cold exposure, and should consider his statement that he had numbness of the feet that began at the time and continued thereafter. See id. The February 2021 VA medical opinion states that review of the record, including the service treatment records, showed “no evidence of . . . cold injury.” The opinion concludes that the Veteran’s hallux valgus (bunion deformity) and onychomycosis (fungal infection of the nails) are not due to cold injuries of the feet, but other factors such as genetics, certain footwear, and age. The opinion notes that most cases of onychomycosis are caused by dermatophytes, and that the exact cause of bunions is unclear. The Board finds that the medical opinion adequately addresses whether the Veteran’s bunions and fungal infection of the toenails were related to in-service cold injuries. However, it does not fully address whether the Veteran may have had other residuals of cold injuries affecting his feet, including numbness, coldness, or pain independent of that caused by the bunions. For example, VA treatment records show that in July 1995, the Veteran stated that his foot was always tender, and sometimes so painful he could not walk. In November 2004, he complained of intermittent left foot pain, especially when walking, and also some numbness. His right foot felt cold. In August 2006, he complained of numbness of the left heel and toes; neuropathy was suspected. In March 2007, he reported pain in the anterior aspect of the left ankle. He stated he had experienced frostbite of the left heel during service, and wondered if persistent pain could be related to the frostbite. In July 2007, he again reported left ankle pain of “unknown etiology.” The treating physician noted that the Veteran had hindfoot valgus and a PTT (partial thromboplastin time) deficiency, but these “did not seem to be the cause of all his pain.” Neuropathic pain from diabetes mellitus was a possibility, according to the physician. According to VA’s website, cold injuries may result in long-term problems, including, in part, changes in muscle, skin, nails, ligaments, and bones; neurologic injury with symptoms such as bouts of pain in the extremities, hot or cold tingling sensations, and numbness; and vascular injury with Raynaud’s Phenomenon with symptoms such as extremities becoming painful and white or discolored when cold. VA Public Health, Cold Injuries, available at https://www.publichealth.va.gov/exposures/cold-injuries/index.asp (last visited April 7, 2021). In light of that information, any foot symptoms distinct from those caused by the bunions and fungal nail infections, such as possible neuropathic symptoms, must be considered in terms of whether they may be linked to in-service cold injuries. Significantly, the service treatment records were destroyed in a fire that occurred at the National Personnel Records Center (NPRC) in July 1973. See November 2005 Letter from National Personnel Records Center; April 2005 VA 21-3101. Thus, there would be no contemporaneous documentation in the file of an in-service cold injury. When service department records are lost or missing while in Government control, VA has a heightened duty to assist, and to consider the applicability of the benefit-of-the-doubt doctrine. See Cromer v. Nicholson, 19 Vet. App. 215, 217 (2005); Washington v. Nicholson, 19 Vet. App. 362, 369-70 (2005). The Veteran provided competent and credible statements regarding cold exposure of his feet while serving in Germany which must be carefully considered, especially in light of the missing service treatment records. He stated that his feet would become cold to the point of numbness, and that he was treated at sick call more than once after returning to the United States. See December 2012 Correspondence. The remark in the February 2021 VA opinion that there is “no evidence of... cold injury” does not account for those statements. Accordingly, on remand, a supplemental medical opinion must be obtained that addresses whether the Veteran had residuals of in-service cold injuries of the feet independent of the hallux valgus and onychomycosis, including numbness, coldness, or pain in the heel or left ankle, and/or other neuropathic symptoms. The matter is REMANDED for the following action: Obtain supplemental VA medical opinion as whether it is at least as likely as not (50% probability or more) that the Veteran had a left or right foot condition, distinct from hallux valgus or onychomycosis, related to in-service cold exposure of the feet. The service treatment records were destroyed in a fire at the NPRC. The examiner must assume that the Veteran had cold exposure of the feet with numbness while serving in Germany during the winter. The opinion must address the following: 1. The Veteran’s complaints of numbness, coldness, left ankle and heel pain, and/or other suspected neuropathic symptoms, as shown in the VA treatment records. 2. The VA treatment records dated in 1961 showing a blister of the right great toe with purulence, blisters on the sole of the foot with scaling and maceration between the toes, and the diagnosis of epidermophytosis. See December 1961 VA Dermatology Consultation Report. 3. The information on VA’s Public Health webpage regarding cold injuries. P.M. DILORENZO Veterans Law Judge Board of Veterans’ Appeals JOHN Z. JONES Veterans Law Judge Board of Veterans’ Appeals H. N. SCHWARTZ Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Rutkin, 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.