Citation Nr: 21040747 Decision Date: 07/06/21 Archive Date: 07/06/21 DOCKET NO. 16-09 387 DATE: July 6, 2021 ORDER Entitlement to service connection for bilateral sciatic peripheral neuropathy is granted. FINDING OF FACT Resolving reasonable doubt in the Veteran's favor, his bilateral sciatic peripheral neuropathy is at least as likely as not related to a documented in-service cold weather injury. CONCLUSION OF LAW The criteria for service connection for bilateral sciatic peripheral neuropathy are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from October 1991 to October 1995. This case comes before the Board of Veterans' Appeals (Board) on appeal from a June 2015 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In April 2019, the Board remanded the appeal. 1. Entitlement to service connection for cold weather injury residuals, to include bilateral sciatic peripheral neuropathy. In this case, the Veteran claims that he has a bilateral foot condition that is the result of frostbite in service. His sister reports he took over-the-counter medications daily for foot pain, which bothered him "over the years until today." See Buddy/Lay Statement (July 2020). Following hospitalization for frostbite in December 1992, the Veteran's service treatment records (STRs) reflect no complaints of or treatment for a foot condition. A separation examination is not of record, and the evidence reflects the Veteran was released directly from active duty to the Georgia National Guard. Generally, service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) 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). Here, VA and private treatment records show the Veteran has had diagnoses of bilateral tarsal tunnel syndrome and bilateral sciatic peripheral neuropathy during the appeal period, and as noted previously, the Veteran was seen for frostbite during service. Thus, the question becomes whether a current disability is related to the Veteran's service. On this question there is probative evidence in favor of and against the claim. For the reasons explained below, the Board concludes that the Veteran's bilateral sciatic peripheral neuropathy is related to his documented in-service 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 evidence against the claim includes an April 2015 VA examination in which an examiner endorses that the Veteran has never been diagnosed with a cold injury and reports that there was no objective evidence to warrant a diagnosis of frostbite residuals on examination. Notably, the examining physician indicated that the Veteran's labs and EMG results were not available for review. In January 2020, VA provided peripheral nerves condition and cold injury residuals examinations where the Veteran was diagnosed with bilateral tarsal tunnel syndrome. The examining clinician documented the Veteran's frostbite, but noted that the Veteran did not have any abnormalities due to frostbite and has not received any treatment since his initial in-service frostbite injury. A contemporaneous foot conditions examination documents a similar finding. The evidence in favor of the claim includes a private medical opinion that relates mild bilateral sciatic peripheral neuropathy to in-service frostbite. See Medical Treatment Record Non-Government Facility (June 2020). In the medical opinion, Dr. M.G. reports that he reviewed the Veteran's STRs and post-service records in addition to obtaining the Veteran's complete medical history and conducting a neurological physical examination before providing his opinion. Overall, Dr. M.G. opined that the Veteran's current diagnosis of bilateral mild sciatic peripheral neuropathy is at least as likely as not due to the foot injury he sustained due to frostbite during military service. By way of rationale, it was explained that cold injury can cause mild reversible temporary neuropathy as well as permanent non-reversible neuropathy and a scientific study on animal models has suggested that cold exposure can cause injury to myelinated fibers within peripheral nerves. Consistent with what is documented in the Veteran's STRs and post-service treatment records, Dr. M.G. also noted that acutely during the period of cold exposure, patients report sensory dysfunction in the extremities in addition to vasomotor disturbance (pallor) that may be followed by swelling, erythema, and exacerbation of pain on rewarming of the affected limbs. Some patients also develop chronic sensory symptoms such as chronic pain, cold hypersensitivity, and parasthesia. (Continued on the next page) Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran's bilateral sciatic peripheral neuropathy is related to service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for bilateral sciatic peripheral neuropathy is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. M. C. WILSON Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Edwards 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.