PERIPHERAL NERVE DISORDERS

MICHAEL J. SKALTSOUNIS · 2026 · Case ID: A26039493

MIXED

Summary

The veteran, who served from February 1959 to April 1962, appeals the denial of service connection for several conditions, including left and right hand numbness (diagnosed as bilateral upper extremity sensory neuropathy), left and right foot numbness (diagnosed as bilateral lower extremity sensory neuropathy), and peripheral artery disease. The veteran also appeals the denial of service connection for epidermophytosis, bilateral flat foot (pes planus), bilateral hammer toes, and hallux valgus, right foot, all claimed as trench foot. The Board granted service connection for the four neuropathy claims and peripheral artery disease, finding the evidence persuasive and giving the veteran the benefit of the doubt. The Board noted the VA examiner's negative opinions were based on insufficient service treatment records and an overly stringent causality standard, while acknowledging that cold exposure could contribute to vascular damage. The Board found the examiner's opinions to have low probative value. The remaining four claims related to trench foot were remanded. The Board found that the veteran's military records confirmed service in Korea, and the examiner's opinions were not fully persuasive regarding the etiology of these conditions, particularly concerning potential toxic exposure risk activity (TERA). The remand directs the AOJ to clarify conflicting TERA findings and obtain new medical opinions on the nature and etiology of epidermophytosis, flat foot, hammer toes, and hallux valgus, including a TERA nexus opinion.

Rationale

Grant based on benefit of the doubt; VA opinion found to have low probative value; Repeated cold exposure could contribute to vascular damage

Special Benefit

NO SPECIAL BENEFIT

Docket No.

260401-643322

Full Decision Text

Citation Nr: A26039493
Decision Date: 04/28/26 Archive Date: 04/28/26

DOCKET NO. 260401-643322
DATE: April 28, 2026

ORDER

Service connection for left hand numbness, diagnosed as left upper extremity sensory neuropathy, is granted.

Service connection for right hand numbness, diagnosed as right upper extremity sensory neuropathy, is granted.

Service connection for left foot numbness, diagnosed as left lower extremity sensory neuropathy, is granted.

Service connection for right foot numbness, diagnosed as right lower extremity sensory neuropathy, is granted.

Service connection for peripheral artery disease, claimed as reduced blood flow to hands and/or feet, is granted.

REMANDED

Service connection for epidermophytosis, claimed as trench foot, is remanded.

Service connection for bilateral flat foot (pes planus), claimed as trench foot, is remanded.

Service connection for bilateral hammer toes, claimed as trench foot, is remanded.

Service connection for hallux valgus, right foot, claimed as trench foot, is remanded.

FINDINGS OF FACT

1. The most probative and persuasive evidence shows that it is at least as likely as not that the Veteran's left hand numbness, diagnosed as left upper extremity sensory neuropathy, is a result of the Veteran's service.

2. The most probative and persuasive evidence shows that it is at least as likely as not that the Veteran's right hand numbness, diagnosed as right upper extremity sensory neuropathy, is a result of the Veteran's service.

3. The most probative and persuasive evidence shows that it is at least as likely as not that the Veteran's left foot numbness, diagnosed as left lower extremity sensory neuropathy, is a result of the Veteran's service.

4. The most probative and persuasive evidence shows that it is at least as likely as not that the Veteran's right foot numbness, diagnosed as right lower extremity sensory neuropathy, is a result of the Veteran's service.

5. The most probative and persuasive evidence shows that it is at least as likely as not that the Veteran's peripheral artery disease, claimed as reduced blood flow to hands and/or feet, is a result of the Veteran's service.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for left hand numbness, diagnosed as left upper extremity sensory neuropathy, have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 4.3.

2. The criteria for entitlement to service connection for right hand numbness, diagnosed as right upper extremity sensory neuropathy, have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 4.3.

3. The criteria for entitlement to service connection for left foot numbness, diagnosed as left lower extremity sensory neuropathy, have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 4.3.

4. The criteria for entitlement to service connection for right foot numbness, diagnosed as right lower extremity sensory neuropathy, have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 4.3.

5. The criteria for entitlement to service connection for peripheral artery disease, claimed as reduced blood flow to hands and/or feet, have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 4.3.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active service from February 1959 to April 1962.

This matter is before the Board of Veterans' Appeals (Board) on appeal from a March 24, 2026, rating decision issued under the Appeals Modernization Act (AMA) by a Department of Veterans Affairs (VA) Regional Office (RO) of the Veterans Benefits Administration (VBA), which is the Agency of Original Jurisdiction (AOJ).

On April 1, 2026, the Veteran submitted a timely VA Form 10182 (Decision Review Request: Board Appeal (Notice of Disagreement) reflecting his decision to appeal the March 24, 2026, rating decision to the Board via the direct review docket. Accordingly, the
Veteran had active service from February 1959 to April 1962.

On April 1, 2026, the Veteran submitted a timely VA Form 10182 (Decision Review Request: Board Appeal (Notice of Disagreement) reflecting his decision to appeal the March 24, 2026, rating decision to the Board via the direct review docket. Accordingly, the Board is limited to review of the evidence in the record through and until the date of the rating decision on appeal. 38 U.S.C. §§ 5104C, 7105, 7113; 38 C.F.R. §§ 20.202(b), 20.301, 3.2500.

Preliminary note

The Board notes that, as shown by the claims record, the Veteran has four additional diagnoses rendered as a result of his claim of service connection for trench foot; namely, epidermophytosis, bilateral flat foot (pes planus), bilateral hammer toes and hallux valgus, right foot. Thus, the Board has expanded the Veteran's trench foot service connection claim to include service connection for epidermophytosis, service connection for bilateral flat foot (pes planus), service connection for bilateral hammer toes and service connection for hallux valgus, right foot. Clemons v. Shinseki, 23 Vet. App. 1 (2009).

Also, the Board notes that, pursuant to 38 C.F.R. § 20.202(c)(2), an appellant may modify a NOD to change the Board docket being requested. The time limit for such modification is within one year from the date that the AOJ mails notice of the decision on appeal, or within 60 days of the date that the Board receives the NOD, whichever is later. See 38 C.F.R. § 20.202(c)(2). "[T]he Board ordinarily may not decide an appeal before this time period is up." Williams v. McDonough, 37 Vet. App. 305 (2024).

As a result of Williams, the Board could normally be precluded from adjudicating this claim until March 31, 2027, which is one year from the date of notice of the rating decision on appeal, and which would be more than 60 days after the NOD was received. However, the Board is granting five of the claims on appeal. Further, because the Board is remanding the four remaining claims, any evidence the Board could not consider will be considered by the AOJ in the adjudication of these four remaining claims. 38 C.F.R. § 3.103(c)(2)(ii). Thus, the Board finds that a docket switch letter pursuant to Williams is not necessary since there is no prejudice to the Veteran by granting five of the claims on appeal. As to the four remaining claims, the Veteran will have an opportunity to submit additional evidence to be considered on remand, and this remand is not considered a final adjudication of the issues on appeal. Accordingly, there is no prejudice to the Veteran in proceeding with the remand.

Finally, the Board notes that the claims on appeal were previously before the Board in March 2026, when the Board remanded them for additional development. The Board notes that, at present, five of the claims on appeal are being adjudicated. However, as will be elaborated below, the four remaining claims must be remanded for compliance with the Board's remand directives.

Service connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection may also be granted for any disease diagnosed after discharge from service when all of the evidence, including lay evidence, establishes that the disability is due to disease or injury which was incurred in or aggravated by service. 38 C.F.R. § 3.303(d).

In order to establish service connection for a claimed disability, the following three elements must be satisfied: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship nexus) between the present disability and the disease or injury incurred or aggravated during service. Hickson v. West, 12 Vet. App. 246
.R. § 3.303. Service connection may also be granted for any disease diagnosed after discharge from service when all of the evidence, including lay evidence, establishes that the disability is due to disease or injury which was incurred in or aggravated by service. 38 C.F.R. § 3.303(d).

In evaluating the evidence in an appeal, it is the responsibility of the Board to weigh the evidence and decide where to give credit and where to withhold the same and, in doing so, accept certain medical opinions over others. Schoolman v. West, 12 Vet. App. 307 (1999). In this regard, the Board has been charged with the duty to assess the credibility and weight given to the evidence. Jandreau v. Nicholson, 492 F.3d 1372 (2007).

Generally, the degree of probative value which may be attributed to a medical opinion issued by a VA or private treatment provider takes into account such factors as its thoroughness and degree of detail, and whether there was review of the claims file. See Prejean v. West, 13 Vet. App. 444, 448-449 (2000). Also significant is whether the examining medical provider had a sufficiently clear and well-reasoned rationale, and a basis in objective supporting clinical data. See Bloom v. West, 12 Vet. App. 185, 187 (1999); Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998). In concluding that no relationship between a current disability and military service exists, the examiner may not rely solely on an absence of medical records and not consider any available competent and credible lay statements. Dalton v. Nicholson, 21 Vet. App. 23 (2007); Buchanan v. Nicholson, 451 F.3d 1331, 1336-1336 (2006).

Competent lay evidence is any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a)(2). This may include some medical matters, such as describing symptoms or relating a contemporaneous medical diagnosis. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).

In adjudicating a claim of service connection, the Board is required to evaluate evidence based on places, types, and circumstances of service, as shown by the veteran's military records and all pertinent medical and lay evidence. Hayes v. Brown, 5 Vet. App. 60, 66 (1993); see also 38 U.S.C. § 1154(a).

When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in approximate balance, with the veteran prevailing in either event. 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021); Gilbert v. Derwinski, 1 Vet. App. 49 (1990).

1. Service connection for left hand numbness, diagnosed as left upper extremity sensory neuropathy, is granted.

2. Service connection for right hand numbness, diagnosed as right upper extremity sensory neuropathy, is granted.

3. Service connection for left foot numbness, diagnosed as left lower extremity sensory neuropathy, is granted.

4. Service connection for right foot numbness, diagnosed as right lower extremity sensory neuropathy, is granted.

5. Service connection for peripheral artery disease, claimed as reduced blood flow to hands and/or feet, is granted.

The Veteran claims service connection for left hand numbness, right hand numbness, left foot numbness, right foot numbness and reduced blood flow to hands and/or feet.

At the outset, the
left hand numbness, diagnosed as left upper extremity sensory neuropathy, is granted.

2. Service connection for right hand numbness, diagnosed as right upper extremity sensory neuropathy, is granted.

3. Service connection for left foot numbness, diagnosed as left lower extremity sensory neuropathy, is granted.

4. Service connection for right foot numbness, diagnosed as right lower extremity sensory neuropathy, is granted.

5. Service connection for peripheral artery disease, claimed as reduced blood flow to hands and/or feet, is granted.

The Veteran claims service connection for left hand numbness, right hand numbness, left foot numbness, right foot numbness and reduced blood flow to hands and/or feet.

At the outset, the Board notes that the Veteran has diagnoses of bilateral upper extremity sensory neuropathy, bilateral lower extremity sensory neuropathy and peripheral artery disease. See October 2024 VA peripheral nerves conditions examination; October 2024 VA artery and vein conditions examination; March 24, 2026, rating decision.

The Veteran asserts that, from 1959 to 1960, he reported to the base at Camp Kaiser, some 60 miles north of Seoul and about 3 miles from the Demilitarized Zone. He was exposed to extremely cold temperatures during the period of over one year in which he was stationed at Camp Kaiser. Despite the extreme cold, the Veteran and fellow service members did not stop doing their physical activities or training. They did not get opportunities for breaks or rest during the duration of exposure and were not provided enough protection against the extreme cold weather. See lay statement, November 2023.

VA has conceded that, as shown by the evidence of record, the Veteran underwent a qualifying event, injury, or disease that had its onset during his service; namely, his military personnel records show that he was stationed in Korea from August 13, 1959, to August 27, 1960. See March 24, 2026, rating decision. In addition, to this information, the Veteran's military personnel records indicate "Inchon Korea" as the location of this period of service.

In an October 2024 VA opinion, a VA examiner opined that the Veteran's claimed disabilities were less likely than not incurred in or caused by the claimed in-service injury, event, or illness. As support for the opinion, the VA examiner explained that there was not enough evidence in STRs to substantiate the claim. Lifestyle choices over 50, such as smoking, poor diet, lack of exercise, and unmanaged diabetes or hypertension, were the primary causes of neuropathy and peripheral artery disease rather than repeated exposure to cold because they led to chronic, systemic damage.

Neuropathy often stemmed from prolonged high blood sugar, alcohol use, or nutritional deficiencies while peripheral artery disease resulted mainly from atherosclerosis, where long-term habits caused arterial narrowing and reduced circulation. Repeated exposure to cold, in contrast, caused acute vasoconstriction and localized tissue damage but did not drive the progressive vascular and nerve deterioration seen in neuropathy and peripheral artery disease. However, repeated exposure to cold could contribute to vascular damage by causing vasoconstriction, endothelial stress, and localized vessel injury, typically as an acute or environmental factor rather than a primary driver of the chronic, progressive nature of neuropathy and peripheral artery disease. Also, repeated exposure to cold in individuals already at risk could exacerbate symptoms or accelerate disease progression.

After careful consideration, the Board finds the October 2024 VA opinions of low probative value as to the nature and etiology of the Veteran's claimed disabilities. Particularly, the VA examiner based the opinions on the absence of injuries in service. Also, the VA examiner used a more stringent standard, that is, one seemingly based on causality, rather than the applicable "approximate balance" standard, where the veteran would be entitled to the benefit of the doubt when the evidence was approximately balanced, that is, nearly equal, if not higher. However, the VA examiner did concede that, as an acute or environmental factor, repeated exposure to cold could contribute to vascular damage. Also, repeated exposure to cold in individuals already at risk could exacerbate symptoms or accelerate disease progression. Moreover, diseases of the nervous system can alternatively be linked to service by the Veteran's credibly statements regarding continuity of symptomatology.

Accordingly, giving the Veteran the benefit of the doubt, service connection for left hand numbness, diagnosed as left upper extremity sensory neuropathy, service connection for right hand numbness, diagnosed as right upper extremity sensory neuropathy, service connection for left foot numbness, diagnosed as left lower extremity sensory neuropathy, service connection for right foot numbness, diagnosed as right lower extremity sensory neuropathy, and service connection for peripheral artery disease, claimed as reduced
could contribute to vascular damage. Also, repeated exposure to cold in individuals already at risk could exacerbate symptoms or accelerate disease progression. Moreover, diseases of the nervous system can alternatively be linked to service by the Veteran's credibly statements regarding continuity of symptomatology.

REASONS FOR REMAND

1. Service connection for epidermophytosis, claimed as trench foot, is remanded.

2. Service connection for bilateral flat foot (pes planus), claimed as trench foot, is remanded.

3. Service connection for bilateral hammer toes, claimed as trench foot, is remanded.

4. Service connection for hallux valgus, right foot, claimed as trench foot, is remanded.

The Board notes that, as shown by the claims record, the Veteran has no diagnosis of trench foot. However, he has four additional diagnoses rendered as a result of his claim of service connection for trench foot; namely, epidermophytosis, bilateral flat foot (pes planus), bilateral hammer toes and hallux valgus, right foot. See October 2024 VA foot conditions examination; October 2024 VA opinion; March 2026 VA skin diseases examination.

In the March 2026 decision, the Board remanded the claim of service connection for trench foot so that the AOJ would afford the Veteran a skin disorder examination to determine the nature and etiology of the Veteran's skin disorder, which at the time had been identified by the October 2024 VA examiner as dermatophytosis.

The Veteran was afforded a March 2026 VA skin diseases examination, in which a VA examiner diagnosed the Veteran with epidermophytosis, a specific type of dermatophytosis. The VA examiner rendered a negative nexus opinion for trench foot and explained that the Veteran did not have a trench foot diagnosis. However, the VA examiner did not render a nexus opinion as to the Veteran's epidermophytosis.

The Board also noted, in the March 2026 decision, that the October 2024 VA examiner had issued a negative nexus opinion as to bilateral flat foot (pes planus), bilateral hammer toes and hallux valgus, right foot, but had not addressed whether the Veteran's disabilities were related to in-service TERA. As such, the AOJ was directed to obtain a TERA nexus opinion. The Board also notes that the October 2024 VA examiner based the negative nexus opinion on the absence of service treatment records pertaining to complaints, treatment, or diagnoses for the Veteran's disabilities.

Further, in the March 2026 decision, the Board noted that, in an October 2024 TERA memorandum, the AOJ determined that the Veteran participated in a TERA that warranted an examination/medical opinion. However, in a February 2025 second TERA memorandum based on a finding that an Individual Longitudinal Exposure Record (ILER) entry for the Veteran was negative, the AOJ determined that the Veteran did not participate in a TERA. The Board noted that the Veteran's military personnel records confirmed his MOS of metal body repairman. See DD Form 214. Since the findings in the October 2024 and February 2025 TERA memoranda were contradictory regarding whether the Veteran participated in a TERA, and no explanation was provided for the contradictory findings that were provided in the February 2025 TERA memorandum, the Board found that a new TERA memorandum had to be obtained and any contradictory findings from previous TERA memoranda of record had to be clearly addressed. The claims record does not show that the AOJ complied with the Board's directive in this matter; that is, a new TERA memorandum has not been obtained and the contradictory findings from previous TERA memoranda of record have not been addressed.

In light of the above, the Board finds that a remand is warranted to ensure substantial compliance with the Board's previous remand directives regarding the Veteran's claims on appeal; that is, for a nexus opinion as to the Veteran's epidermophytosis, bilateral flat foot (pes planus), bilateral hammer toes and hallux valgus, right foot, to include a TERA opinion subject to the AOJ's clarification as to whether the Veteran participated in a TERA. See Stegall v. West, 11 Vet. App
the Board's directive in this matter; that is, a new TERA memorandum has not been obtained and the contradictory findings from previous TERA memoranda of record have not been addressed.

The matters are REMANDED for the following action:

1. Conduct all necessary development to verify the Veteran's participation in a TERA. Issue and associate with the record an updated TERA Memorandum and ILER. Should the AOJ find that the Veteran did not participate in a TERA, it must clarify the conflicting evidence with respect to the Veteran's participation in a TERA based on his MOS, metal body repairman, pursuant to the October 2024 TERA Memorandum.

2. The Veteran must be afforded a VA examination by another examiner with appropriate expertise to determine the nature and etiology of the Veteran's claimed epidermophytosis, bilateral flat foot (pes planus), bilateral hammer toes and hallux valgus, right foot. Any and all studies, tests, and evaluations that are deemed necessary should be conducted. The claims file, including this remand, should be reviewed by the examiner. After a review of the Veteran's claims file and an examination of the Veteran, the examiner should provide an opinion responding to the following:

(a) Whether it is at least as likely as not (i.e., the likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's epidermophytosis originated during, or is etiologically related to, active-duty service, to include, if applicable, toxic exposure risk activity (TERA).

(b) Whether it is at least as likely as not (i.e., the likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's bilateral flat foot (pes planus) originated during, or is etiologically related to, active-duty service, to include, if applicable, toxic exposure risk activity (TERA).

(c) Whether it is at least as likely as not (i.e., the likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's bilateral hammer toes originated during, or are etiologically related to, active-duty service, to include, if applicable, toxic exposure risk activity (TERA).

(d) Whether it is at least as likely as not (i.e., the likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's hallux valgus, right foot, originated during, or is etiologically related to, active-duty service, to include toxic exposure risk activity (TERA).

*The examiner is advised that the Veteran is considered competent to be able to report injuries and symptoms, and that his reports must be considered in formulating the requested opinions. If the Veteran's reports are discounted, the examiner should provide a reason for doing so.

*A complete rationale should be given for all opinions d conclusions expressed. If any opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner does not have the knowledge or training that is necessary to provide the requested opinion.

Michael J. Skaltsounis

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Aquino Ramos, Carlos M.

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.

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