Citation Nr: 0004768 Decision Date: 02/24/00 Archive Date: 02/28/00 DOCKET NO. 97-27 222 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Cleveland, Ohio THE ISSUE Entitlement to service connection for residuals of a right foot injury with parasthesias of the right leg. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD S. L. Wright, Associate Counsel INTRODUCTION The veteran served on active duty from March 1995 to September 1996. This matter comes before the Board of Veterans' Appeals (Board) from a May 1997 rating decision by the Cleveland, Ohio, Regional Office (RO) of the Department of Veterans Affairs (VA). The Board remanded this case in June 1999 for further development. FINDING OF FACT The veteran does not suffer from current disability of the right foot or right lower extremity which is related to her military service, including any injury during such service. CONCLUSION OF LAW Right foot and/or right leg disability was not incurred in or aggravated during the veteran's active military service. 38 U.S.C.A. §§ 1110, 5107 (West 1991); 38 C.F.R. § 3.303 (1999). REASONS AND BASES FOR FINDING AND CONCLUSION The veteran contends that she has residuals from a right foot injury with parasthesias of her right leg that can be directly tied to her period of active service. She provided testimony regarding her claim at a personal hearing held at the Regional Office in January 1998. At that time, she testified that she injured her leg during a seven-mile run in service and that she has continued to have problems with that right leg since the injury. She indicated that she has muscle strength loss and that her leg sometimes goes numb. She also indicated that she received many diagnoses in service and that she ultimately received a Medical Board discharge because of the disability. She also testified that she was prescribed a hard shoe as treatment in service. The Board noted in its June 1999 remand that the claim was well-grounded under 38 U.S.C.A. § 5107(a). Because the record demonstrated that the underlying issue involved medically complex determinations, the Board remanded the case for additional development. Such development has been accomplished. In this regard, the veteran underwent several VA examinations in October 1999. Additional private medical records were also obtained. After reviewing the record as a whole, the Board finds that the duty to assist the veteran has been met. 38 U.S.C.A. § 5107(a). Applicable law provides that service connection will be granted if it is shown that the veteran suffers from disability resulting from an injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty, in active military service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303. That an injury occurred in service alone is not enough; there must be chronic disability resulting from that injury. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303(b). Certain chronic disabilities, such as organic diseases of the nervous system, are presumed to have been incurred in service if manifest to a compensable degree within one year of discharge from service. 38 U.S.C.A. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). The veteran's service medical records document right foot and leg problems in service. For instance, pes planus was diagnosed at entrance. The veteran also complained of pain in her left foot with running in April 1995 and reported that she was starting to experience the same problems with her right foot. She was diagnosed with boot stress. In July 1995, she again complained of bilateral foot pain and pain around the top of her foot, spreading around to the fascia. She had pain with gradual walking and during and after a run. She was diagnosed with foot pain of unknown etiology, perhaps extensor tendonitis. In July 1995, she had right foot pain to palpation of the 1st metatarsal of the medial aspect and she was diagnosed with mild hallux valgus without other abnormality. In August 1995, the veteran's right ankle was examined and her sprain was found to be slowly resolving. She again was diagnosed with hallux valgus and metatarsus varus. She was prescribed a right foot hard shoe. In September 1995, the problems with the right foot 1st metatarsal joint were found to be resolving. In October 1995, she complained of right foot and leg numbness and was again noted to have a hallux valgus deformity. In November 1995, she was noted to have neuropathy of unknown etiology in the right leg and in December 1995 tests revealed no evidence of neuropathy, root irritation or entrapment of the peroneal nerve. In January 1996 she was noted to have subjective parasthesias/numbness/weakness without objective findings. A February 1997 VA examination of the feet showed normal gait with no significant supination or pronation of the feet. She was able to heel walk, toe walk, and fully squat without any difficulty. She could also tandem walk without difficulty. Her deep tendon reflexes and strength were intact. There was no muscular atrophy and no evidence of significant toe deformity. A normal foot and ankle examination bilaterally was reported. VA general medical and joints examinations conducted on the same date resulted in a pertinent diagnosis of right patella maltracking with alleged altered sensation of the entire right lower extremity. Private medical records dated in 1998 document treatment essentially for back complaints with some complaints of right leg pain. An October 1998 clinical entry is to the effect that there were no neurological symptoms in the lower extremity. On VA peripheral nerve examination in August 1998, the examiner noted that the claims file was extensively reviewed. The veteran's complaints were noted, but neurological examination was essentially normal. The reported impression was that at that time there was no objective neurological deficits. In September 1998, the veteran underwent further VA examination. At that point, the veteran's gait was normal and her station was neutral. She was able to walk forward and backward on her heels and toes as well as in tandem fashion without difficulty. She could squat fully without difficulty and was able to hop six times on each foot without difficulty. There was no evidence of painful motion, edema, calluses or unusual shoe wear. Again, there was no supination or pronation of the feet. The examiner found normal arches and stated that, in his opinion, there was no evidence of pes planus either. Her weight bearing alignment was normal. The diagnosis of bilateral hallux valgus with mild bilateral first and fifth metatarsal bunions was made. There was no neuropathy of the right lower extremity and an EMG of the right lower extremity was normal. The examiner who conducted the examination of the feet commented that there was no relationship between any condition of the feet or right knee to military service and that there was no neuropathy of the right lower extremity. In October 1999, the veteran underwent VA examinations of the feet, joints, muscles and peripheral nerves. On examination of the feet, the veteran denied any stiffness, swelling, heat or redness of her foot and reported that no treatment was necessary for her feet. She said that she did not need corrective shoes, crutches, braces or a cane. Her feet were bilaterally symmetrical. There was no objective evidence of painful motion, edema, instability, weakness or tenderness. She did not have any abnormalities in the anatomical structure of the foot itself, she had a normal arch and that examiner saw no hallux valgus. Her gait was unremarkable, with mild bunions. She had normal muscle function and no neurological abnormalities. The examiner further commented that the bunions were no present during service or prior to 1998, but had developed since that time. The same examiner conducted the examinations of the joints, muscles and peripheral nerves. The examination of the joints resulted in a diagnostic impression that no joint disease was identified upon examination. Examination of the muscles resulted in a diagnostic impression that the veteran had normal muscle function with an occasional deep ached after long term walking. Examination of the peripheral nerves resulted in a diagnostic impression of no neurologic abnormalities at that time. The examiner commented that he or she could not see any connection between current findings and the injury suffered during service. The record in the present case is somewhat unusual in that the veteran's inservice complaints related to the right lower extremity are well-documented and apparently led to a medical board proceeding. Recognizing the medical complexity of this case, the Board remanded the case in June 1999 for additional medical development. It appears clear from the various VA medical examinations that although the veteran has subjective complaints, no disability of the right foot or right lower extremity can be medically identified as being related to service. Although the record includes sufficient evidence of current disability which is presumed true for well-grounded purposes, the clear preponderance of the evidence is against a finding that any current disability of the right foot and/or right lower extremity is related to the veteran's service. It appears that no clinical diagnosis of any right foot disability can be made except for bunions, and the bunions have been shown to have developed after service. Moreover, trained medical professionals have not been able to diagnose any disability of the right lower extremity. The Board acknowledges the veteran's statements and testimony and does not doubt her sincerity in advancing this claim. However, in medical matters the Board must assign significant probative value to the findings and opinions of medical personnel who have had the opportunity to exam the veteran and review her claims file. Further, the Board has reviewed the evidence in light of the provisions of 38 U.S.C.A. § 5107(b), but there is not a state of equipoise of the positive evidence and the negative evidence to otherwise permit favorable resolution of the present appeal. ORDER The appeal is denied. ALAN S. PEEVY Member, Board of Veterans' Appeals