In my opinion, yes you can have SFN with a normal nerve count and quality. I fall into this camp. My neurologists found damage to my arms during their physical exam. But when I had my punch biopsy on my legs, my results were normal (and I do have symptoms in my legs). There are a few others on this message board who are in this similar situation.

In my other online group, there are many people who fall into this camp as well. There was one individual today who posted about their punch biopsy results - the report stated they had SFN on a portion of their leg that didn't hurt, yet had a normal punch biopsy from a part of their leg that was burning and was tremendously painful. Other people had their 1st punch biopsy turn out normal and when they had it repeated one or two years later, it showed SFN.

It seems that punch biopsy results can be discordant with levels of pain and burning. At least that is what I'm observing from the message boards that I pay attention to.