Citation Nr: 1104753 Decision Date: 02/07/11 Archive Date: 02/14/11 DOCKET NO. 07-09 997 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Columbia, South Carolina THE ISSUES 1. Entitlement to service connection for headaches. 2. Entitlement to service connection for bilateral pes planus, claimed as hurting feet. 3. Entitlement to service connection for hyperlipidemia. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD Simone C. Krembs, Counsel INTRODUCTION The Veteran served on active duty from January 1988 to June 1988, and from December 2003 to March 2005. He had additional service in the National Guard. This matter comes before the Board of Veterans' Appeals (Board) from a July 2006 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO) that denied the Veteran's claims of entitlement to service connection for headaches, bilateral pes planus, and hyperlipidemia. The appeal is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the appellant if further action is required. REMAND The Veteran asserts that he developed a chronic headache disorder during his second period of active service. In written statements submitted in support of his claim and in receiving VA treatment, he reported that he began getting headaches while stationed in the Persian Gulf and that his headaches had worsened over time. Statements written by the Veteran's wife in support of his claim corroborate these contentions. The Veteran also asserts that he developed chronic foot pain during his second period of active service. His service treatment records show that he was found to have pre-existing bilateral pes planus during his first period of active service. The records associated with his second period of active service show that he complained of burning foot pain at the time of his separation from his second period of service. Clinical evaluation of the feet, however, was normal. Post-service clinical records show that the Veteran has continued to complain of foot pain. Statements written by the Veteran's wife in support of his claim attest to the Veteran's ongoing foot discomfort. The Veteran underwent VA examination of the feet in January 2006 and VA neurological examination in June 2006. At the time of the foot examination, he complained of bilateral arch pain that had its onset during the middle of his tour in Iraq and seemed to be getting worse. He stated that his feet currently were very sore all the time. The pain worsened after 30 minutes of standing, requiring that he sit. Physical examination revealed calluses but no other structural abnormalities. He was, however, tender in the area of both medial longitudinal arches. His foot posture was normal in the standing position, as was his Achilles alignment. His arches were shallow but present in weight bearing and non-weight bearing. The diagnosis was no objective evidence of any condition affecting the feet other than bilateral onychomycosis of the toenails and bilateral tinea pedis. The examiner did not, however, address the Veteran's in-service diagnosis of pes planus, including whether his pes planus was aggravated as a result of his second period of active service, or his complaints of burning foot pain at the time of his separation from his second period of active service. On VA examination in June 2006, the Veteran stated that he had experienced a nagging headache ever since he went to Iraq in May 2005. He described the headaches as dull, but noted that they occurred every three to four days. Neurological examination revealed no abnormalities. The impression was tension headaches. The examiner did not comment as to whether the Veteran's current headache disorder was related to the headaches he experienced in service. The Veteran is competent to state that he experienced headaches and foot pain during service, and to testify as to the continuation of such symptoms after his separation from service. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). Additionally, the Veteran is competent to state that his pes planus disability worsened during service. See Falzone v. Brown, 8 Vet. App. 398, 403 (1995). Because he is not competent, however, to relate his in-service symptoms to any currently diagnosed disorders, and such relationship remains unclear to the Board, the Board finds that additional VA examinations are necessary in order to fairly decide his claims. McLendon v. Nicholson, 20 Vet. App. 79 (2006). Next, hyperlipidemia or elevated serum (blood) cholesterol is not a disability for which VA compensation benefits are payable. Thus, in order for the Veteran's hyperlipidemia to be eligible for service connection, his hyperlipidemia must be evidence of an underlying disability or result in or aggravate another disability. In this case, the Veteran is alleging that his hyperlipidemia is aggravating his service-connected hypertension. VA's duty to assist includes a duty to provide a medical examination or obtain a medical opinion where it is deemed necessary to make a decision on the claim. 38 U.S.C.A. § 5103A(d) (West 2002); 38 C.F.R. § 3.159(c)(4) (2010); Robinette v. Brown, 8 Vet. App. 69 (1995). The Veteran has not yet been afforded a VA examination with respect to his claim of entitlement to service connection for hyperlipidemia. In addition, no treating physician has opined as to any relationship between his hyperlipidemia and his service-connected hypertension. As it remains unclear to the Board whether the Veteran's hyperlipidemia caused or aggravated his development of hypertension, or any other cardiovascular disorder, the Board finds that a remand for an examination and etiological opinion is necessary in order to fairly decide the merits of his claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006). Accordingly, the case is REMANDED for the following actions: 1. Forward the claims file to the examiner who conducted the June 2006 neurological examination for the purpose of ascertaining whether any current headache disorder is etiologically related to his period of active service. If the examiner who conducted the June 2006 examination is no longer available, forward the file to another qualified examiner. No further examination of the Veteran is necessary, unless the examiner determines otherwise. The examiner should specifically offer an opinion as to whether it is as likely as not (50 percent probability or greater) that the Veteran's current headache disorder is etiologically related to his period of active service. In rendering this opinion, the examiner should consider the Veteran's statements regarding the incurrence of headaches in service, and as to the continuation of headaches after service, as both competent and credible. The claims file should be made available to and reviewed by the examiner in conjunction with rendering the opinion. The examiner should indicate in the examination report that the claims file was reviewed. The rationale for the opinion, with citation to relevant medical findings, must be provided. 2. Schedule the Veteran for an appropriate VA examination to determine the nature, extent, onset and etiology of any bilateral foot disability found to be present. The claims file should be made available to and be reviewed by the examiner, and the examination report should reflect that review. The examiner should state the likelihood that any bilateral foot disability found to be present existed prior to service. If the examiner concludes that a bilateral foot disability found to be present preexisted service, the examiner should indicate the likelihood that the disability worsened during service. If the examiner diagnoses the Veteran as having a bilateral foot disability that did not pre-exist service, the examiner must opine as to whether it is at least as likely as not that the condition is related to or had its onset during service. In offering each of these opinions, the examiner should specifically acknowledge and comment on the Veteran's service and post-service treatment records showing complaints, diagnoses, and treatment relating to bilateral foot disabilities, including pes planus. In rendering these opinions, the examiner should consider the Veteran's statements regarding the incurrence of foot pain in service, and as to the continuation of foot pain after service, as both competent and credible. The rationale for the opinions, with citation to relevant medical findings, must be provided. 3. Schedule the Veteran for an examination for the purpose of ascertaining whether his hyperlipidemia is etiologically related to his service-connected hypertension, and whether his hyperlipidemia has resulted in or aggravated another disability. The claims file must be reviewed by the examiner and the examination report should reflect that review. The examiner should specifically opine as to whether it is as likely as not (50 percent probability or greater) that the Veteran's current hyperlipidemia is etiologically related to his service- connected hypertension, and whether it is as likely as not that his elevated cholesterol and triglycerides have resulted in or aggravated another disability, to include any cardiovascular disability. The examiner should determine the approximate date of onset of the Veteran's hyperlipidemia, and the effect of the elevation on his development of cardiovascular disease, or any other related disability. The rationale for the opinions must be provided. 4. Then, readjudicate the Veteran's claims. If action remains adverse to the Veteran, issue a supplemental statement of the case and allow the appropriate time for response. Then, return the case to the Board, if otherwise in order. The appellant has the right to submit additional evidence and argument on the matters the Board is remanding. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2009). _________________________________________________ CHERYL L. MASON Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (2010).