Citation Nr: 18143598 Decision Date: 10/19/18 Archive Date: 10/19/18 DOCKET NO. 16-15 518 DATE: October 19, 2018 REMANDED The claim of entitlement to service connection for left wrist pain is remanded. The claim of entitlement to service connection for a right foot disability is remanded. The claim of entitlement to an initial compensable evaluation for a cesarean section scar is remanded. The claim of entitlement to an initial evaluation in excess of 10 percent for insomnia is remanded. REASONS FOR REMAND The Veteran had honorable active duty service with the United States Navy from May 2003 to December 2010. 1. The claim of entitlement to service connection for left wrist pain is remanded. The Veteran’s September 2012 VA examination report indicated that the Veteran did not have a present diagnosis pertaining to her left wrist, but noted reports of pain since 2004, as well as flare ups for a couple of weeks at a time. The examiner reported that the Veteran did not have a present diagnosis pertaining to her wrist, which provided the basis for the denial of service connection. In April 2016, the Veteran reported that her left wrist pain limited her range of motion during flare ups, and she experienced sharp pain in her wrist at least three times per day. Any physical activity involving her wrist worsened that pain. The Board will afford the Veteran another VA examination. 2. The claim of entitlement to service connection for a right foot disability is remanded. The Veteran’s September 2012 VA examination report indicated that the Veteran did not have a present diagnosis pertaining to her right foot, but noted tendonitis that had resolved after an in-service injury. This lack of diagnosis provided the basis for the denial of service connection. The Veteran’s service treatment records reflect an injury in May 2007 with a physical fitness test subsequently waived due to a foot injury. Imaging at the time suggested hallux valgus. In April 2016, the Veteran reported that her foot always hurt during service, including while standing on watch, working, and during physical training. Her foot reportedly swelled when she had to wear boots. This pain reportedly occurred during service and continued after discharge. The Board will afford the Veteran another VA examination. 3. The claim of entitlement to an initial compensable evaluation for a cesarean section scar is remanded. The Board cannot make a fully informed decision regarding the initial evaluation for a cesarean section scar as the medical and lay evidence of record suggests a worsening of the condition. In the Veteran’s September 2012 VA examination, she reported “on and off aching” associated with her scar, but the examiner did not indicate that the scar was painful. In February 2014, VA treatment records note irritation and discomfort with the scar. In April 2016, the Veteran reported that she experienced “stabbing pains” in her pelvis, and pain occurred on the “inside” of her scar that sometimes intensified throughout the day. She also reported that her scar regularly reopens and get infected, which she treats with topical cream. The duty to conduct a contemporaneous examination is triggered when the evidence indicates that there has been a material change in disability or that the currently assigned disability rating may be incorrect. See Caffrey v. Brown, 6 Vet. App. 377, 381 (1994); see also Snuffer v. Gober, 10 Vet. App. 400, 403 (1997) (holding that a Veteran is entitled to a new examination after a two-year period between the last VA examination and the Veteran’s contention that the pertinent disability had increased in severity). In the present case, it has been approximately six years since the Veteran was last afforded a VA examination to determine the current severity of her scar, and she has specifically asserted that her condition has worsened since this examination. As such, a new VA examination is warranted to more accurately assess the severity of the Veteran’s cesarean section scar. 4. The claim of entitlement to an initial evaluation in excess of 10 percent for insomnia is remanded. The Board cannot make a fully informed decision regarding the initial evaluation for insomnia as the medical and lay evidence of record suggests a worsening of the condition. In the Veteran’s September 2012 VA examination, she reported experiencing persistent sleep problems in service, including difficulty falling asleep and remaining asleep, as well as associated daytime tiredness. The Veteran reportedly self-medicated with Benadryl to help her sleep. In the Veteran’s April 2016 Substantive Appeal, she reported more symptoms associated with her insomnia. She reportedly mixed Benadryl with a shot of alcohol as her body became tolerant to Benadryl alone. She awakens to feelings of panic and anxiety in the middle of the night, and her daytime drowsiness negatively impacts her new job. She endorses symptoms of forgetfulness and depression. The duty to conduct a contemporaneous examination is triggered when the evidence indicates that there has been a material change in disability or that the currently assigned disability rating may be incorrect. See Caffrey v. Brown, 6 Vet. App. 377, 381 (1994); see also Snuffer v. Gober, 10 Vet. App. 400, 403 (1997) (holding that a Veteran is entitled to a new examination after a two-year period between the last VA examination and the Veteran’s contention that the pertinent disability had increased in severity). In the present case, it has been approximately six years since the Veteran was last afforded a VA examination to determine the current severity of her insomnia, and she has specifically asserted that her condition has worsened since this examination. As such, a new VA examination is warranted to more accurately assess the severity of the Veteran’s insomnia. The matters are REMANDED for the following action: 1. Contact the Veteran and her representative in order to identify any outstanding non-VA treatment records regarding the issues on appeal. If non-VA providers are identified, obtain releases for those records. Make all reasonable attempts to obtain the non-VA treatment records and associate them with the claims file. If such records cannot be obtained, inform the Veteran and her representative, and afford an opportunity for her to provide these outstanding records. 2. Obtain any relevant, outstanding VA treatment records that are not already associated with the claims file. If no records are available, the claims folder must indicate this fact and the Veteran should be notified in accordance with 38 C.F.R. § 3.159 (e). All attempts to contact the Veteran should be documented in the record. 3. Once the aforementioned development is complete, schedule the Veteran for a VA examination to determine the nature and etiology of her wrist and foot pain. A complete copy of the claims file must be made available to the examiner. The examiner should take a history from the Veteran regarding observable symptomatology. After a thorough review of the medical and lay evidence of record, the examiner should opine as to the following: (a.) Identify any and all disabilities pertaining to the Veteran’s right foot and left wrist. (b.) Is it at least as likely as not (i.e. a probability of 50 percent or more) that the Veteran’s left wrist disability had its onset during active service or otherwise resulted from active military service? (c.) Is it at least as likely as not (i.e. a probability of 50 percent or more) that the Veteran’s right foot disability had its onset during active service or otherwise resulted from active military service? The examination report should specifically state that a review of the record was conducted. The examiner should provide a complete rationale for all opinions provided. If an opinion cannot be provided without resorting to mere speculation, the examiner should identify all medical and lay evidence considered in this conclusion, fully explain why this is the case and identify what additional evidence (if any) would allow for a more definitive opinion. 4. Schedule the Veteran for a VA examination to determine the present nature and severity of her insomnia. A complete copy of the claims file must be made available to the examiner. The examiner should take a history from the Veteran regarding associated symptomatology. After a thorough review of the medical and lay evidence of record, the examiner should discuss the following: (a.) The present severity of the Veteran’s insomnia, including any indicated or related mental health diagnoses, with discussion of any occupational impairment caused by the condition. 5. Schedule the Veteran for a VA examination to determine the present nature and severity of her cesarean section scar. A complete copy of the claims file must be made available to the examiner. The examiner should take a history from the Veteran regarding associated symptomatology. After a thorough review of the medical and lay evidence of record, the examiner should discuss the following: (a.) The present nature and severity of the Veteran’s scar, including any and all occupational or functional impairment; (b.) The measurements of the scar; (c.) Whether the scar is painful, unstable, or both painful and unstable. TANYA SMITH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD H. Fisher, Associate Counsel