Citation Nr: 18143875 Decision Date: 10/22/18 Archive Date: 10/22/18 DOCKET NO. 14-26 427 DATE: October 22, 2018 ORDER The application to reopen the claim for service connection for an eye condition is granted. Entitlement to service connection for a lumbar spine disability is denied. Entitlement to service connection for a left hip disability, to include as secondary to lumbar spine disability is denied. Entitlement to service connection for a left leg disability, to include as secondary to lumbar spine disability is denied. Entitlement to service connection for a left shoulder disability, to include as secondary to lumbar spine disability is denied. Entitlement to service connection for diabetes mellitus, type II, to include as secondary to lumbar spine disability is denied. Entitlement to service connection for a heart disability, to include as secondary to lumbar spine disability is denied. Entitlement to service connection for hypertension, to include as secondary to lumbar spine disability is denied. Entitlement to service connection for a gastric disability, to include gastroesophageal reflux disease (GERD) and hiatal hernia, to include as secondary to lumbar spine disability is denied. Entitlement to service connection for osteoarthritis, to include as secondary to lumbar spine disability is denied. REMANDED Entitlement to service connection for a cervical spine disability, to include as secondary to lumbar spine disability is remanded. Entitlement to service connection for a left foot disability, to include as secondary to lumbar spine disability is remanded. Entitlement to service connection for radiculopathy of the lower extremities, to include as secondary to lumbar spine disability is remanded. Entitlement to service connection for nocturia is remanded. Entitlement to service connection for residuals of heat stroke is remanded. Entitlement to service connection for an eye disability is remanded. FINDINGS OF FACT 1. In an unappealed December 1976 rating decision, the RO denied the Veteran’s claim of entitlement to service connection for an eye condition. 2. The evidence received since the December 1976 rating decision, by itself or in conjunction with previously considered evidence, relates to an unestablished fact necessary to substantiate the claim for service connection for an eye condition. 3. A left hip disability is not currently manifest and did not manifest at any point during the appeal period. 4. A left leg disability is not currently manifest and did not manifest at any point during the appeal period. 5. A left shoulder disability is not currently manifest and did not manifest at any point during the appeal period. 6. An osteoarthritis disability is not currently manifest and did not manifest at any point during the appeal period. 7. A heart disability is not currently manifest and did not manifest at any point during the appeal period. 8. A chronic lumbar spine disability did not manifest in service and is not attributable to service. 9. Hypertension did not manifest in service and is not attributable to service. 10. Hypertension is not caused or aggravated by service-connected disease or injury. 11. Type II diabetes mellitus did not manifest in service and is not attributable to service. 12. Type II diabetes mellitus is not caused or aggravated by service-connected disease or injury. 13. A gastric disability diagnosed as hiatal hernia did not manifest in service and is not attributable to service. 14. A gastric disability diagnosed as hiatal hernia is not caused or aggravated by service-connected disease or injury. CONCLUSIONS OF LAW 1. The December 1976 rating decision denying service connection for an eye condition is final. 38 U.S.C. § 7105 (2012); 38 C.F.R. §§ 20.302, 20.1103 (2017). 2. Since the December 1976 rating decision, new and material evidence has been received with respect to the Veteran’s claim of entitlement to service connection for an eye condition; therefore, the claim is reopened. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156 (2017). 3. A left hip disability was not incurred in or aggravated by service. 38 U.S.C. § 1131 (2012); 38 C.F.R. § 3.303 (2017). 4. A left hip disability is not proximately due to or the result of (causation or aggravation) a service connected disease or injury. 38 C.F.R. § 3.310 (2017). 5. A left leg disability was not incurred in or aggravated by service. 38 U.S.C. § 1131 (2012); 38 C.F.R. § 3.303 (2017). 6. A left leg disability is not proximately due to or the result of (causation or aggravation) a service connected disease or injury. 38 C.F.R. § 3.310 (2017). 7. A left shoulder disability was not incurred in or aggravated by service. 38 U.S.C. § 1131 (2012); 38 C.F.R. § 3.303 (2017). 8. A left shoulder disability is not proximately due to or the result of (causation or aggravation) a service connected disease or injury. 38 C.F.R. § 3.310 (2017). 9. An osteoarthritis disability was not incurred in or aggravated by service. 38 U.S.C. § 1131 (2012); 38 C.F.R. § 3.303 (2017). 10. An osteoarthritis disability is not proximately due to or the result of (causation or aggravation) a service connected disease or injury. 38 C.F.R. § 3.310 (2017). 11. A heart disability was not incurred in or aggravated by service. 38 U.S.C. § 1131 (2012); 38 C.F.R. § 3.303 (2017). 12. A heart disability is not proximately due to or the result of (causation or aggravation) a service connected disease or injury. 38 C.F.R. § 3.310 (2017). 13. A lumbar spine disability was not incurred in or aggravated by service. 38 U.S.C. § 1131 (2012); 38 C.F.R. § 3.303 (2017). 14. Hypertension was not incurred in or aggravated by service. 38 U.S.C. § 1131 (2012); 38 C.F.R. § 3.303 (2017). 15. Hypertension is not proximately due to or the result of (causation or aggravation) a service connected disease or injury. 38 C.F.R. § 3.310 (2017). 16. Type II diabetes mellitus was not incurred in or aggravated by service. 38 U.S.C. § 1131 (2012); 38 C.F.R. § 3.303 (2017). 17. Type II diabetes mellitus is not proximately due to or the result of (causation or aggravation) a service connected disease or injury. 38 C.F.R. § 3.310 (2017). 18. A gastric disability diagnosed as hiatal hernia was not incurred in or aggravated by service. 38 U.S.C. § 1131 (2012); 38 C.F.R. § 3.303 (2017). 19. A gastric disability diagnosed as hiatal hernia is not proximately due to or the result of (causation or aggravation) a service connected disease or injury. 38 C.F.R. § 3.310 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1976 to July 1976. This case comes before the Board of Veterans’ Appeals (Board) on appeal of January 2014 and December 2014 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). Service Connection Pertinent legal criteria Veterans are entitled to compensation from VA if they develop a disability “resulting from personal injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty.” 38 U.S.C. § 1110 (wartime service), 1131 (peacetime service). To establish a right to compensation for a present disability, a veteran must show: “(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service”-the so-called “nexus” requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed.Cir. 2004). For certain chronic disorders, including arthritis, diabetes mellitus, and hypertension, service connection may be granted if the disease becomes manifest to a compensable degree within one year following separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1137 (2012); 38 C.F.R. §§ 3.307, 3.309 (2017). However, such presumptive service connection is only applicable to veterans who served 90 days or more during a war period or after December 31, 1946. In this case, the Veteran had less than 90 days of active service and therefore, these regulations pertaining to service connection on a presumptive basis are not applicable. Service connection is also warranted for disability which is proximately due to or the result of a service-connected disease or injury. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. 38 C.F.R. § 3.310(a). Any increase in severity of a non-service connected disease or injury that is proximately due to or the result of a service connected disease or injury, and not due to the natural progress of the nonservice connected disease or injury will be service connected. However, VA will not concede that a non-service-connected disease or injury was aggravated by a service-connected disease or injury unless the baseline level of severity of the nonservice-connected disease or injury is established by medical evidence created before the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the nonservice-connected disease or injury. The rating activity will determine the baseline and current levels of severity under the Schedule for Rating Disabilities (38 C.F.R. Part 4) and determine the extent of aggravation by deducting the baseline level of severity, as well as any increase in severity due to the natural progress of the disease, from the current level. 38 C.F.R. § 3.310(b). For secondary service connection to be granted, generally there must be (1) evidence of a current disability; (2) evidence of a service-connected disease or injury; and (3) nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). The Board notes that the Veteran has not claimed that his disabilities on appeal are the result of combat with the enemy. Therefore, the combat provisions of 38 U.S.C. § 1154 (2012) are not for consideration. In general, rating decisions and Board decisions that are not timely appealed are final. See 38 U.S.C. §§ 7104, 7105 (2012); 38 C.F.R. §§ 20.1100, 20.1103 (2017). Pursuant to 38 U.S.C. § 5108, a finally disallowed claim may be reopened when new and material evidence is presented or secured to that claim. “New” evidence means evidence not previously submitted to the agency decision-maker. “Material” evidence means evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened and must raise a reasonable possibility of substantiating the claim. See 38 C.F.R. § 3.156(a) (2017). The threshold for determining if there is new and material evidence is low. See Shade v. Shinseki, 24 Vet. App. 110 (2010). In the determination of whether new and material evidence has been received, the credibility of the evidence is to be presumed. See Justus v. Principi, 3 Vet. App. 510, 513 (1992). The VA is not, however, bound to consider credible that which is the patently incredible. See Duran v. Brown, 7 Vet. App. 216 (1994). Eye condition The RO denied service connection for an eye condition in a December 1976 rating decision because there was no evidence of a current disability. The Veteran did not appeal the denial of the December 1976 rating decision and new and material evidence was not associated with the claims folder within one year of the rating decision. The decision therefore became final. At the time of the prior final rating decision in December 1976, the record in pertinent part included the Veteran’s service treatment records as well as the Veteran’s statement that he had an eye condition related to an in-service heat stroke. A June 1976 service treatment record documented emergency room treatment due to a heat stroke. Laboratory findings were within normal limits. As the December 1976 rating decision is final, new and material evidence is therefore required to reopen the claim. In reviewing the evidence added to the claims folder since the December 1976 denial, the Board finds that additional evidence has been submitted which is sufficient to reopen the Veteran’s claim. Specifically, the medical evidence now documents diagnoses of an eye disability to include cataracts and glaucoma. See a November 2013 VA examination report; see also a VA treatment record dated June 2017. Moreover, an October 2012 private treatment report from C.B., M.D. indicates that the Veteran’s current vision problems are related to the in-service heat stroke. As indicated above, the Veteran’s previous claim was denied in part because there was no evidence of a current eye condition related to service. As the new evidence now indicates current disability of the eye related to service, the Board finds that the new evidence relates to an unestablished fact necessary to substantiate the claim. As new and material evidence has been received, the claim for service connection for an eye condition is reopened. Left hip, left leg, left shoulder, heart, and osteoarthritis disabilities The Veteran contends that he has left hip, left leg, left shoulder, heart, and osteoarthritis disabilities that are related to his service, to include as due to an injury from suffering a heat stroke which caused him to fall. He alternatively contends that the left hip, left leg, and left shoulder disabilities are secondary to his lumbar spine disability. See, e.g., the Veteran’s claim for VA benefits dated September 2014. The evidence of record establishes that the Veteran does not have a current disability of the left hip, left shoulder, or heart. Additionally, although he has radiculopathy of the lower extremities, as will be discussed below, this is a separate claim that will be remanded for further evidentiary development. There is no other current left leg disability. Also, while the Veteran evidences degenerative disc disease of the cervical spine and lumbar spine, there are no other disabilities of record manifested by osteoarthritis. The Board acknowledges that the Veteran has not been provided a VA examination for his claimed left hip, left leg, left shoulder, and osteoarthritis disabilities. However, a VA treatment evaluation dated June 2015 indicates normal musculoskeletal findings with regard to the left hip, left leg, and left shoulder, and no general osteoarthritis disabilities was identified. The remainder of medical evidence which includes many VA and private treatment records are likewise absent of such. Further, the Veteran was afforded a VA examination for his claimed heart disability in November 2013. After examination of the Veteran and consideration of his medical history, the VA examiner declined to diagnose the Veteran with a heart disability. He specifically noted the absence of findings for a cardiac condition. The Board acknowledges that Dr. C.B. opined in an October 2012 private treatment report that the Veteran has “cardiac problems” that are due to his in-service heat stroke. However, Dr. C.B. did not identify a specific cardiac disability and indeed, did not conduct any cardiac testing. On the contrary, the November 2013 VA examination documents comprehensive cardiac testing and the absence of any heart disability. As such, the Board finds the report of “cardiac problems” related to service by Dr. C.B. to be of no probative value. In this case, the Board finds that the most probative evidence weighs against finding that the criteria have been met for a current disability of the left hip, left leg, left shoulder, heart, and osteoarthritis. In this regard, the Board finds it highly probative that the VA medical findings do not document any objective evidence of such and that such findings were based on thorough examinations. The Board has considered the Veteran’s statements that he has left hip, left leg, left shoulder, and osteoarthritis disabilities. He has also submitted statements from family and friends indicating such. The Veteran as well as his family and friends are competent to provide evidence of that which he experiences, including his symptomatology and medical history. Layno v. Brown, 6 Vet. App. 465, 469 (1994). In addition, lay evidence can be competent and sufficient to establish a diagnosis of a condition when: (1) a layperson is competent to identify the medical condition; (2) the layperson is reporting a contemporaneous medical diagnosis; or, (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007)); Kahana v. Shinseki, 24 Vet. App. 428, 433, n.4 (2011). However, competence must be distinguished from probative weight. Although the Veteran as well as his family and friends are competent to relate what he experiences through the senses, the lay evidence is lacking in detail to support the conclusion that there is a current disability of the left hip, left leg, left shoulder, heart, and osteoarthritis. The Veteran’s lay assertions are therefore afforded less probative weight, and less credibility than the VA medical findings. In this instance, the Board concludes that the most probative evidence establishes that the Veteran does not have a disability of the left hip, left leg, left shoulder, heart, and osteoarthritis due to disease or injury. The existence of a current disability is the cornerstone of a claim for VA disability benefits. See Degmetich v. Brown, 104 F.3d 1328 (Fed. Cir. 1997). Therefore, in the absence of current disability, there can be no valid claim. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). In this case, there is no disability that resulted from a disease or injury. Under the circumstances, the Veteran has not met the regulatory requirements to establish service connection for left hip, left leg, left shoulder, heart and osteoarthritis disabilities under any theory of entitlement and service connection must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. Here, however, as the preponderance of the evidence is against the claims, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Lumbar spine disability, diabetes mellitus, hypertension, and gastric disability The Veteran contends that his current lumbar spine disability, diabetes mellitus, hypertension, and gastric disability are related to service. He specifically contends that the lumbar spine disability, diabetes mellitus, and hypertension are due to the in-service heat stroke which caused him to fall and injure his back which subsequently caused weight gain and thereby caused his diabetes and hypertension. See, e.g., the October 2012 private treatment report from Dr. C.B. Also, correspondence dated September 2014 from the Veteran’s attorney notes the Veteran’s contention that medication taken for the lumbar spine disability caused a gastric disability. The Veteran therefore contends that if the lumbar spine disability is service connected, then service connection on a secondary basis is warranted for his diabetes mellitus, hypertension, and gastric disability. He does not contend that the diabetes, hypertension, and gastric disability are secondary to his current service connected disabilities which are a bilateral hearing loss disability and tinnitus. As discussed above, the Veteran’s service treatment records document his heat stroke in June 1976 and the Board further finds the Veteran credible with regard to injuring himself from falling due to the heat stroke. A November 2013 VA examination revealed that the Veteran underwent laminectomy of the lumbar spine in February and April 2010. Also, a private treatment record dated October 2012 from Dr. C.B. indicates the Veteran has degenerative disc disease problems that had its onset in service. Further, the November 2013 VA examiner noted treatment for hypertension with an onset of 15 to 20 years ago as well as diabetes mellitus, type II, with onset around 1998. Also, with regard to a gastric disability, the VA examiner noted diagnosis of hiatal hernia that had an onset of 2012. The Board acknowledges a finding of gastritis/GERD by Dr. C.B. in his October 2012 private treatment report. However, Dr. C.B. did not provide any examination of the Veteran. Rather, he only noted the Veteran’s use of Aciphex as a rationale for his diagnosis and further reported that the Veteran should be tested for gastritis/GERD. Notably, the Veteran reported to the November 2013 VA examiner that he only used Omeprazole for the hiatal hernia. Moreover, the VA examiner documented EGD testing from December 2012 which did not reveal GERD. The remainder of medical evidence is likewise absent a finding of gastritis/GERD, and notably, in a December 2012 VA evaluation, the Veteran denied GERD. As such, to the extent the Veteran contends that he has GERD based on the findings of Dr. C.B., the Board finds that Dr C.B.’s finding of gastritis/GERD in his October 2012 is of no probative as to whether the Veteran currently evidences such. The Board has carefully evaluated the evidence and finds that a preponderance of the evidence of record is against a finding that the Veteran’s current lumbar spine disability, hypertension, diabetes mellitus, and hiatal hernia are related to his service on a direct or presumptive basis. Specifically, the Veteran was afforded a VA examination in November 2013 for his lumbar spine disability, hypertension, diabetes mellitus, and hiatal hernia. The VA examiner specifically considered the Veteran’s report of the in-service heat stroke and injury from such. The VA examiner concluded after examination of the Veteran and review of the Veteran’s medical history that it is less likely than not that the Veteran has a lumbar spine disability, hypertension, diabetes mellitus, and hiatal hernia that are caused by or related to service, to include the injury from the heat stroke. Regarding the lumbar spine disability, the examiner noted the Veteran’s report that following the heat stroke, the Veteran fell on a curb standing upright and not from a height. This implied the possibility of the impact not being severe. Further, although the Veteran reported back symptoms since the injury, the examiner noted the absence of treatment for the back disability for more than 30 years after separation from service which negated the possibility of service connection. With respect to the Veteran’s hypertension, the VA examiner’s rationale for his conclusion was based on an absence of hypertension symptoms during the Veteran’s period of active duty as well as no treatment for hypertension for several years following service. He further noted based on his review of medical literature that there is not a known direct link between essential hypertension and a heat stroke. With regard to the Veteran’s diabetes mellitus, the VA examiner’s rationale for his conclusion was based on the Veteran’s report of an onset of around 1998 for the Veteran’s diabetes which was more than 20 years after the Veteran’s separation from service. While the examiner noted the Veteran’s report that he is not able to exercise due to his back disability and that he therefore developed diabetes is due to weight gain, the examiner further noted that this did not imply that all individuals who gain weight and cannot exercise develop diabetes mellitus. With respect to the Veteran’s hiatal hernia, the VA examiner’s rationale for his conclusion was based on his finding that the record did not reveal a documentation of hiatal hernia until 2012 and that the Veteran’s service treatment records did not indicate findings consistent with hiatal hernia. The November 2013 VA examination was based on upon thorough review of the record and analysis of the Veteran’s entire history. See Bloom v. West, 12 Vet. App. 185, 187 (1999) [the probative value of a physician’s statement is dependent, in part, upon the extent to which it reflects “clinical data or other rationale to support his opinion”]. Additionally, the VA examiner’s opinion is consistent with the Veteran’s documented medical history, which is absent any report of symptomatology consistent with a lumbar spine disability, hypertension, diabetes mellitus, and hiatal hernia for many years after active service. The examiner also noted the Veteran’s in-service injury from his heat stroke which he determined to be less likely as not related to the current status post lumbar laminectomy residuals, hypertension, and diabetes. The Board notes that the Veteran has not submitted a medical opinion contrary to the VA examiner’s as to the hiatal hernia. However, the Board acknowledges that the Veteran submitted private opinions dated October 2012 from Dr. C.B. which indicate that the Veteran’s lumbar spine disability, hypertension, and diabetes are related to the Veteran’s service. Specifically, in finding the Veteran has status post lumbar laminectomy with degenerative disc disease related to service, Dr. C.B. noted the Veteran’s many postservice medical visits for his spine problems, chronicity of symptomatology since the in-service injury, and review of medical literature indicating that the Veteran’s spine injury accelerated the onset of the degenerative process. He also indicated no other plausible underlying reason for the Veteran’s current back symptoms. Pertinently, Dr. C.B. did not address the severity of the back injury sustained by the Veteran due to the heat stroke or the absence of treatment for the Veteran’s back for more than 30 years after separation from service. As discussed above, the November 2013 VA examination report indicates that the injury was not of a severity greater than mild based on the absence of treatment for the back until more than 30 years after separation from service and that the Veteran fell on a curb standing upright rather than from a height. Moreover, the VA examiner considered the Veteran’s report of continuity of symptoms but concluded after examination of the Veteran and consideration of his medical history that such complaints were not congruent with a positive nexus. Therefore, the Board finds that the November 2013 VA examiner is of greater probative value than the report of Dr. C.B. in evaluation of the Veteran’s lumbar spine disability claim. Also, in finding that the Veteran’s diabetes is due to the in-service spine trauma, Dr. C.B. noted the Veteran’s spine injury in service made it impossible for him to exercise which caused weight gain thereby causing the diabetes as well as the Veteran’s chronicity of diabetes symptoms following service. Additionally, in finding that the Veteran’s hypertension is due to the in-service spine trauma, Dr. C.B. again discussed the Veteran’s subsequent weight gain and chronicity of symptoms. He also indicated no other plausible underlying reason for the Veteran’s current diabetes and hypertension symptoms. However, Dr. C.B. did not address the Veteran’s initial treatment for diabetes or hypertension which was not for many years following separation from service. Further, Dr. C.B. did not address in his rationale the Veteran’s reported onset of these disabilities, which as discussed above, was around 1998 for the diabetes and in the early to mid-1990s for the hypertension. On the contrary, the November 2013 VA examiner addressed such findings and further noted review of medical literature in determining that the Veteran’s diabetes mellitus and hypertension are not related to service. Thus, the Board finds the VA examination report to be of greater probative value than the report of Dr. C.B. in evaluation of the Veteran’s diabetes and hypertension claims. The Board acknowledges the statements from the Veteran as well as statements submitted by the Veteran’s family and friends in support of his claim. To the extent the Veteran as well as his family and friends assert his current lumbar spine disability, hypertension, diabetes mellitus, and hiatal hernia are related to his service, they are competent to report that he has a current diagnosis (as that is documented in the record). They are also competent to report that he has had symptoms since service. However, arthritis of the lumbar spine as well as diabetes, hypertension and hiatal hernia were not noted during service. The Board observes that the Veteran has reported longstanding symptoms related to his back, hypertension, diabetes, and hiatal hernia. The Board notes that the Veteran is competent to report his symptoms both current and past. However, this lay evidence is inconsistent with the normal findings in the service treatment records and no objective report of any of these disabilities for many years following the Veteran’s separation from service. Further, the objective findings are more credible and more probative than his after-the-fact lay assertions. We conclude that the objective findings and Veteran’s report of onset of disabilities for many years following service are far more probative and credible than the lay evidence submitted in support of a claim for benefits. The Board must find that the Veteran’s statements with regard to a nexus between his lumbar spine disability, hypertension, diabetes mellitus, and hiatal hernia and service to be of minimal probative value and outweighed by the VA opinion, prepared by a skilled neutral professional. The Board also notes that as discussed above, the Veteran has indicated that his diabetes, hypertension, and hiatal hernia are related to his lumbar spine disability and that service connection is warranted on a secondary basis. However, as discussed above, service connection is not warranted for a lumbar spine disability; as such, service connection on a secondary basis is not warranted for diabetes mellitus, hypertension, and hiatal hernia. For the reasons and bases expressed above, the Board finds that the preponderance of the evidence is against the Veteran’s claims of entitlement to service connection for a lumbar spine disability, hypertension, type II diabetes mellitus, and a gastric disability. The benefits sought on appeal are accordingly denied. REASONS FOR REMAND Eye, cervical spine, left foot, residuals of heat stroke, nocturia, and radiculopathy of the lower extremities are remanded. With respect to the Veteran’s claim of entitlement to service connection for an eye disability, the Veteran contends that he has an eye disability that is related to his service, to include the in-service heat stroke. As discussed above, the Veteran’s service treatment records document the heat stroke in June 1976. Although no treatment for his eyes was noted at that time, the Veteran currently evidences cataracts and glaucoma. See a November 2013 VA examination report; see also a June 2017 VA treatment record. The Board notes that Dr. C.B. opined in an October 2012 private treatment report that the Veteran’s current vision problems are due to his in-service heat stroke. His rationale was based on his finding that the Veteran entered service with no eye disabilities, his treatment for and symptoms of vision problems since service, and review of medical literature discussing an association between heat stroke and brain hyper-intensities that can cause vision problems if located in the correct area. However, Dr. C.B. did not specifically address which eye disabilities are related to service, but rather only referenced “vision problems.” Further, although D.J., O.D. opined in a June 2017 private treatment report that it is possible that the Veteran may have experienced ischemic optic neuropathy to the right optic nerve related to the in-service heat stroke, such opinion is speculative. Also, while the Veteran submitted a statement dated December 2016 that a Dr. A.W. informed him that his heat stroke could have caused ocular nerve damage, no rationale was provided for that opinion and such opinion was speculative. Moreover, although a VA examiner opined in a November 2013 report that the Veteran has age-related cataracts, she did not provide an opinion as to the Veteran’s glaucoma and whether it is at least as likely as not that the Veteran has an eye disability related to service. There is no other medical opinion of record which addresses the etiology of the Veteran’s current eye disability. In light of the foregoing, the Board finds that an opinion should be obtained on remand which addresses such. With regard to the Veteran’s claims of service connection for cervical spine and left foot disabilities as well as residuals of heat stroke, radiculopathy of the lower extremities and nocturia, the Veteran contends that these disabilities are due to his service, to include from his in-service heat stroke which caused him to fall. As discussed above, the Veteran’s service treatment records document the reported heat stroke, although the treatment records are absent findings related to the cervical spine, left foot, lower extremities, or genitourinary system. However, the current medical evidence documents findings of degenerative disc disease of the cervical spine, nocturia, and radiculopathy. See VA treatment records dated November 2013 and August 2016; see also a private treatment record from Dr. C.B. dated October 2012. Further, although the medical evidence does not document a specific left foot disability, a February 2014 VA treatment record notes his use of a left foot brace and antalgic gait. Moreover, although the medical evidence does not indicate any other residuals of heat stroke, as discussed above, the Board notes that such injury was documented and the Veteran has not been provided a VA examination to determine whether he has any other specific residuals from the heat stroke. As the record therefore indicates the Veteran evidences impairment of the cervical spine, left foot, and genitourinary system as well as neurological impairment of the lower extremities and residuals of heat stroke, the Board finds that the Veteran should be provided VA examinations to determine the etiology of these disabilities, to include whether such disabilities are related to his in-service heat stroke. The matters are REMANDED for the following action: 1. Arrange for the Veteran to undergo a VA examination by an appropriate examiner to determine the etiology of any eye disability, cervical spine disability, left foot disability, nocturia, and radiculopathy of the lower extremities as well as residual of a heat stroke. The entire claims file, must be made available to the examiner. The examiner should provide an opinion as to the following: a. Whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran has an eye disability to include cataracts and/or glaucoma that is related to his service, to include his injury from sustaining a heat stroke. b. Whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran has a cervical spine disability to that is related to his service, to include his injury from sustaining a heat stroke. c. Whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran has a left foot disability that is related to his service, to include his injury from sustaining a heat stroke. d. Whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran has radiculopathy of the lower extremities that is related to his service, to include his injury from sustaining a heat stroke. e. Whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran has a disability manifested by nocturia that is related to his service, to include his injury from sustaining a heat stroke. f. Whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran has residuals of a heat stroke that are related to his service. The underlying reasons for all opinions expressed must be provided. 2. Review the claims file to ensure that all of the foregoing requested development is completed, and arrange for any additional development indicated. Then readjudicate the claims on appeal. If any of the benefits sought remain denied, issue an appropriate supplemental statement of the case. H. N. SCHWARTZ Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Arif Syed, Counsel