Citation Nr: 18144985 Decision Date: 10/25/18 Archive Date: 10/25/18 DOCKET NO. 17-50 651 DATE: October 25, 2018 ORDER Entitlement to service connection for a bilateral foot condition is denied. Entitlement to service connection for hypertension is denied. REMANDED Entitlement to service connection for erectile dysfunction (ED) is remanded. Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), is remanded. FINDINGS OF FACT 1. The Veteran’s bilateral foot condition did not begin during active service, or is otherwise related to an in-service injury, event, or disease. 2. The Veteran’s hypertension is not related to service. CONCLUSIONS OF LAW 1. The criteria for service connection for a bilateral foot condition have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 2. The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the United States Army from April 1973 to April 1976. This case comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). Service Connection Generally, to establish a right to compensation for a present disability, a veteran must show: (1) a present disability; (2) an 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). 1. Entitlement to service connection for a bilateral foot condition is denied. The Veteran submitted his claim of entitlement to service connection for a bilateral foot condition in June 2015. On his March 2016 Notice of Disagreement (NOD), the Veteran asserted that he is entitled to service connection for a bilateral foot condition because he was treated many times during his active duty for this condition, and he still continues to suffer from the condition to this day. He stated that the enclosed treatment records [attached to his NOD] showed that he had received ongoing treatment for his condition. However, the records attached to the Veteran’s NOD are very limited and do not indicate he has a current bilateral foot condition since service. The Veteran attached two pages from a January 2016 medical record. While the attached January 2016 medical record indicates that “at times his gout flares up and [his] toes get red, swollen and painful,” there is no bilateral foot condition diagnosis. Additionally, an August 2013 x-ray referenced that the Veteran had severe foot pain. The x-ray results revealed that on his right foot, he had mild degenerative changes of the first MTP joint with mild spurring of the calcaneus. As for his left foot, a hallux valgus deformity was noted. The Board finds that the Veteran’s claim for a bilateral foot condition meets the first element of a current disability, but service connection is not warranted because there is a lack of evidence that supports the Veteran incurred an injury or disease to is feet while inservice or that he has continuously had problems with his feet since service. The Veteran’s service treatment records do not show any diagnosis or treatment related to his feet. Clinical examination of the feet was determined to be normal at the time of the entrance examination and also at the time of the separation examination. The available post-service medical records also do not show any indication that the Veteran has had any issues with his feet associated with an incident or disease that occurred during service. As such, the claim lacks evidence of inservice incurrence. The Board has considered a December 2015 record that reports the Veteran wanted his feet checked for “some type of fungus,” but there is no development beyond this note indicating this condition was incurred in service. As the record does not establish that the Veteran incurred an injury or disease to his foot during service, this claim for service connection is denied. In reaching its determination, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim for service connection for a bilateral foot condition, that doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). 2. Entitlement to service connection for hypertension is denied. The Veteran's submitted his claim of entitlement to service connection for hypertension in June 2015. The Veteran has not submitted any specific reasons as to why he believes he is entitled to service connection for hypertension. While the record establishes that the Veteran has a current disability of hypertension, the record does not indicate any evidence of inservice incurrence. Service treatment records (STRs) do not document any issues with high blood pressure. Blood pressure recorded at the time of the entrance examination was 134/70. At the time of the separation examination, blood pressure was recorded as 120/66. The Veteran's blood pressure actually improved during active duty. The Board acknowledges that the Veteran has not undergone a VA examination for this claim. However, as discussed, the current evidence on record does not support a finding that the Veteran had hypertension during service. Accordingly, this claim does not meet the McClendon threshold and does not trigger the VA’s duty to assist. McClendon v. Nicholson, 20 Vet. App. 79, 81 (2006). As the claim lacks the required second element of inservice incurrence, a grant of service connection is not warranted for this claim. In reaching its determination, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). REASONS FOR REMAND 3. Entitlement to service connection for erectile dysfunction (ED) is remanded. The Veteran’s post service medical records indicate that he has a decreased libido and erectile dysfunction. He is allergic to Viagra, so he is taking vardenafil (Levitra) for his condition. As such, a current disability has been established. His service treatment records indicate the Veteran had urinary problems during service. On January 2, 1974, the Veteran complained of burning while urinating and having discharge twice a day. On June 11, 1974, he complained of having a venereal disease. While he did not have any burning sensation, he had a slight discharge. There is also a note on a chronological record of medical care that says the Veteran may have had a urinary tract infection. Thus, there is sufficient evidence to meet the first two elements of service connection. There is a current disability of erectile dysfunction, and there is some evidence of an inservice incurrence. However, there is not an etiology opinion of record. The Board finds that the VA’s duty to assist is triggered, and a remand is required to provide the Veteran with a VA examination. McClendon v. Nicholson, 20 Vet. App. 79, 81 (2006). Also, on his September 2017 Form 9 he stated that his ED is secondary to his anxiety. On remand, the examiner should opine on whether his ED is secondary to any mental disorder the Veteran may have. 4. Entitlement to service connection for an acquired psychiatric disorder, to include anxiety and PTSD, is remanded. Service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. The record does not include a PTSD diagnosis in accordance with 38 C.F.R. § 4.125(a); however, the record indicates the Veteran has been diagnosed with a mental disorder, including anxiety. On July 26, 2016, the Veteran was seen to establish contact with mental health services. He reported having experienced, anxiety, dizziness, trouble sleeping, stress, loss of [interest in] doing things, and [being] emotional.” He also reported having anxiety all the time, dizziness, confusion, and [being] hopeless, [and] upset.” He reported that he had experienced these symptoms since the 1970’s when a friend was killed during a fight. A VA medical record from September 29, 2017, indicates that the Veteran has anxiety, insomnia, and anger and he takes escitalopram to treat his symptoms. He also stated on his September 2017 Form 9 that he is currently in counseling for his anxiety. There is also evidence that a reported stressor has occurred. On his March 2017 PTSD statement in support of claim for PTSD, the Veteran described being at a local pool hall when a fight broke out and he witnessed a soldier, L.M., get killed. An August 25, 2017, JSSRC memorandum in the claims file verifies that the named soldier, L.M., was killed of intentional homicide under circumstances consistent with the Veteran’s narrative. However, there is no opinion on record that indicates the Veteran’s current mental disorder(s) is associated with service and the inservice stressor of the Veteran’s friend being killed during a fight. The Board finds that the VA’s duty to assist has been triggered, and a VA medical examination is warranted. The Veteran has recurrent symptoms of a mental disorder, the inservice stressor is sufficient to establish an event may have occurred in service, and the Veteran’s statements indicate that these mental disorder symptoms may be associated with his active duty service, but there is not sufficient competent medical evidence for the Board to make a determination on the claim because there is no competent etiology opinion on record. McClendon v. Nicholson, 20 Vet. App. 79, 81 (2006). Accordingly, a remand is needed to provide the Veteran a VA examination to determine whether he has a current disability of PTSD, or any mental disorder, and to obtain a medical opinion on the etiology of the Veteran’s mental disorder. It should be noted that, while the Veteran reported on his March 2017 Statement in Support of Claim for PTSD that he witnessed his friend killed during a pool fight, this report contradicts his earlier claim from June 26, 2016, where he indicated that he did not witness the fight that killed his friend. As such, while making his or her determination on remand, the examiner should be aware that he or she is not to assume that the Veteran was a witness to the fight that he reports led to his current psychiatric disorder. These matters are REMANDED for the following action: 1. Obtain all updated private and VA medical records and associate them with the record to the extent possible, including any counseling records associated with the Veteran’s psychiatric disorder. 2. Schedule the Veteran for a VA examination to determine the nature and etiology of the Veteran’s erectile dysfunction. The evidentiary record, including a copy of this remand, must be made available to and reviewed by the examiner. The opinion must include a notation that this record review took place. After the record review and examination of the Veteran, the VA examiner is asked to respond to the following inquiry: a. Is it at least as likely as not that the Veteran’s erectile dysfunction was either incurred in, or otherwise related to, the Veteran’s active duty service? b. Is it at least as likely as not that the Veteran’s erectile dysfunction is caused by OR aggravated by his mental condition? If aggravation is found, then the examiner should quantify the degree of such aggravation, if possible. The Board notes that the Veteran is not currently service connected for a mental condition; however, the Board has requested a medical opinion regarding whether the Veteran has a mental condition and if it is related to his military service A complete rationale for all opinions should be set forth and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 3. Schedule the Veteran for a VA examination with a suitably qualified health care professional to determine the nature and etiology of any mental health disorder found on examination or present during the appeal period. The evidentiary record, including a copy of this remand, must be made available to and reviewed by the examiner. The opinion must include a notation that this record review took place. After the record review and examination of the Veteran, the VA examiner is asked to respond to the following inquiries: a. Is a DSM-V diagnosis of PTSD warranted? b. If so, is it as likely as not (50 percent or greater probability) that the PTSD is related to service, to include the verified stressor? The verified stressor is that the Veteran's friend was killed in a fight but the Veteran did not actually witness the murder. c. Is it as likely as not (50 percent or greater probability), that the Veteran has any other diagnosed mental disorder which is etiologically linked to his active duty service? In rendering this opinion, the examiner is advised that the Veteran is competent to report his symptoms and history. Such reports must be acknowledged and considered in formulating any opinion. If the medical professional rejects the Veteran’s reports, he or she must provide an explanation for such rejection. A complete rationale for all opinions should be set forth and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. G. A. WASIK Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Department of Veterans Affairs