Citation Nr: 18148768 Decision Date: 11/08/18 Archive Date: 11/08/18 DOCKET NO. 16-23 963 DATE: November 8, 2018 ORDER Entitlement to service connection for impairment of sphincter control, also claimed as bowel urgency leakage, is remanded. Entitlement to service connection for erectile dysfunction is remanded. Entitlement to service connection for plantar warts of the left foot, also claimed as a left foot skin condition, is denied. Entitlement to service connection for plantar warts of the right foot, also claimed as a right foot skin condition, is denied. REMANDED Entitlement to service connection for impairment of sphincter control, claimed as bowel urgency leakage, is remanded. Entitlement to service connection for erectile dysfunction is remanded. FINDINGS OF FACT 1. Plantar warts of the left foot, also claimed as a left foot condition and a skin condition, did not have its clinical onset in service and is not otherwise related to service. 2. Plantar warts of the right foot, also claimed as a right foot condition and a skin condition, did not have its clinical onset in service and is not otherwise related to service. CONCLUSIONS OF LAW 1. The criteria for plantar warts of the left foot, also claimed as a left foot condition and a skin condition, have not been met. 38 U.S.C. §§ 1110, 1117, 5107; 38 C.F.R. § 3.303. 2. The criteria for plantar warts of the right foot, also claimed as a right foot condition and a skin condition, have not been met. 38 U.S.C. §§ 1110, 1117, 5107; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1985 to May 1996. These issues are on appeal from a March 2014 rating decision. The Board notes that the Veteran completed the RAMP Opt-In election form and elected to participate in RAMP. However, the Veteran’s appeal is not eligible for RAMP because it was already before the Board. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. “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.” Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). An alternative method of establishing incurrence or aggravation and a nexus to service is through a demonstration of continuity of symptomatology. 38 C.F.R. § 3.303 (b). Continuity of symptomatology may be established if a claimant can demonstrate (1) that a condition was noted during service; (2) evidence of post- service continuity of the same symptomatology; and (3) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology. The theory of continuity of symptomatology can be used only in cases involving those diseases explicitly recognized as chronic under 38 C.F.R. § 3.309 (a). See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). The Veteran contends that he has a bilateral foot condition to include plantar warts and athlete’s foot that is due to active duty service. Service treatment records show that during service the Veteran had dry skin under his feet in June 1986. See STRs received June 2016. Post service private treatment records show that the Veteran treated plantar warts with over the counter wart removal and antifungal cream and that it greatly improved and at the time of examination no warty tissue under feet was noted. See medical treatment records non-government facility received April 2013 at 46 and 47. The Board notes that a January 2014 contract examiner opined that the Veteran’s skin rash and plantar warts are at least as likely as not due to activities related to service including heavy sweating and prolonged physical activity could have promoted the development of these conditions, consistent with activities performed during service. See C&P exam received February 2014 at 67. However, the Board finds that service treatment records have no indication of plantar warts and in fact the service separation exam was silent for any foot condition. The Boards notes that only a 1986 STR notes dry skin under the feet, but no plantar warts were noted. The Veteran underwent a bilateral foot skin exam in June May 2015. The examiner diagnosed athlete’s foot (tinea pedis) and opined that it was less likely than not that that the condition was related to military service, including the June 1986 dry skin under the Veteran’s feet. He provided the rationale that a skin condition did not appear until many years post service. He also noted that there was no foot skin condition noted at the Veteran’s service separation examination and that in a 1996 treatment note he denied any skin foot problems. Also during the May 2015 VA bilateral foot skin examination no plantar warts were noted. The examiner also found significant the fact that since he was released from active duty service the Veteran worked as a firefighter which involves plenty physical activity, including running and entry into warm fire environments that could cause sweaty feet. The Board finds the May 2015 examiner’s opinion probative, as it was based on detailed review of the claims file and supported by rationale. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). For the foregoing reasons, it is the Board’s conclusion that the criteria for service connection for a bilateral foot skin condition, to include plantar warts have not been met. In reaching this conclusion, 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, and the claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra. REASONS FOR REMAND The Veteran seeks service connection for erectile dysfunction and a bowel disability. After a review of the claims file, the Board finds that additional development is needed prior to deciding the issues on appeal. The Veteran has argued that these conditions are related to his currently service connected lumbar spine disability. See March 2015 NOD at 1. In reference to the bowel disability issue, the Veteran has been afforded a VA examination and an opinion has been obtained regarding its nature and relation to a cervical spine disability. See October 2016 rectum and anus VA examination. However, this opinion need to be supplemented. The October 2016 anus and rectum VA examiner opined that the Veteran’s bowel incontinence was not related to the cervical spine disability on a direct basis, but he failed to provide secondary service connection opinion and rationale in relation to the Veteran’s current service connected lumbar spine disability. Regarding the erectile dysfunction claim. The record shows that the Veteran has been diagnosed with erectile dysfunction. See Medical treatment records non-government facility received April 2013 at 30,32 and 39. He has not been afforded a VA examination to determine whether the diagnosis erectile dysfunction is secondary to his service connected lumbar spine disability. The Board notes that in a July 2016 letter, Dr. R. K. opines that “considering every possible sound medical etiology/principles to at least the 50 percent level of probability and its more likely than not that the Veteran’s current impairment of sphincter control, bowel urgency/leakage and erectile dysfunction are due to his lower back issues.” See Medical treatment records non-government facility received July 2016 at 2. However, the Board affords this opinion very little probative weight as it was not supported by rationale. Overall, no probative opinion has been given addressing whether the claimed disabilities are caused or aggravated by the Veteran’s service-connected lumbar spine disability. Considering the above, VA examinations and aggravation opinions addressing whether the erectile dysfunction and bowel disability conditions were caused by or are aggravated by the service connected lumbar spine disability should be obtained. Further, for completeness of the record, all outstanding relevant VA outpatient treatment and private treatment records should be obtained and associated with the claim file. The matters are REMANDED for the following action: 1. Update the VA medical record from January 2018 forward. Also request any outstanding private treatment records. 2. After the above development, schedule the Veteran for an appropriate VA examination to determine the nature of the Veteran’s erectile dysfunction disability. Specifically, if it is secondary to the Veteran’s service-connected lumbar spine disability. The examiner should be given access to the Veteran’s claim file. All appropriate tests should be conducted. All diagnoses should be noted. After a full examination of the Veteran, the examiner should provide the following opinion: whether it is at least as likely as not that the erectile dysfunction is caused by or aggravated by the service connected lumbar spine disability, or any service connected disability. A complete rationale should be provided for any opinion rendered. 3. Simultaneously, schedule the Veteran for an appropriate VA examination to determine the nature of the Veteran’s bowel disability. Specifically, if it is secondary to the Veteran’s service connected lumbar spine disability. The examiner should be given access to the Veteran’s claim file. All appropriate tests should be conducted. All diagnoses should be noted. After a full examination of the Veteran, the examiner should provide the following opinion: (1) whether it is at least as likely as not that any bowel disability is caused by or aggravated by the service connected lumbar spine disability, or any service connected disability. A complete rationale should be provided for any opinion rendered. MARJORIE A. AUER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Davis, Associate Counsel