Citation Nr: 18151961 Decision Date: 11/20/18 Archive Date: 11/20/18 DOCKET NO. 16-52 914 DATE: November 20, 2018 REMANDED Entitlement to service connection for hypertension is remanded. Entitlement to service connection for residuals of kidney transplant surgery, to include as secondary to hypertension, is remanded. Entitlement to an initial evaluation in excess of 10 percent for a service-connected left heel spur is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from June 1981 to December 1985. He also had additional service of an unknown nature in the Air Force Reserve until November 1992. This matter comes before the Board of Veterans' Appeals (the Board) on appeal from a September 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Houston, Texas. 1. Entitlement to service connection for hypertension is remanded. The Veteran asserts that hypertension initially manifested in 1990, during his service in the Air Force Reserve. The Board notes that the criteria to establish service connection for disabilities incurred during periods of Active Duty for Training (ACDUTRA) and Inactive Duty Training (INACDUTRA) differ from those pertaining to active duty service. Specifically, while service connection may be established for disabilities resulting from injuries incurred on periods of ACDUTRA and INACDUTRA, service connection is warranted for diseases initially manifesting on periods of ACDUTRA only. As such, additional development is necessary to determine the exact dates of the periods of ACDUTRA and INACDUTRA served by the Veteran while in the Air Force Reserves prior to November 1992. Further, the Board concludes that the April 2014 VA hypertension examination is inadequate for the purpose of readjudicating the Veteran’s claim, as no etiological opinion was requested or provided. On remand, such an opinion must be obtained after the nature of the Veteran’s Reserve service is verified. 2. Entitlement to service connection for residuals of kidney transplant surgery, to include as secondary to hypertension, is remanded. The Veteran claims that his kidney disease and consequent transplant surgery was caused by his hypertension. As such, the Board must defer readjudication of this issue at this time. Further, the Board concludes that the April 2014 VA examination is inadequate, the examiner did not offer a medical nexus opinion and cited inconsistent dates for the onset of the Veteran’s kidney disease and surgery. Further, an October 2017 VA treatment record alludes to treatment received by the Veteran from a private nephrologist. The record before the Board is devoid of private treatment records from a non-VA nephrologist. While this private provider is not named, the Board concludes that the Veteran should be requested to identify this physician and complete a release so that VA can obtain these pertinent and reasonably identified records. 3. Entitlement to an initial evaluation in excess of 10 percent for a service-connected left heel spur is remanded. Initially, the Board observes that in an August 2018 rating decision, the Agency of Original Jurisdiction (AOJ) proposed to reduce the initial evaluation assigned for the Veteran’s service-connected left heel spur, and the Veteran disagreed with this proposal, requesting a hearing on the matter. While this does not equate to a separate appeal because the disagreement is premature until the rating reduction is implemented, the issue before the Board is nonetheless intertwined with the proposed rating reduction, and the testimony at the reduction hearing, and the subsequent actions of the AOJ will impact the issue before the Board. Also, the Board finds that the VA examinations regarding the feet, dated in April 2014, November 2015, and August 2018, are inadequate because the examiners did not differentiate between the symptoms associated with the Veteran’s service-connected left heel spur as opposed to those associated with his nonservice-connected plantar fasciitis, pes planus, and hallux valgus. Mittleider v. West, 11 Vet. App. 181, 182 (1998). Lastly, so that the VA examiners are fully apprised of the Veteran’s complete disability picture, the Board concludes that updated VA and private treatment records should be sought, obtained, and associated with the file. The matters are REMANDED for the following actions: 1. The AOJ must obtain and associated with the file all records from the VAMC in Houston, Texas, and associated facilities dated after March 23, 2018. 2. The AOJ must contact the Veteran and request that he complete a release for any outstanding private treatment records that are pertinent to the issues remanded by the Board. In these releases, the Veteran should provide a time period in which he was treated at each facility identified. The AOJ should then obtain the records identified by the Veteran. The Board is particularly interested in records from the private nephrologist identified in an October 2017 VA treatment record. All records obtained should be associated with the Veteran's file. If any identified and requested records are not available, or if the search for any such records otherwise yields negative results, that fact should clearly be documented in the file, and the Veteran should be informed in writing. 3. The AOJ must contact the Defense Finance and Accounting Service, the National Personnel Records Center and any other appropriate repository and request the Veteran's pay stubs from his service in the Air Force Reserve prior to November 1992. Attempts to secure the pay stubs should be clearly documented in the file, along with any negative responses. 4. Based on the information obtained from the above instructions, the AOJ must verify the exact dates of each period of ACDUTRA and INACDUTRA that the Veteran attended during his service in the Air Force Reserve. The AOJ must prepare a summary of this information and associate it with the claims file. 5. The AOJ must request that the Veteran be scheduled for an appropriate VA examination to evaluate his service-connected left heel spur. The frequency and severity of all manifestations of this disability must be described in detail. The complete electronic record must be made available to, and reviewed by, the VA examiner prior to conducting the examination. All testing necessary to properly evaluation this disability and its resulting functional impairment must be completed and reported. The examiner must provide a statement attempting to differentiate between the symptoms associated with his service-connected left heel spur and those secondary to his nonservice connected plantar fasciitis, pes planus, hallux valgus, and any other disability affecting the left foot and/or ankle. If such a statement cannot be provided, an explanation for this finding must be stated. If the examiner cannot provide an opinion without resorting to mere speculation, this should be so stated along with supporting rationale. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to the particular question. 6. Thereafter, the AOJ must request that the Veteran be scheduled for an appropriate VA examination to determine the nature, onset, and etiology of his hypertension and residuals of a kidney transplant. The complete electronic record must be made available to, and reviewed by, the VA examiner prior to conducting the examination. All necessary studies and tests should be conducted. The examiner is specifically requested to address the following: a. Confirm or rule out diagnoses of hypertension and residuals of kidney transplant surgery. b. For each disability identified in part (a), provide an approximate date of initial onset (month and year). c. For each disability identified in part (a), provide an opinion concerning whether the disability is proximately due to or the result of the Veteran’s service. d. If it is concluded that the Veteran’s hypertension is causally-related to the Veteran’s active duty or Air Force Reserve service, provide an opinion concerning whether his kidney transplant residuals were caused by his hypertension. e. If it is concluded that the Veteran’s hypertension is causally-related to the Veteran’s active duty or Air Force Reserve service, provide an opinion concerning whether his kidney transplant residuals were/are aggravated caused by his hypertension. If the examiner cannot provide an opinion without resorting to mere speculation, this should be so stated along with supporting rationale. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to the particular question. 7. After undertaking any additional development deemed appropriate, and giving the Veteran full opportunity to supplement the record, the AOJ must readjudicate the Veteran's pending issues in light of any additional evidence added to the record. If any benefit sought on appeal remains denied, the Veteran and his representative should be furnished with a Supplemental Statement of the Case and be afforded the applicable opportunity to respond before the record is returned to the Board for further review. Michael J. Skaltsounis Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Scott W. Dale, Counsel