Citation Nr: 18152184 Decision Date: 11/21/18 Archive Date: 11/21/18 DOCKET NO. 17-32 677 DATE: November 21, 2018 ORDER Entitlement to service connection for bilateral foot fungus is granted. REMANDED The issue of entitlement to service connection for low back disability is remanded. The issue of entitlement to service connection for right knee disability is remanded. The issue of entitlement to service connection for asthma is remanded. The issue of entitlement to service connection for sleep apnea is remanded. The issue of entitlement to service connection for acquired psychiatric disability is remanded. FINDING OF FACT The Veteran’s bilateral foot fungus is related to military service. CONCLUSION OF LAW The criteria for service connection for bilateral foot fungus are met. 38 U.S.C. §§ 1131, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(a) (2018). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1986 to May 1990. This matter comes before the Board of Veterans’ Appeals (Board) from a March 2016 rating decision from a Department of Veterans Affairs (VA) Regional Office (RO). Bilateral Foot Fungus To establish service connection on a direct basis, a Veteran must show: (1) evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the benefit of the doubt will be granted to the claimant. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on the merits, the preponderance of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). Here, the Veteran’s private medical records indicate that he has a current diagnosis of a fungal infection of the bilateral feet. The Veteran has claimed that he was treated for the infection during active duty. The service treatment records indicate treatment for an ingrown toenail in April 1989. The Veteran’s private physician stated that the current infection is consistent with the ingrown toenail in service, and with activity the Veteran engaged in during service, including running in military boots. The physician concluded that the current bilateral fungal infection of the feet was most likely related to the Veteran’s service. No evidence contradicts this opinion. As such, it is at least as likely as not that current disability relates to service. Thus, service connection for bilateral foot fungus is warranted. REASONS FOR REMAND Service Connection for a Low Back Disability and Right Knee Disability A remand is necessary to provide the Veteran an examination for his claimed low back and right knee disabilities. The medical record indicates the Veteran has both a low back and right knee disability manifesting with pain and limited movement. The Veteran has alleged that these conditions are secondary to his left knee disability. The Veteran’s left knee disability is service connected. Therefore, the Veteran should be provided a VA examination to determine the nature, severity, and etiology of low back and right knee disabilities. See 38 C.F.R. § 3.310. Service Connection for Asthma and Sleep Apnea A remand is necessary to conduct additional development and provide the Veteran an examination for his asthma and sleep apnea. The evidence indicates he has a current diagnosis of obstructive sleep apnea, and that it is comorbid with asthma, although, there is no formal diagnosis of asthma. The Veteran alleges that he had symptoms of both conditions while in service, including a reported asthma attack and daytime somnolence. Further, he alleges he was exposed to asbestos while at Camp Lejeune. This evidence is sufficient to warrant a VA examination to determine the nature, severity, and etiology of asthma and sleep apnea. Further, the Board notes that there has not been any development of the Veteran’s claim that he was exposed to asbestos. Upon remand, the RO should request that the Veteran to specify more directly how he was exposed to asbestos. Once the Veteran has been given an opportunity to detail his exposure, the RO should conduct the necessary development to verify his allegation. Service Connection for Acquired Psychiatric Disability A remand is necessary to provide the Veteran with an examination into his service connection claim for acquired psychiatric disability. He claimed service connection for anxiety. However, his private physician has diagnosed him with posttraumatic stress disorder, which the physician related to service based on a review of personnel records. See 38 C.F.R. § 3.304(f). As the evidence indicates there is a current acquired psychiatric disability and that it may be related to an in-service incident, VA should provide the Veteran with a VA compensation examination. The matters are REMANDED for the following action: 1. Obtain relevant VA medical evidence that has not been included in the claims file. 2. Request from the Veteran details regarding his claimed contact with asbestos during service. Thereafter, conduct the necessary development to verify the consistency of the Veteran’s allegation with available records. 3. Schedule an examination to determine the nature and etiology of any low back and/or right knee disability. After reviewing the claims file, the examiner should answer the following questions. (a). What are the Veteran’s current lower back and right knee disorders? (b). Is it at least as likely as not (i.e., probability of 50 percent or greater) that a lower back and/or right knee disability relates to an in-service injury, event, or disease? (c). If the answer to (b) is negative, is it at least as likely as not that a lower back and/or right knee disability is due to or caused by service connected left knee disability? (d). If the answers to (b) and (c) are negative, is it at least as likely as not that a lower back and/or right knee disability is aggravated (i.e., worsened beyond the natural progress of the disorder) by service-connected left knee disability? Please explain in detail any opinion provided. 4. Schedule an examination to determine the nature and etiology of obstructive sleep apnea and asthma. After reviewing the claims file, the examiner should answer the following questions. (a). Does the Veteran have obstructive sleep apnea and asthma? (b). If so, is it at least as likely as not (i.e., probability of 50 percent or greater) that obstructive sleep apnea and/or asthma relates to an in-service injury, event, or disease? In addressing this question, the examiner should discuss any evidence of asbestos exposure, the Veteran’s claims of experiencing respiratory difficulty during service, his reports of daytime somnolence while in service, and his reports that he stopped breathing while sleeping. Please explain in detail any opinion provided. 5. Schedule an examination to determine the nature and etiology of any acquired psychiatric disability. After reviewing the claims file, the examiner should answer the following questions. (a). What are the Veteran’s current psychiatric disabilities? (b). If the Veteran is diagnosed with PTSD – is it at least as likely as not (i.e., probability of 50 percent or greater) that PTSD is related to a verified in-service stressor? (c). If any other acquired psychiatric disorder is diagnosed – is it at least as likely as not that any such disorder is related to an in-service injury, event, or disease? Please explain in detail any opinion provided. CHRISTOPHER MCENTEE Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Reed, Associate Counsel