Citation Nr: 18152196 Decision Date: 11/21/18 Archive Date: 11/21/18 DOCKET NO. 16-38 728 DATE: November 21, 2018 ORDER Entitlement to an initial 50 percent disability rating, and no higher, for esophageal ring, pre-cancerous Barrett’s esophagus, is granted. Entitlement to an initial 30 percent disability rating, and no higher, for gastroesophageal reflux disease (GERD) and hiatal hernia is granted. Entitlement to service connection for a dental disability for compensation purposes is denied. Entitlement to service connection for tuberculosis is denied. REMANDED Entitlement to service connection for a bilateral foot disability, to include as secondary to service-connected radiculopathy of the right lower extremity, is remanded. FINDINGS OF FACT 1. The Veteran’s current dental disorder is not considered a disability for VA compensation purposes. 2. The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of tuberculosis or a residual of tuberculosis. 3. Throughout the appeal period, the Veteran’s esophageal ring, pre-cancerous Barrett’s esophagus, is manifested by symptoms which more nearly approximate a severe stricture of the esophagus permitting liquids only. 4. Throughout the appeal period, the Veteran’s GERD and hiatal hernia are manifested by symptoms which more nearly approximate persistently recurrent epigastric distress with pyrosis and regurgitation, accompanied by substernal arm or shoulder pain, productive of considerable impairment of health. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a dental disability for compensation purposes have not been met. 38 U.S.C. §§ 1110, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303, 3.381, 4.150 (2017). 2. The criteria for service connection for tuberculosis have not been met. 38 U.S.C. §§ 1110, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303 (2017). 3. The criteria for an initial 50 percent disability rating, but no higher, for esophageal ring, pre-cancerous Barrett’s esophagus, have been met. 38 U.S.C. §§ 1155, 5107(b) (2012); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.114, Diagnostic Code 7203 (2017). 4. The criteria for an initial 30 percent disability rating, but no higher, for GERD and hiatal hernia have been met. 38 U.S.C. §§ 1155, 5107(b) (2012); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.114, Diagnostic Code 7346 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1997 to November 1999, August 2000 to April 2001, and March 2003 to May 2004. In September and October 2015 claims, the Veteran stated he seeks service connection for bilateral fallen arches. In a November 2015 claim, the Veteran stated he seeks service connection for a foot disability secondary to service-connected radiculopathy of the right lower extremity. The Board has recharacterized the issue as entitlement to service connection for a bilateral foot disability to afford the Veteran a broader scope of review. See Browkowski v. Shinseki, 23 Vet. App. 79 (2009); see also Clemons v. Shinseki, 23 Vet. App. 1 (2009). Service Connection 1. Entitlement to service connection for a dental disability for compensation purposes, to include as secondary to the service-connected esophageal ring, pre-cancerous Barrett’s esophagus, and/or GERD and hiatal hernia The Veteran contends his current dental condition, including erosion or wear on the enamel and tooth loss, is associated with constant vomiting and acid reflux due to his service-connected esophageal ring, pre-cancerous Barrett’s esophagus, and GERD and hiatal hernia. See, e.g., April 2016 representative brief; June 2013 VA gastroenterology note; November 2012 claim. Dental disorders are treated differently than other medical disorders in the VA benefits system. Under current VA regulations, compensation is only available for certain types of dental and oral conditions listed under 38 C.F.R. § 4.150. These conditions include, in relevant part, loss of teeth due to loss of substance of the body of the maxilla or mandible due to trauma or disease such as osteomyelitis rather than as a result of periodontal disease. Treatable carious teeth, replaceable missing teeth, and dental or alveolar abscesses are not considered disabling conditions, and may be considered service connected solely for establishing eligibility for VA outpatient dental treatment. See 38 C.F.R. § 3.381(b). The Veteran’s service treatment records indicate that in September 1999 and February 2003, the Veteran’s wisdom teeth, numbers 1, 16, 17, and 32, were reported as missing. In an April 2004 Report of Medical Assessment, the Veteran reported he had a cracked tooth. The Veteran’s service treatment records do not document tooth extractions during service, or indicate that the Veteran suffered any trauma to his face or mouth, a disease such as osteomyelitis, or any concerns regarding the maxilla or mandible. Although the service treatment records are not clear as to exactly when or why the Veteran’s wisdom teeth were extracted, the Board finds the Veteran’s service treatment records do not indicate any bone loss of the maxilla or mandible during active duty service. Further, although the Veteran reported a cracked tooth, neither the Veteran nor his representative contends a tooth was lost or extracted during service due to bone loss of the maxilla or mandible due to dental trauma or disease such as osteomyelitis. A July 2013 VA dental examiner opined that there was no significant dental erosion evident upon examination. However, even if the Board were to find the Veteran has current erosion or wear on his teeth, this is not a disability for VA compensation purposes. See 38 C.F.R. §§ 3.381(b), 4.150. A December 2014 VA dental note indicates the Veteran was missing portions of the coronal aspect and/or restorations in teeth numbers 19 and 32. The Board finds the preponderance of the competent and credible evidence of record is against finding that the Veteran’s reported tooth loss following service was due to bone loss of the maxilla or mandible due to dental trauma or disease such as osteomyelitis during active duty service. Instead, the December 2014 dental note indicates the Veteran’s missing portions of teeth numbers 19 and 32 were due to a fall at work in which the Veteran reported hitting his face. Further, treatable carious teeth and replaceable missing teeth are not considered disabling conditions. See 38 C.F.R. § 3.381(b). The Board has sympathetically considered the Veteran’s lay statements. However, as the Veteran has not been diagnosed with a dental disability for which service connection may be granted, the criteria for service connection for a dental disability for compensation purposes have not been met. Accordingly, the Board must conclude that the preponderance of the evidence is against the claim of entitlement to service connection for a dental disability for compensation purposes. The benefit of the doubt doctrine is therefore not applicable, and the claim must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Fagan v. Shinseki, 573 F.3d 1282, 1287 (Fed. Cir. 2009). 2. Entitlement to service connection for tuberculosis The Veteran contends he has a current disability of tuberculosis which began during active duty service. See, e.g., November 2013 notice of disagreement. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury or event. See 38 C.F.R. § 3.303. The Veteran’s service treatment records indicate the Veteran had a positive purified protein derivative (PPD) skin test in 2000. See, e.g., April 2004 nursing note; July 2000 Report of Medical History; July 2000 Report of Medical Examination. At the time of the Veteran’s separation from service, an April 2004 chest x-ray indicated a normal chest. An April 2004 nursing note reported the Veteran denied signs or symptoms of active tuberculosis. A March 2012 VA primary care physician history and physical note indicates the Veteran reported a history of tuberculosis in 2001 [sic] and that he was treated with INH, and underwent yearly chest x-rays until about one year prior. The physician assessed a positive PPD test, and ordered a screening chest x-ray. The remainder of the Veteran’s VA treatment records do not include any complaints, treatment, or diagnoses related to tuberculosis. A July 2013 VA tuberculosis examination report indicates the Veteran does not now have or was ever diagnosed with active or latent tuberculosis. The examiner noted the Veteran’s treatment during service following a positive PPD skin test, but noted the Veteran did not have any symptoms or chest x-ray abnormalities. The VA examiner noted the Veteran denied any symptoms of tuberculosis, and upon examination there was no evident respiratory distress, no dyspnea with walking or talking, his lungs were clear to auscultation in all fields, and an April 2012 chest x-ray was normal. Other than his general contention that he has a current disability related to tuberculosis, the Veteran has not provided further information regarding any current diagnosis of, or treatment for, tuberculosis or residuals of tuberculosis, or any functional impairment caused by such a condition. Therefore, the Board finds the Veteran’s general reports of tuberculosis do not constitute a current disability. See Saunders v. Wilkie, 886 F.3d 1356, 1367-68 (Fed. Cir. 2018). Accordingly, the Board finds the preponderance of the competent and credible evidence of record is against a finding that the Veteran has, or has had at any time during the appeal, tuberculosis or a current residual of tuberculosis. Congress has specifically limited entitlement to service-connected benefits to cases where there is a current disability. “In the absence of proof of a present disability, there can be no valid claim.” Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). For these reasons, the Board must conclude that the preponderance of the evidence is against the claim of entitlement to service connection for tuberculosis. The benefit of the doubt doctrine is therefore not applicable, and the claim must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Fagan, 573 F.3d at 1287. Increased Ratings A disability rating is determined by the application of VA’s Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. VA has a duty to acknowledge and consider all regulations that are potentially applicable through the assertions and issues raised in the record, and to explain the reasons and bases for its conclusions. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as “staged ratings.” Fenderson v. West, 12 Vet. App. 119, 126-27 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). 3. Entitlement to an initial compensable disability rating for esophageal ring, pre-cancerous Barrett’s esophagus There is no diagnostic code dedicated to rating esophageal ring or Barrett’s esophagus. When an unlisted condition is encountered, it will be permissible to rate the disability under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous. 38 C.F.R. § 4.20. The Veteran’s esophageal ring and pre-cancerous Barrett’s esophagus has been rated by analogy to an esophageal stricture under 38 C.F.R. § 4.114, Diagnostic Code 7203. See July 2016 rating decision. Under Diagnostic Code 7203, a moderate stricture of the esophagus is rated as 30 percent disabling. A severe stricture permitting liquids only is rated as 50 percent disabling. A stricture permitting passage of liquids only with marked impairment of general health is rated as 80 percent disabling. 38 C.F.R. § 4.114. Diagnostic Code 7204 pertains to spasm of the esophagus (cardiospasm). If the spasm is not amenable to dilation, it is to be rated as for the degree of obstruction (stricture). 38 C.F.R. § 4.114. First, the Board finds that the medical evidence of record indicates the Veteran has undergone multiple esophageal dilations due to dysphagia associated with his esophageal ring and Barrett’s esophagus, and a June 2016 VA examiner indicated the Veteran’s condition is amenable to dilation. See also October 2016 statement of the case (discussing that the condition is amenable to dilation). However, the June 2016 VA examiner indicated the Veteran has required multiple dilations for an esophageal stricture. See also September 2016 VA EGD consultation report (scarring of the esophagus); May 2016 VA gastroenterology consultation note (esophageal stricture requiring frequent empiric esophageal dilations). Accordingly, given the Veteran’s symptomatology and location, the Board will rate the Veteran’s esophageal ring and pre-cancerous Barrett’s esophagus by analogy under Diagnostic Code 7203, and finds Diagnostic Code 7204 is not for application. Next, the Board finds that the totality of the evidence of record indicates that throughout the appeal period, the manifestations of the Veteran’s esophageal ring and Barrett’s esophagus more nearly approximate a severe stricture of the esophagus permitting liquids only. The Veteran’s VA treatment records indicate that throughout the appeal period, the Veteran’s esophageal ring and Barrett’s esophagus have been manifested by esophagitis, and dysphagia to solid foods with occasional food impaction every eight months to one year requiring treatment by dilation. See, e.g., May 2016 VA gastroenterology consultation note. The June 2016 VA examiner indicated the Veteran’s esophageal stricture is severe. Accordingly, the Board finds the manifestations of the Veteran’s esophageal ring and pre-cancerous Barrett’s esophagus more nearly approximate the criteria for an initial 50 percent disability rating under Diagnostic Code 7203. However, the Board finds the preponderance of the competent and credible evidence of record is against finding that the manifestations of the Veteran’s esophageal ring and pre-cancerous Barrett’s esophagus more nearly approximate a stricture of the esophagus permitting liquids only with marked impairment of general health. Although the Veteran’s symptoms will progress to solid dysphagia about every eight months to one year, the medical evidence of record indicates the Veteran’s dysphagia is relieved by the esophageal dilations, and the Veteran’s VA treatment records and the July 2013 or June 2016 VA examination reports do not indicate the Veteran’s esophageal ring, Barrett’s esophagus, esophagitis, or dysphagia have resulted in a marked impairment of the Veteran’s general health. In a September 2016 VA primary care secure messaging note, the Veteran reported he had been encouraged by his management to apply for leave under the Family and Medical Leave Act (FMLA), but indicated this was due to missing work for an esophageal dilation and scheduled follow-up EGD due to an episode of solid dysphagia. The Veteran did not indicate that the manifestations of his esophageal ring and/or Barrett’s esophagus otherwise impact the state of his general health. See also June 2016 VA examination report (the Veteran reported losing sick time for treatments and recovery, but did not indicate impairment of his general health). Accordingly, the Board finds the criteria for an 80 percent disability rating under Diagnostic Code 7203 have not been met. 38 C.F.R. § 4.114. For these reasons, the Board finds the criteria for an initial disability rating of 50 percent, but no higher, for esophageal ring, pre-cancerous Barrett’s esophagus, have been met. 4. Entitlement to an initial disability rating in excess of 10 percent for GERD and hiatal hernia The Veteran’s service-connected GERD and hiatal hernia have been rated under Diagnostic Code 7346 for a hiatal hernia. See July 2016 rating decision. The Veteran’s VA treatment records also include diagnoses of duodenopathy, gastropathy, and H. pylori. See, e.g., September 2016 EGD consultation report; May 2016 VA gastroenterology consultation; August 2013 EGD consultation report; July 2012 EGD consultation report. Under the schedule of ratings for the digestive system, ratings under Diagnostic Codes 7301 to 7329, inclusive, 7331, 7342, and 7345 to 7348 inclusive cannot be combined with each other. A single evaluation will be assigned under the diagnostic code which reflects the predominant disability picture, with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation. 38 C.F.R. § 4.114. Diagnostic Code 7304 pertains to gastric ulcers, Diagnostic Code 7305 to duodenal ulcers, and Diagnostic Code 7307 to hypertrophic gastritis. 38 C.F.R. § 4.114. However, the Board finds the medical evidence of record indicates the Veteran predominantly experiences symptoms related to GERD and hiatal hernia, as will be discussed below, and therefore a rating under Diagnostic Code 7346 for hiatal hernia reflects the Veteran’s predominant disability picture. The Board notes that rating the Veteran’s esophageal ring, pre-cancerous Barrett’s esophagus, under Diagnostic Code 7203 as a separate disability from his GERD and hiatal hernia is not specifically precluded under 38 C.F.R. § 4.114. See also 38 C.F.R. § 4.113. However, as the Veteran’s dysphagia has been evaluated as a manifestation of the Veteran’s esophageal ring and pre-cancerous Barrett’s esophagus, the Board may not evaluate the dysphagia as a symptom of the Veteran’s GERD and hiatal hernia, as that would constitute pyramiding. See 38 C.F.R. § 4.14. Under Diagnostic Code 7346, a 10 percent rating is warranted for two or more of the symptoms for the 30 percent evaluation of less severity. A 30 percent rating is warranted for persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal arm or shoulder pain, productive of considerable impairment of health. A 60 percent rating is warranted for symptoms of pain, vomiting, material weight loss and hematemesis or melena with moderate anemia; or other symptom combinations productive of severe impairment of health. 38 C.F.R. § 4.114. The Board finds that the totality of the evidence of record indicates that throughout the appeal period, the manifestations of the Veteran’s GERD and hiatal hernia more nearly approximate persistently recurrent epigastric distress with pyrosis and regurgitation, accompanied by substernal arm or shoulder pain, productive of considerable impairment of health. Both the July 2013 and June 2016 VA examiners indicated the Veteran’s signs and symptoms of GERD include pyrosis, reflux, regurgitation, sleep disturbance caused by esophageal reflux, nausea, and vomiting. The June 2016 VA examiner indicated the Veteran experiences persistently recurrent epigastric distress as well as substernal pain, and stated the Veteran’s signs and symptoms of GERD are productive of considerable impairment of his health. The medical evidence of record indicates the Veteran’s GERD and hiatal hernia symptoms have included substernal and epigastric pain throughout the appeal period. See, e.g., May 2016 VA gastroenterology note; December 2014 VA primary care note; July 2013 VA examination report; March 2012 VA primary care history and physical note. Further, although the Veteran reported some relief of his symptoms with the use of prescribed medications and following esophageal dilations, the Board finds the Veteran’s VA treatment records indicate his GERD and hiatal hernia symptoms, as well as the manifestations of his duodenopathy, gastropathy, and H. pylori, produced what more nearly approximates a considerable impairment of his health throughout the appeal period. Accordingly, the Board finds the criteria for an initial disability rating of 30 percent under Diagnostic Code 7346 have been met. 38 C.F.R. § 4.114. However, the Board finds the preponderance of the competent and credible evidence of record is against finding that the Veteran meets the criteria for a 60 percent disability rating under Diagnostic Code 7346. First, the Veteran’s representative contends the Veteran’s symptoms more closely represent a 60 percent rating. See June 2017 representative statement; January 2017 VA Form 9. However, under Diagnostic Code 7346, the symptoms listed under the first provision of the criteria for a 60 percent rating are conjunctive, meaning that the Veteran must demonstrate all of the listed symptoms to be entitled to the rating. The evidence of record does not indicate the Veteran has experienced material weight loss, as the Veteran has only reported one period of intentional weight loss in January 2015, and otherwise his weight has been reported as stable. See July 2016 VA gastroenterology note; June 2016 VA examination report; January 2015 VA gastroenterology note; July 2012 VA gastroenterology note; March 2012 VA primary care history and physical note. Further, neither the Veteran nor his representative contends the Veteran has experienced material weight loss due to his GERD and/or hiatal hernia. Accordingly, the criteria under the first provision for a 60 percent disability rating under Diagnostic Code 7346 have not been met. 38 C.F.R. § 4.114. Next, the second provision under Diagnostic Code 7346 for a 60 percent rating is disjunctive from the first, as the Veteran may also meet the criteria for a 60 percent rating if his symptom combination is productive of a severe impairment of health. 38 C.F.R. § 4.114. However, the Board finds the preponderance of the competent and credible evidence of record is against finding that the Veteran’s overall disability picture, to include his GERD, hiatal hernia, duodenopathy, gastropathy, and H. pylori, more nearly approximates a symptom combination productive of a severe impairment of health. The June 2016 VA examiner reviewed the evidence of record, and specifically noted the frequency, severity, and duration of the Veteran’s symptoms, but ultimately opined that the combination of all the Veteran’s symptoms is only productive of a considerable impairment of health. The Veteran’s VA treatment records do not indicate the Veteran’s symptom combination is productive of what more nearly approximates a severe impairment of his health, as the treatment records indicate the Veteran has reported improvement of his GERD symptoms with his prescribed medications and following esophageal dilations. See, e.g., July 2016 VA primary care nurse practitioner note; January 2015 VA gastroenterology note; September 2013 VA primary care note; June 2013 VA gastroenterology note; July 2012 VA gastroenterology note. Again, the Veteran has reported needing to take sick leave and possible FMLA leave to attend appointments and for recovery time from EGD and dilation procedures, but not due to his symptoms. See, e.g., September 2016 VA primary care secure messaging note; June 2016 VA examination report. Accordingly, the Board finds the criteria for a 60 percent disability rating under Diagnostic Code 7346 have not been met. 38 C.F.R. § 4.114. For these reasons, the Board finds the criteria for an initial disability rating of 30 percent, but no higher, for GERD and hiatal hernia have been met. Lastly, in the case of Rice v. Shinseki, 22 Vet. App. 447 (2009), the United States Court of Appeals for Veterans Claims held, in substance, that every claim for an increased evaluation includes a claim for a total disability rating based on individual unemployability (TDIU) where the veteran claims that his service-connected disabilities prevent him from working. In a September 2012 claim, the Veteran indicated he wanted to apply for pension benefits and reported he could not work due to his Barrett’s esophagus. However, the Veteran also indicated he was employed. In a July 2013 VA general medical examination, the Veteran reported he had lost a prior job because of being sleepy from his GERD symptoms at night, but stated he was working full time and clarified that he was not seeking pension benefits. The evidence of record indicates the Veteran continues to work full time. See, e.g., February 2016 VA podiatry note; December 2014 VA primary care note; June 2013 VA physician emergency department note. The Veteran has indicated his conditions and their treatment cause him to use all of his sick leave from work. See, e.g., June 2016 VA examination report; October 2013 notice of disagreement. However, neither the Veteran nor his representative has put forth statements indicating that the Veteran’s service-connected esophageal ring, Barrett’s esophagus, GERD, and/or hiatal hernia renders him unemployable. Accordingly, as neither the Veteran nor his representative has raised the issue of TDIU as a result of his esophageal ring, pre-cancerous Barrett’s esophagus, and/or GERD and hiatal hernia, and as the objective evidence does not suggest that he cannot work due to these disabilities, the Board concludes that the issue of TDIU has not been raised. REASONS FOR REMAND Entitlement to service connection for a bilateral foot disability, to include as secondary to service-connected radiculopathy of the right lower extremity, is remanded. The Veteran contends his current bilateral foot disability was incurred or aggravated during active duty service. The Veteran’s December 1996 enlistment examination includes a notation of bilateral pes planus. In a March 1999 service treatment record there was a notation of a right foot contusion and right ankle pain following a blunt trauma injury, and in a June 2003 record the Veteran complained of constant left foot pain after stepping on a hubcap and stretching his foot. The Veteran’s VA treatment records include current diagnoses of bilateral plantar fasciitis, right foot pes planus, and tarsal tunnel syndrome. See, e.g., February 2016 VA podiatry note. The Veteran also contends his current foot disability is secondary to his service-connected radiculopathy of the right lower extremity. See November 2015 claim. A remand is required to afford the Veteran a VA examination to determine the nature and etiology of any current foot disability. See 38 U.S.C. § 5103A(d); McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). As an examination is required, on remand the Veteran’s updated VA treatment records should also be obtained. The matter is REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from September 2016 to the present. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any current right and/or left foot disabilities. After a review of the claims file, and interview and examination of the Veteran, the examiner is asked to respond to the following inquiries: a) Please identify with specificity all right and left foot disabilities which are currently manifested, or which have been manifested at any time since September 2015. The examiner should specifically address the diagnoses of bilateral plantar fasciitis, right foot pes planus, and tarsal tunnel syndrome. The examiner should also note that service connection has already been established for radiculopathy of the right and left lower extremities. b) Did the Veteran’s preexisting bilateral pes planus undergo an increase in severity during the Veteran’s active duty service? The examiner should specifically address whether the underlying condition, as contrasted to symptoms, worsened during service. c) If the answer to (b) is yes, was any increase in the preexisting bilateral pes planus clearly and unmistakably (i.e., undebatably) due to the natural progression of the condition? If the examiner finds the Veteran’s left and/or right pes planus was permanently worsened beyond normal progression (aggravated) by the Veteran’s active duty service, the examiner should attempt to quantify the degree of aggravation beyond the baseline level of disability of the left and/or right pes planus. d) For each foot diagnosis other than pes planus, is it at least as likely as not (i.e. probability of 50 percent or greater) that the Veteran’s current foot disability was either incurred in, or is otherwise related to, the Veteran’s military service? The examiner should specifically discuss the March 1999 service treatment record noting a right foot contusion and right ankle pain following a blunt trauma injury, and the June 2003 service treatment record noting the Veteran’s complaint of constant left foot pain after stepping on a hubcap and stretching his foot. e) For each foot diagnosis, is it at least as likely as not (i.e. probability of 50 percent or greater) that the Veteran’s current foot disability was caused by his service-connected radiculopathy of the right lower extremity? f) For each foot diagnosis, is it at least as likely as not (i.e. probability of 50 percent or greater) that the Veteran’s current foot disability is aggravated by his service-connected radiculopathy of the right lower extremity? Aggravation indicates a worsening of the underlying condition as compared to an increase in symptoms. If aggravation is found, the examiner should attempt to identify the baseline level of the foot disability that existed before aggravation occurred. 3. After the above development, and any additionally indicated development, has been completed, readjudicate the issue on appeal. If the benefit sought is not granted to the Veteran’s satisfaction, send the Veteran and his representative a supplemental statement of the case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. DONNIE R. HACHEY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Delhauer, Counsel