Citation Nr: 18154526 Decision Date: 12/04/18 Archive Date: 11/30/18 DOCKET NO. 15-13 193 DATE: December 4, 2018 ORDER Entitlement to an effective date earlier than July 23, 2012, for the establishment of service connection for post-traumatic stress disorder (PTSD) is denied. New and material evidence having been received, the petition to reopen the claim for service connection for chondromalacia patella of the left knee (claimed as a left knee condition) is granted. New and material evidence having been received, the petition to reopen the claim for service connection for a left eye condition is granted. New and material evidence having been received, the petition to reopen the claim for service connection for a right eye condition is granted. REMANDED Entitlement to service connection for a right foot disability is remanded. Entitlement to service connection for a neck disability is remanded. Entitlement to service connection for chondromalacia patella of the left knee (claimed as a left knee condition) is remanded. Entitlement to service connection for right knee osteoarthritis is remanded. Entitlement to service connection for a left eye condition is remanded. Entitlement to service connection for a right eye condition is remanded. Entitlement to service connection for diabetes mellitus, type II, to include as due to herbicide exposure, is remanded. Entitlement to service connection for hypertension, to include as secondary to diabetes mellitus, type II, is remanded. FINDINGS OF FACT 1. VA did not receive a claim, formal or informal, for service connection for PTSD until July 23, 2012. 2. In a September 1998 rating decision, the Regional Office (RO) denied service connection for a left knee condition. The Veteran did not perfect her appeal within the prescribed time limit and, therefore, the decision became final. 3. Evidence received since the September 1998 rating decision relates to previously unestablished elements of the claim for service connection for a left knee condition and raises a reasonable possibility of substantiating the claim. 4. In a May 1978 rating decision, the RO denied service connection for a left eye condition. The Veteran did not perfect her appeal within the prescribed time limit and, therefore, the decision became final. 5. Evidence received since the May 1978 rating decision relates to previously unestablished elements of the claim for service connection for a left eye condition and raises a reasonable possibility of substantiating the claim. 6. In a November 2013 rating decision, the RO denied service connection for a right eye condition. The Veteran did not perfect her appeal within the prescribed time limit and, therefore, the decision became final. 7. Evidence received since the November 2013 rating decision relates to previously unestablished elements of the claim for service connection for a right eye condition and raises a reasonable possibility of substantiating the claim. CONCLUSIONS OF LAW 1. The criteria for an effective date earlier than July 23, 2012, for the grant of service connection for PTSD have not been met. 38 U.S.C. § 5110 (2012); 38 C.F.R. §§ 3.114, 3.400, 3.816 (2017). 2. The September 1998 rating decision that denied service connection for a left knee condition is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.104(a), 20.302. 3. New and material evidence sufficient to reopen the claim for service connection for a left knee condition has been received. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. § 3.156. 4. The May 1978 rating decision that denied service connection for a left eye condition is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.104(a), 20.302. 5. New and material evidence sufficient to reopen the claim for service connection for a left eye condition has been received. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. § 3.156. 6. The November 2013 rating decision that denied service connection for a right eye condition is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.104(a), 20.302. 7. New and material evidence sufficient to reopen the claim for service connection for a right eye condition has been received. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. § 3.156. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty with the U.S. Army from July 1975 to March 1977. For many years thereafter, she served in the Army Reserve and the Army National Guard. These matters come to the Board of Veterans’ Appeals (Board) from two separate appeal streams. In July 2012, the Veteran filed claims for service connection for PTSD and tinnitus, and for disabilities related to her left knee, right knee, neck, right foot and both eyes. After most of these claims were denied, she filed a Notice of Disagreement regarding the denial of service connection for all conditions except tinnitus and both eye conditions, and she took issue with the effective date for the grant of service connection for PTSD. She appealed these matters to the Board in April 2015, and she attended a hearing before the Board in July 2018. In March 2016, the Veteran filed claims for service connection for diabetes mellitus, type II, and hypertension, and she filed a new claim for service connection for a bilateral eye disorder that the RO properly interpreted as a petition to reopen her previous claims. After these claims were denied, she filed a Notice of Disagreement regarding all issues. In August 2017, she appealed these issues to the Board. She did not request a hearing. In November 2018, the two separate appeal streams were merged. All issues are presently before the Board. Entitlement to an effective date earlier than July 23, 2012, for the establishment of service connection for PTSD Except as otherwise provided, the effective date of an evaluation and award for compensation will be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. The date of receipt of a claim is the date on which a claim, information, or evidence is received by VA. 38 C.F.R. § 3.1(r). A “claim” is defined as a formal or informal communication, in writing, requesting a determination of entitlement, or evidencing a belief in entitlement to a benefit. 38 C.F.R. §§ 3.1(p), 3.151; see also Rodriguez v. West, 189 F.3d 1351 (Fed. Cir. 1999). Any communication or action indicating intent to apply for one or more VA benefits may be considered an informal claim; but an informal claim must identify the benefit sought. 38 C.F.R. § 3.155. VA must look to all communications from a veteran that may be interpreted as applications or claims for benefits, formal and informal; and it is required to identify and act on informal claims for benefits. Servello v. Derwinski, 3 Vet. App. 196, 198 (1992). In some cases, a report of examination or hospitalization may be accepted as an informal claim for benefits. 38 C.F.R. § 3.157(b). However, treatment records do not constitute informal claims when service connection has not yet been established for the condition. Sears v. Principi, 16 Vet. App. 244 (2002). While VA should broadly interpret submissions from a veteran, it is not required to conjure up claims not specifically raised. Brannon v. West, 12 Vet. App. 32 (1998) (the mere existence of medical records cannot be construed as an informal claim); Talbert v. Brown, 7 Vet. App. 352, 356-57 (1995). Importantly, the mere presence of a disability does not establish intent on the part of a veteran to seek service connection for that condition. See KL v. Brown, 5 Vet. App. 205, 208 (1993); Crawford v. Brown, 5 Vet. App. 33, 35 (1995). The Veteran asserts that she is entitled to an effective date as early as the 1990s when she attempted to file a claim with VA, or as early as 2003 when she was formally diagnosed with PTSD. Unfortunately, a thorough review of the Veteran’s claims file does not reveal any documentation that could be construed as a claim for service connection for PTSD before July 2012. Prior to her present claim, the Veteran filed multiple claims for service connection for various disabilities. In March 1977, she filed a claim for a left eye condition, back pain and arm weakness. Later, in February 1997, she filed a claim for bronchitis and a left knee injury. The record does not show any additional claims until her present claim for service connection that is dated July 17, 2012, and that was received at VA on July 23, 2012. As an aside, the Board notes that, in an April 2013 letter, VA incorrectly noted that the claim was received on July 23, 2012, and it assigned July 23, 2012, as the effective date on that basis. The Board will not disturb this determination, as it is in the Veteran’s favor. In July 2018, to substantiate her claim for an earlier effective date, the Veteran testified before the Board that a representative filed a PTSD claim on her behalf in the 1990s, and “then [she] didn’t hear nothing.” Rather, she “found out that [he] had died and all of his stuff just hung in limbo land somewhere.” She confirmed that she did not hear from the VA regarding her PTSD until around “2014” when she “tried to file again.” The Board has considered whether any evidence of record prior to July 2012 could serve as an informal claim that would entitle the Veteran to an earlier effective date under 38 C.F.R. § 3.155. However, there are no letters, treatment records or other documents in the claims file received prior to July 2012 from which any such intent can be construed. To this effect, the claims file contains an August 1996 record of a claim filed in February 1996 that was disallowed because it appears the Veteran failed to respond to inquiries from VA. Although it is unclear what disability the Veteran was claiming, other documents from around that time indicate that the claim likely related to an accident in December 1992. A June 1996 letter specifically asks the Veteran to provide more information “regarding your accident in December 1992” and voluminous records submitted in July 1995 and January 1997 refer to a specific injury to the Veteran’s right knee in December 1992. There are no other documents in the Veteran’s claims file from the 1990s or otherwise that refer at all to PTSD or that could be construed as a claim for service connection for PTSD. Moreover, the Veteran conceded that she did not attempt to file another claim for PTSD until the present claim, around twenty years later. Thus, it stands to reason that if the Veteran did, in fact, file a claim in the 1990s and she had not heard from VA regarding that claim for over twenty years, she would have taken steps to follow up with VA at some point in the interim period. Yet, there is no record in the claims file of any attempts to inquire about this claim. To be clear, the Veteran’s assertion that her claim was pending for twenty years is not on its face incredible. Rather, it must be weighed in light of other evidence of record. The evidence shows that the Veteran had extensive interaction with VA since her discharge from active duty in 1977 and throughout the 1990s, including by filing claims, attending VA examinations, submitting marriage and birth certificates and receiving education benefits. This indicates that the Veteran knew how to contact VA and frequently did contact VA whenever concerns arose. Based on this and the fact that there is no evidence of any claim for PTSD filed prior to July 2012, the Board concludes that the Veteran’s assertions of having filed a claim for PTSD in the 1990s is not credible. As for the Veteran’s assertion that she was diagnosed with PTSD as early as 2003, the Board notes that there are no medical records in the claims file to substantiate this assertion. However, even if such records were available, this would not change the outcome because the mere existence of medical records cannot be construed as an informal claim for service connection. Brannon, 12 Vet. App. 32. Moreover, as stated above, the presence of a disability is not enough to establish intent on the part of the Veteran to seek service connection for that condition. See KL, 5 Vet. App. 208; Crawford, 5 Vet. App. 35. The effective date of an award of service connection will be the later of the date the claim was received by VA or the date the disability arose. Thus, even if the Veteran could show she was diagnosed with PTSD in 2003, the effective date for the Veteran’s award of service connection must still be July 2012 when her claim was received at VA. See 38 C.F.R. § 3.816(c)(2). For these reasons, the Board finds that an effective date prior to July 23, 2012, is not warranted in this case. In making this determination, the Board has considered the provisions of 38 U.S.C. § 5107(b) regarding benefit of the doubt; however, as the preponderance of the evidence is against the Veteran’s appeal for an earlier effective date, the doctrine is inapplicable. See Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). As a concluding point, the Board takes note that, at the Veteran’s July 2018 hearing, there was some confusion as to whether the issue of entitlement to a disability rating in excess of 30 percent for PTSD is presently on appeal before the Board. Based on a careful review of the claims file, the Board finds that it is not. After the Veteran’s claim for service connection for PTSD was granted in November 2013, the Veteran filed a Notice of Disagreement specifically indicating that she was appealing the effective date of that award. The Statement of the Case (SOC) that followed only addressed the issue of an earlier effective date, and the Veteran filed an appeal to the Board that referred only to the issue of an earlier effective date. The Board notes that the Veteran submitted a January 2014 letter from her doctor indicating that the Veteran is significantly impaired by her PTSD. However, a Notice of Disagreement filed prior to March 24, 2015, must have been a written communication from a Veteran or her representative expressing dissatisfaction with a determination and a desire to contest the result. While special wording was not required, it must have been in terms that could be reasonably construed as disagreement with that determination and a desire for appellant review. 38 C.F.R. § 20.201 (2013). Here, the letter was written by the Veteran’s doctor rather than by the Veteran or her representative. Moreover, in her formal NOD that was filed only a few months prior to that letter, she specifically indicated that she was appealing only the effective date. Indeed, the Veteran had an opportunity to clarify her intent after she received the SOC that did not consider the issue of an increased disability rating, but she declined to do so. In sum, the Board finds that the Veteran did not appeal the disability rating of her PTSD. If the Veteran wishes to bring a new claim for a disability rating in excess of 30 percent for PTSD, she may do so by filing such a claim with her RO. New and Material Evidence For each of the following claims in this section, the RO declined to reopen them on the basis that the evidence submitted since the last final decision regarding those claims was not new and material. Although the RO did not reopen these claims, the Board has an obligation to make an independent determination of its jurisdiction. Barnett v. Brown, 8 Vet. App. 1 (1995), aff’d, 83 F.3d 1380 (Fed. Cir. 1996). The Board is required to determine whether new and material evidence has been received before it can reopen a claim and readjudicate service connection or other issues on the merits. See Barnett, 83 F.3d 1383-84. In general, if new and material evidence is presented or secured with respect to a finally adjudicated claim, VA shall reopen and review it. 38 U.S.C. § 5108. New evidence means existing evidence not previously submitted to agency decision makers. Material evidence means existing evidence that, by itself or when considered with the previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the prior final denial of the claim, and it must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). In determining whether evidence is new and material, the credibility of the new evidence is presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). The threshold for determining whether new and material evidence raises a reasonable possibility of substantiating a claim is “low.” See Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). In determining whether this low threshold is met, VA should not limit its consideration to whether the new evidence relates specifically to the reason why the claim was last denied. Instead, it should ask whether the evidence could reasonably substantiate the claim were the claim to be reopened, either by triggering VA’s duty to assist or through consideration of an alternative theory of entitlement. Shade, 24 Vet. App. at 118. Whether new and material evidence has been received sufficient to reopen the claim for service connection for a left knee condition The matter of service connection for a left knee condition comes to the Board on appeal from a November 2013 rating decision that declined to reopen the Veteran’s original claim for service connection for a left knee condition on the basis that evidence submitted since the last final decision was not new and material. In February 1997, the Veteran filed a claim for service connection for a left knee condition that was denied in September 1998. The evidence available at that time included the Veteran’s service records and a July 1998 VA examination. The Veteran did not appeal this decision. In July 2012, the Veteran once again filed a claim for service connection for a left knee condition. Evidence received since the previous final decision includes an October 2013 VA examination, the Veteran’s July 2018 hearing testimony that discusses the circumstances of the injury to her left knee in greater detail, and an article submitted by the Veteran that discusses how the physical demands of service adversely affect servicemembers. This evidence is new, as it was not received by the RO in September 1998 when the prior final decision was rendered. Presumed credible, this evidence indicates that the Veteran’s left knee condition may have had its onset in service or may be otherwise related to service. Thus, it at least triggers VA’s duty to assist by providing a medical examination. For these reasons, the Board finds that new and material evidence sufficient to reopen the Veteran’s claim has been received, and the claim is reopened. See 38 C.F.R. § 3.156. The Board finds, however, that a remand for additional development is necessary prior to rendering a decision on this matter. Whether new and material evidence has been received sufficient to reopen the claim for service connection for a left eye condition In March 1977, the Veteran filed a claim for service connection for a left eye condition that was denied in May 1978 because there was no evidence that her condition that pre-existed service (then identified as impaired vision and amblyopia) was permanently aggravated thereby. The Veteran did not appeal this decision. Later, in July 2012, the Veteran brought a new claim for a left eye condition. In its November 2013 rating decision, the RO declined to reopen the claim on the basis that the evidence submitted since the May 1978 decision was not new and material. The Veteran did not appeal this decision either. The evidence available at the time of the May 1978 decision included the Veteran’s service records and an April 1978 VA examination. Finally, in March 2016, the Veteran filed the present claim for service connection for a left eye condition. Evidence received since the May 1978 decision includes service records from additional periods of service that indicate that the Veteran began wearing contact lenses during service, and that she suffered from extreme photophobia. It also contains new treatment records that indicate the presence of additional eye conditions. This evidence is new, as it did not exist in May 1978 when the prior final decision was rendered. Presumed credible, this evidence indicates that the Veteran’s left eye condition may have had its onset in service or it may have been permanently aggravated thereby. Thus, it at least triggers VA’s duty to assist by providing a medical examination. For these reasons, the Board finds that new and material evidence sufficient to reopen the Veteran’s claim has been received, and the claim is reopened. See 38 C.F.R. § 3.156. The Board finds, however, that a remand for additional development is necessary prior to rendering a decision on this matter. Whether new and material evidence has been received sufficient to reopen the claim for service connection for a right eye condition In July 2012, the Veteran brought a claim for service connection a right eye condition. In its November 2013 rating decision, the RO denied the claim on the basis that the Veteran’s right eye condition was not incurred in or otherwise caused by service. The Veteran did not appeal this decision. The evidence available at the time of the November 2013 decision included the Veteran’s service records and a VA examination for an unrelated claim in which the Veteran indicated that her eyesight had worsened. In March 2016, the Veteran filed the present claim for service connection for a right eye condition. Evidence received since the prior final decision includes new treatment records that indicate the presence of additional eye conditions. This evidence is new, as it was not before the RO in November 2013 when the prior final decision was rendered. Presumed credible, this evidence indicates that the Veteran’s right eye condition may have had its onset in service. Thus, it at least triggers VA’s duty to assist by providing a medical examination. For these reasons, the Board finds that new and material evidence sufficient to reopen the Veteran’s claim has been received, and the claim is reopened. See 38 C.F.R. § 3.156. The Board finds, however, that a remand for additional development is necessary prior to rendering a decision on this matter. REASONS FOR REMAND Entitlement to service connection for a right foot disability is remanded. The Veteran asserts that she suffers from a right foot disability that was incurred in or caused by service. She also asserts that this disability developed as secondary to her right knee condition (discussed below). During her July 2018 hearing before the Board, the Veteran testified that, during service, she was not afforded appropriate footwear because the Army lacked clothing and materials that were suitable to women. She said that women were not immediately provided combat boots and, once they were provided such, they were given boots were that were old, previously used, and not the right size. Throughout basic training, her boots hurt her feet and made her feet feel numb. The Veteran’s service treatment records include a few brief notations regarding the Veteran’s feet. Specifically, a note from January 1986 indicates that the Veteran experienced swelling in both ankles. Similarly, in June 1986, the Veteran is noted to have experienced swelling and numbness in her feet intermittently for three weeks. The doctor noted that her boots offered her poor support. Based on the foregoing, the Board finds that a remand is required to provide the Veteran with a VA examination to consider the nature and etiology of any right foot condition. VA must provide a medical examination or obtain a medical opinion if the evidence indicates the existence of a current disability or persistent or recurrent symptoms of a disability that may be associated with an event, injury, or disease in service, and the record does not contain sufficient medical evidence to decide the claim. 38 U.S.C. § 5103A(d)(2); 38 C.F.R. § 3.159(c)(4)(i); McLendon v. Nicholson, 20 Vet. App. 79 (2006). The threshold for determining whether the evidence “indicates” that there “may” be a nexus between a current disability and an in-service event, injury, or disease is low. McLendon, 20 Vet. App. at 83. Here, the Veteran has testified that she suffers from a right foot condition and her service records show that she suffered from pain and numbness in her feet during service. The low standard to provide a VA examination has been met. As a concluding point, the Board notes that the Veteran’s representative referred to a “bilateral” foot disability at both the July 2018 hearing and in his written brief. However, the Veteran has only brought a claim for a disability of the right foot. If the Veteran wishes to pursue service connection for a left foot disability, she may do so by submitting a claim to her RO. Entitlement to service connection for a neck disability is remanded. The Veteran’s claim for service connection for a neck disability must also be remanded for a VA examination because the low threshold to require an examination has been met. McLendon, 20 Vet. App. at 83. The Veteran asserts that her current neck disability was incurred in service or is otherwise related to service. The Veteran’s treatment records show that she suffers from chronic neck pain and cervical spine disease, and that she has a history of trauma to her neck that includes a fractured cervical spine and a tracheotomy. A June 2015 note specifically indicates that the Veteran “broke her neck” and “as a result, her neck has been her biggest problem.” In his August 2017 and July 2018 written briefs, the Veteran’s representative asserted multiple theories for the cause of the Veteran’s neck disability. One such theory was that it was caused by the nature of the Veterans military occupational specialty (MOS) during active service in the 1970s (tactical wire operations specialist). Indeed, an April 1976 treatment note during active service indicates that the Veteran’s neck was “supple.” Later in September 1975, it is noted that the Veteran experienced a lump on the back of her neck for two weeks. In addition, a recent medical record indicates that the Veteran underwent spine surgery at some point between 1993 and 1997 when she was still in the Army Reserve. It is unclear on the record what was the reason for that surgery and whether her current neck problems are related that or to her prior service. Accordingly, a remand of this claim is warranted. Entitlement to service connection for a left knee condition is remanded. The Veteran also asserts that she currently suffers from a left knee condition that was incurred in or caused by service. The Veteran’s service records and treatment records indicate that she suffered from continued issues with her left knee for many years, including various injuries and surgeries, but there is some confusion as to the sequence of events and the circumstances of those injuries. The record shows that the Veteran underwent two operations on her left knee in 1989, including an arthroscopy for chondromalacia of the patella and an impinging medial band. There is some suggestion in the record that the operation was the result of falling at work, but it is unclear whether she fell at her civilian job at Nevada State Prison or during her service with the Army. Indeed, a memorandum dated February 1991 regarding a medical evaluation of the Veteran indicates that her surgeries were not the result of an in-service injury. However, at her July 2018 hearing before the Board, the Veteran provided a more detailed history of her left knee and suggested that her surgeries were the end result of repeated knee injuries that began with one such injury that was incurred on active duty in the 1970s. She testified that she “bashed” her left knee during basic training. She was given steroids and she begged her superiors not to send her home. Her knee had “never been the same since” and, as a result, she kept “bashing” it “over and over” until finally it had to be repaired. She acknowledged the memorandum indicating that her left knee was not injured in the line of duty, and said that she did not know why there was not a line of duty report for the first time she injured her knee. A November 1991 letter indicates that the Veteran successfully returned to work and to her duties in the Army Reserve following her surgeries, but that she continued to complain of aching in her knee. Indeed, a letter dated December 1991 confirms that she was returned to duty with no restrictions. However, the record also shows that she was placed on a physical profile in June 1995 that restricted her from running and that noted that she suffers from degenerative joint disease in her left knee. In addition, her June 1995 Report of Medical History notes that she fell on an escalator injuring her knee, but there is no additional information regarding the circumstances of that accident. The Veteran was afforded a VA examination in July 1998 in conjunction with her original claim for a left knee condition. However, this examination appears to have, at times, confused her left and right knee disabilities. In addition, it did not provide an opinion as to whether the Veteran’s current left knee disability was caused by or aggravated by service. Given the extensive and unclear history of the Veteran’s left knee disability and that fact that the Veteran has not been afforded a VA examination that considers whether her left knee condition was caused by service, this claim must be remanded for a new VA examination. Entitlement to service connection for right knee osteoarthritis is remanded. The Veteran asserts that she currently suffers from right knee osteoarthritis that was incurred in or otherwise caused by service. Medical records indicate that the Veteran is currently diagnosed with osteoarthritis (or advanced degenerative arthritis) of the right knee. Indeed, service records show that the Veteran injured her right knee during an Army Physical Fitness Test in December 1992 when she slipped on ice, and she was diagnosed with a sprained right knee. In January 1993, the office of the Adjutant General found that this injury was incurred in the line of duty. However, at a VA examination in October 2013, the examiner found that the Veteran’s osteoarthritis is less likely than not related to service because there is no evidence that the Veteran required any further treatment for her in-service right knee sprain. In addition, in July 1998, she reported to VA that she had no problems with her right knee, and there is no record of osteoarthritis until October 2012. Nevertheless, the record contains written notations from the Veteran, received at VA in July 1995, indicating that she disagreed with the finding that she was completely healed from her December 1992 injury. She specifically noted that she was “not allowed to be a part of this hearing” and that she “had an ongoing problem” with her right knee. Moreover, in her July 2018 testimony, the Veteran clarified that she also injured her right knee during combat training in Silver Spring, although she did not provide details as to when that injury took place. In multiple written briefs, the Veteran’s representative also suggested that the Veteran’s current right knee condition is due to wear and tear that resulted from the rigors of her various MOSs. He submitted an article to support his contention that such is the case. The Board finds that a remand for a new VA examination is warranted because the nexus opinion in the October 2013 examination report only relates the Veteran’s condition to her December 1992 injury and it did not consider whether it was caused by other circumstances of the Veteran’s service. In addition, it did not consider the Veteran’s competent lay statements that she had ongoing problems with her right knee even after she was fount fit for continued duty. Stefl v. Nicholson, 21 Vet. App. 120 (2007) (a medical opinion is inadequate if it offers an incomplete analysis or if it does not consider all raised theories of entitlement); see also Nieves-Rodriquez v. Peake, 22 Vet. App. 295 (2008) (a medical opinion is not adequate if it does not consider all the relevant evidence of record, including lay statements). Finally, with regard to the Veteran’s claims for both knees, the Board notes that the record contains a document from the Nevada State Industrial Insurance System indicating that the Veteran may have submitted a claim regarding an injury to her knees at work. In addition, a notation in an October 2013 VA examination report indicates that the Veteran is currently in receipt of Social Security disability benefits for an injury to her knees. Accordingly, on remand, these documents should be obtained and associated with the claims file. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c). Entitlement to service connection for a left eye condition and a right eye condition are remanded. The Veteran asserts that she currently suffers from left and right eye conditions that developed during service, although she does not identify any specific conditions. Treatment records indicate that the Veteran suffers from amblyopia and presbyopia in her left eye and that she underwent surgery for strabismus in 2011. In addition, it is noted that her right eye “drifts” and that she also suffers from bilateral cataracts. Treatment notes from October 2012 query whether the Veteran’s vertigo is caused by an eye condition; and, in October 2013, the Veteran complained that her eyesight has deteriorated so much that she cannot enjoy reading as much as she once did. Service treatment records show that, as of April 1986, the Veteran had become “clearly photophobic” and she could not tolerate sunlight. At that time, it was noted that the Veteran suffers from amblyopia and exotropic strabismus in the left eye. In addition, an April 1986 in-service examination report noted residual strabismus in the right eye that remained following surgery to correct it. Moreover, service treatment records show that the Veteran began wearing contacts by 1986, although she did not wear them as late as 1982. Based on the foregoing, the Board finds that the low threshold to require a VA examination is met regarding the Veteran’s claims for service connection for disabilities in both eyes. McLendon, 20 Vet. App. at 83. Entitlement to service connection for diabetes mellitus, type II, to include as due to herbicide exposure, is remanded. The Veteran asserts that she was exposed to herbicide agents or other contaminants during her service at Fort McClellan, Alabama, and that, as a result, she currently suffers from diabetes mellitus, type II. The Veteran’s service records confirm that she completed basic training at Fort McClellan as part of the U.S. Women’s Army Corps. VA has a duty to assist a veteran by making reasonable efforts to obtain evidence necessary to substantiate her claim. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c). Accordingly, after the Veteran filed this claim, VA contacted the National Archives and Records Administration in order to verify the Veteran’s alleged exposure to herbicide agents. Unfortunately, VA was unable to locate the relevant unit’s records regarding training at Fort McClellan. A response from the Defense Personnel Records Information Retrieval System instructed VA to contact the Armed Forces Pest Management Board for more information concerning herbicides and pesticides on Department of Defense facilities. Indeed, a November 2016 Deferred Rating Decision acknowledged this instruction and further instructed the RO to make the suggested inquiry. However, there is no evidence in the claims file that any such inquiry was made. Based on the foregoing, the Board finds that this claim must be remanded for additional development. Specifically, development consistent with the M21-1MR should be undertaken, to include contacting the Armed Forces Pest Management Board regarding the storage of herbicides and other contaminants at Fort McClellan, Alabama in 1975. If exposure to herbicide agents or other contaminants is confirmed, a VA examination for diabetes mellitus, type II, and hypertension (discussed below) should be obtained. Entitlement to service connection for hypertension, to include as secondary to diabetes mellitus, type II, is remanded. Finally, with respect to the issue of entitlement to service connection for hypertension, the Board finds that it is inextricably intertwined with the diabetes claim remanded herein. Although the record shows that the Veteran currently suffers from hypertension, service connection for hypertension depends upon whether the Veteran is service connected for diabetes. Accordingly, this claim must also be remanded. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (holding that two or more claims are inextricably intertwined if resolution of one could have significant impact on the resolution of another). These matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from June 2017 to present. 2. Obtain the Veteran’s records from the Social Security Administration. Document all requests for information as well as all responses in the claims file. 3. Ask the Veteran to complete a VA Form 21-4142 for any private treatment he received for his disabilities of the right foot, neck, knees and eyes, and for diabetes and hypertension. Make two requests for the authorized records, unless it is clear after the first request that a second request would be futile. 4. Ask the Veteran to complete a VA Form 21-4142 for records from the Nevada State Industrial Insurance System. Make two requests for the authorized records, unless it is clear after the first request that a second request would be futile. 5. Contact the appropriate Federal agencies, to include the Armed Forces Pest Management Board, and attempt to verify the Veteran’s claim regarding being exposed to herbicide agents or contaminants while completing basic training at Fort McClellan, Alabama, in 1975. Specifically, attempt to verify whether herbicides or other contaminants were stored or used at Fort McClellan. If more details are needed, contact the Veteran to request the information. Because these are Federal records, efforts to obtain them should be ended only if it is concluded that the records sought do not exist or that further efforts to obtain them would be futile. If there remains insufficient information to verify exposure to herbicide agents or contaminants, a Memorandum of Unavailability documenting all of VA’s actions to obtain the records should be prepared and associated with the claims file, and the Veteran should be notified in writing that the records cannot be found. 6. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of the Veteran’s left and right knee disabilities. The clinician is asked to take a full and detailed history of any injuries or treatment related to the left and right knee. Then, provide an opinion as to the following: (a.) Whether the Veteran’s left knee disability was at least as likely as not (50 percent or greater probability) caused by or is otherwise related to the Veteran’s service. (b.) Whether the Veteran’s right knee disability is at least as likely as not (50 percent or greater probability) caused by or is otherwise related to the Veteran’s service. In providing answers to the above questions, the examiner should consider the Veteran’s competent lay statements regarding observable symptomatology and her reported history of injuries. 7. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of the Veteran’s right foot disability. Provide an opinion as to the following: (a.) Whether the Veteran’s right foot disability was at least as likely as not (50 percent or greater probability) caused by or is related to the Veteran’s service. (b.) Whether the Veteran’s right foot disability is at least as likely as not (50 percent or greater probability) (1) proximately due to the Veteran’s right knee disability, or (2) aggravated beyond its natural progression thereby. 8. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any current neck disability. The clinician is asked to do the following: (a.) Identify any current neck disabilities. (b.) Opine whether it is at least as likely as not (50 percent or greater probability) that any current neck disability was incurred in or is otherwise related to service. 9. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any current disabilities of the left and right eye. The clinician is asked to do the following: (a.) Identify any current disabilities of the left and right eye. (b.) Regarding any right eye disability, the examiner must opine whether it is at least as likely as not (50 percent or greater probability) that any current disability of the left and right eye was incurred in or is otherwise related to service. (c.) Regarding any left eye disability, the examiner must opine whether any current disability clearly and unmistakably (undebatable) preexisted the Veteran’s service. If the examiner finds it did clearly and unmistakably preexist service, the examiner must opine whether it was clearly and unmistakably not aggravated by service. If the examiner finds that it either did not clearly and unmistakably preexist service, or was not clearly and unmistakably aggravated by service, the examiner must opine whether it was at least as likely as not incurred in or related to service. 10. If the development in #5 reveals that the Veteran was exposed to herbicide agents or contaminants during service, schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of the Veteran’s diabetes mellitus, type II, and hypertension. The clinician is asked to provide an opinion as to the following: (a.) Whether the Veteran’s diabetes mellitus, type II, is at least as likely as not (50 percent or greater probability) caused by or related to the Veteran’s service, to include any verified exposure to herbicide agents or contaminants. (b.) Whether the Veteran’s hypertension is at least as likely as not (50 percent or greater probability) (1) proximately due to the Veteran’s diabetes mellitus, type II, or (2) aggravated beyond its natural progression thereby. K. PARAKKAL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Freda J. F. Carmack, Associate Counsel