Citation Nr: 18161282 Decision Date: 12/31/18 Archive Date: 12/31/18 DOCKET NO. 16-52 363 DATE: December 31, 2018 ORDER Entitlement to service connection for a low back disorder, diagnosed as lumbar spondylosis, is granted. Entitlement to service connection for a left foot disorder, diagnosed as pes planus, calcaneal spurs, status-post left metatarsal bunionectomy, and hammertoes, is granted. Entitlement to service connection for varicose veins of the legs is granted. REMANDED Entitlement to service connection for a right index finger disorder is remanded. FINDINGS OF FACT 1. The Veteran has a current low back disorder, diagnosed as lumbar spondylosis, that manifested during active service. 2. The Veteran has current left foot disorders, diagnosed as pes planus, calcaneal spurs, status-post left metatarsal bunionectomy, and hammertoes, that manifested during active service. 3. The Veteran has varicose veins in both legs that manifested during active service. CONCLUSIONS OF LAW 1. A low back disorder, diagnosed as lumbar spondylolysis, was incurred in active service. 38 U.S.C. §§ 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2017). 2. A left foot disorder, diagnosed as pes planus, calcaneal spurs, status-post left metatarsal bunionectomy, and hammertoes, was incurred in active service. 38 U.S.C. §§ 1101, 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2017). 3. Varicose veins in the legs were incurred in active service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1978 to August 1998. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). Law and Analysis Service connection may be established for disability resulting from personal injury suffered or disease contracted in line of duty in the active military, naval, or air service. 38 U.S.C. §§ 1110, 1131. That an injury or disease occurred in service is not enough; there must be chronic disability resulting from that injury or disease. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303(b). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. As arthritis is considered to be a chronic disease for VA compensation purposes, if chronicity in service is not established, a showing of continuity of symptoms after discharge may support the claim. 38 C.F.R. §§ 3.303(b), 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). In addition, for veterans who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities, including arthritis, are presumed to have been incurred in service if they manifested to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. Low Back Disorder In considering the evidence of record under the laws and regulations as set forth above, the Board concludes that the Veteran is entitled to service connection for a low back disorder. The Veteran’s complete service treatment records are unavailable; however, the available records do show that he was referred to radiology in April 1998 for lumbar spine x-rays in order to rule out any lumbar spine dysfunction or displacement. The impression was bilateral L-5 spondylolysis without identifiable spondylolisthesis. An April 1998 retirement examination also noted the diagnosis, and the Veteran reported a medical history of recurrent back pain. In May 1998, he was referred for an orthopedic follow-up for his back pain. A fellow servicemember also submitted an October 2016 lay statement indicating that he observed the Veteran on a daily basis from 1991 to 1994 and that he complained of back problems at that time. Post-service treatment records show that the Veteran was later seen in June 2007 for lower back and leg pain stemming from an on-the-job injury sustained in October 2005 while he was working as a truck driver. The Veteran has not been afforded a VA examination in connection with his claim for a low back disorder. However, the evidence clearly shows that he complained of back problems in service and was diagnosed with lumbar spondylosis therein, prior to his civilian work injury. He continues to have that same diagnosis and has reported a continuity of symptomatology since service. The Board notes that the Veteran is competent to report the onset of his low back symptoms in service, and the contemporaneous records corroborate his reports. See e.g. Layno v. Brown, 6 Vet. App. 465, 470 (1994) (providing that a Veteran is competent to report on that of which she or he has personal knowledge). Accordingly, resolving any reasonable doubt in favor of the Veteran, the Board finds that his lumbar spondylosis manifested in service, and service connection is warranted. Left Foot Disorder In considering the evidence of record under the laws and regulations as set forth above, the Board concludes that the Veteran is entitled to service connection for a left foot disorder. The Veteran’s complete service treatment records are unavailable; however, the available records include his April 1998 retirement examination report. In that report, it was noted that the Veteran underwent a foot operation in January 1998 and was awaiting pin removal. He also reported having a medical history of foot trouble. The examiner specifically indicated that the Veteran had undergone an arthroplasty of the left second toe in 1991 and a left bunionectomy in January 1988. He also recommended that the Veteran seek further specialist examinations, including a podiatry follow-up. In a May 1998, an examiner noted a status-post left bunionectomy and a status-post arthroplasty of the left second toe in 1991 and of the left fifth toe in January 1998 and indicated that he was referred for podiatry for his foot problems. An October 2016 lay statement from a fellow servicemember also indicates that he observed the Veteran on a daily basis from 1991 to 1994 and that he complained of a left foot disorder and hammertoe at that time. The post-service medical records show that the Veteran received treatment for complaints of chronic burning and aching pain in his left foot over the years. In January 2014, it was noted that he had undergone left foot surgery three times pertaining to problems with a bunion, hammertoe, and bone spur. In October 2017, the Veteran was assessed as having chronic pain, and it was noted that he was being followed by podiatry for foot pain. Diagnostic imaging was performed in January 2017, which revealed bilateral pes planus, bilateral posterior calcaneal spurs, prior bunionectomy changes at the left first metatarsal, prior trauma versus surgical changes at the proximal phalanx of the first digit of the left foot and at the proximal interphalangeal joint of the fifth digit of the left foot, prior fusion at the proximal interphalangeal joint of the second digit of the left foot, and bilateral hammertoes. The Veteran was afforded a VA examination in November 2017 during which the examiner noted January 2017 diagnostic imaging of the feet had revealed a left foot prior fracture versus post-surgical changes at the proximal phalanx of the first digit, bunionectomy changes, surgical changes with small wire at the proximal interphalangeal joint of the second digit which is fused, prior trauma versus surgical changes at the proximal interphalangeal joint of the fifth digit, pes planus with calcaneal pitch at 16 degrees, and a small posterior calcaneal spur. The impression from the imaging including bilateral pes planus, bilateral posterior calcaneal spurs, prior bunionectomy changes at the left first metatarsal, prior trauma versus surgical changes at the proximal phalanx of the first digit of the left foot and at the proximal interphalangeal joint of the fifth digit of the left foot, and prior fusion at the proximal interphalangeal joint of the second digit of the left foot. In a November 2017 addendum, the VA examiner clarified that, after reviewing the diagnostic study of the Veteran’s feet, the diagnosis of the left foot is pes planus, calcaneal spurs, status-post left metatarsal bunionectomy, and hammertoes. She opined that the pain that the Veteran experienced in his feet during service is at least as likely caused by these diagnoses. The Veteran has consistently claimed that his left foot symptoms began in service, and the available service treatment records do document treatment for his left foot. There is no evidence of an intercurrent injury. The November 2017 VA examiner’s addendum opinion also supports the claim. Accordingly, resolving any reasonable doubt in favor of the Veteran, the Board finds that his left foot disorder manifested in service, and service connection is warranted for pes planus, calcaneal spurs, status-post left metatarsal bunionectomy, and hammertoes. Varicose Veins In considering the evidence of record under the laws and regulations as set forth above, the Board concludes that the Veteran is entitled to service connection for varicose veins in his legs. The Veteran’s complete service treatment records are unavailable; however, the available records include an April 1998 retirement examination report noting that he had prominent bilateral varicosities of both legs. The examiner recommended further specialist examinations, including a surgical follow-up for varicose veins. In May 1998 medical assessment, the examiner commented that the Veteran was being referred for his varicose veins. An October 2016 lay statement from a fellow servicemember also indicates that he observed the Veteran on a daily basis from 1991 to 1994 and that he complained of problems with the veins in his legs. Post-service treatment records show continuing symptomology, and in January 2017, a treatment provider ordered pressure stockings with a notation that the Veteran should be referred to vascular surgery if they were ineffective. A June 2018 treatment record also indicates that the Veteran’s varicose veins increased in severity. The Veteran has not been afforded a VA examination in connection with his claim for service connection for varicose veins. However, he is competent to report that his varicose veins began in service and have continued since that time, and there is no reason to doubt the credibility of his statements. Indeed, the available contemporaneous records corroborate his assertions. Accordingly, resolving any reasonable doubt in favor of the Veteran, the Board finds that his varicose veins manifested in service, and service connection is warranted. REASONS FOR REMAND The Veteran has claimed that he has a right index finger disorder that is related to his military service. Post-service treatment records show that he has been seen for a throbbing finger, that he has chronic finger pain that shoots to the wrist, and that his pain may be related to carpel tunnel syndrome. He has not been afforded a VA examination in connection with the claim. The Veteran’s service treatment records are unavailable. In cases such as this one, where some of the claimant's service records may be unavailable through no fault of the claimant, there is a heightened obligation to assist the claimant in the development of his case. O'Hare v. Lewinski, 1 Vet. App. 365 (1991). Therefore, the Board finds that the Veteran should be afforded a VA examination and medical opinion to determine the nature and etiology of any current right index finger disorder that may be present. The matter is REMANDED for the following action: 1. The agency of original jurisdiction (AOJ) should request that the appellant provide the names and addresses of any and all health care providers who had provided treatment for the Veteran for his right index finger. After acquiring this information and obtaining any necessary authorization, the AOJ should obtain and associate these records with the claims file. The AOJ should also secure any outstanding VA treatment records. 2. The AOJ should contact the National Personnel Records Center (NPRC), the Records Management Center (RMC), the Veteran’s unit, or any other appropriate location, to request the Veteran’s complete service treatment records. If any requested records are not available, or the search for any such records otherwise yields negative results, that fact must clearly be documented in the claims file. Efforts to obtain these records must continue until it is determined that they do not exist or that further attempts to obtain them would be futile. The non-existence or unavailability of such records must be verified and this should be documented for the record. Required notice must be provided to the Veteran and his representative, to include notice of alternative sources of evidence that may substitute for any missing service treatment records. 3. After completing the preceding development, the Veteran should be afforded a VA examination to determine the nature and etiology of any right index finger disorder that may be present. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file, including any available service treatment records, post-service medical records, and assertions. It should be noted that, at the time of this remand, the complete service treatment records are unavailable. It should also be noted that the Veteran is competent to attest to factual matters of which he has first-hand knowledge. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should state this with a fully reasoned explanation. The examiner should opine as to whether it is at least as likely as not that the Veteran has a right index finger disorder that manifested in service or is otherwise causally or etiologically related to his military service. (The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a certain conclusion is so evenly divided that it is as medically sound to find in favor of the conclusion as it is to find against it.) A clear rationale for all opinions must be provided and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 4. The AOJ should conduct any other development that may be indicated as a consequence of the actions taken in the preceding paragraphs. J.W. ZISSIMOS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. Kuczynski