Citation Nr: 18100740 Decision Date: 04/20/18 Archive Date: 04/20/18 DOCKET NO. 14-27 592 DATE: April 20, 2018 ISSUES DECIDED: 0 ISSUES REMANDED: 5 REMANDED ISSUES The issues of entitlement to service connection for bilateral pes planus, entitlement to service connection for a right knee disability, entitlement to service connection for a right shoulder disability, entitlement to service connection for a skin disorder, and entitlement to service connection for a respiratory disorder, to include as due to undiagnosed illness, are remanded for additional development. The Veteran served on active duty from January 1981 to January 1985 with the United States Marine Corps. From 1985 to 2012, he served with the United States Marine Corps Reserves with active duty periods from January 1993 to April 1993, from November 1994 to April 1995 (active duty for special work), from March 1999 to September 1999, from July 2000 to September 2000, from October 2001 to April 2002, from May 2002 to September 2002 and from January 2003 to January 2005. He had additional periods of active duty for training (ACDUTRA), some lasting 1 to 2 months, each year between 2005 and retirement in 2012. He was awarded a Bronze Star Medal and a Legion of Merit in recognition of his service. In November 2017, the Veteran testified at a video conference hearing before the undersigned Veterans Law Judge. A transcript of the proceeding is associated with the electronic claims file. Regarding his orthopedic disabilities, the Veteran contends that they had onset during service or were aggravated therein. He argues he was physically active every day for over 30 years in order to stay in shape and provide the best service possible to the Marine Corps when he was called to active duty. See December 2017 Correspondence. He also indicated that when he was not on active duty or training, he worked at a desk job, which was not physically demanding. See October 2012 Statement in Support of Claim. The first mention of pes planus appears in a March 1994 Report of Medical Examination on which it was noted the Veteran had pes planus that was mild and asymptomatic. The Veteran contends this was caused by years of training in combat boots and that he dealt with it himself by using insoles in his shoes. He argues that although he did not seek treatment during a period of active duty, he initially felt pain on account of that service and the condition worsened during his subsequent duty periods. The Veteran was not afforded a VA examination of his feet. Here, the Veteran has a current disability that he acquired after many years in the Marine Corps and Marine Corps Reserves training in combat boots. The Board finds that without an examination to determine whether the Veteran’s pes planus has been aggravated or is at least as likely as not related to his active duty service that there is insufficient evidence to decide the case. The Veteran testified at his November 2017 hearing before the Board of Veterans’ Appeals (Board) that he initially began experiencing knee pain when running in the 1990s and he took Ibuprofen or Advil and kept running. The pain continued to get worse until he sought treatment in 2000. He attributes the pain to wear and tear on account of military training. In February 2002, the Veteran sought treatment for bilateral knee pain, although no diagnosis was rendered. In October 2010, the Veteran received a diagnosis of patellofemoral syndrome. X-rays in January 2012 showed mild osteoarthritis. In a December 2017 correspondence, the Veteran indicated while on active duty he hiked anywhere from 10-50 miles in a given week and jumped out of moving and stationary vehicles and rotary and fixed wing aircraft. The August 2013 VA examination opinion does not take into account this lay testimony or that the Veteran has osteoarthritis in his knee, which is considered a chronic disability for VA purposes. The Board finds that the Veteran should be afforded another VA examination to determine whether it is at least as likely as not that the Veteran has a current right knee disability caused by wear and tear during many years of active duty periods. The Veteran believes his current right shoulder disability resulted from carrying a 23 lb machine gun and accompanying ammunition and corresponding back pack in combat and during training. See December 2017 Correspondence. At his hearing before the Board, he explained that he would use his right arm to swing his back pack around his back and now he did not have full range of motion in the shoulder any longer. A private treatment record dated in August 2011 indicated that the Veteran was currently a reservist on active duty and had a suspect rotator cuff/labral tear. It was recommended he follow up with a civilian provider for physical therapy and MRI of the right shoulder. Records dated in 2011 and 2012 indicate various diagnoses of impingement syndrome, mild degenerative joint disease and rotator cuff tendonitis in the right shoulder. The Veteran has not been afforded a VA examination in connection with his claim. On remand, an examination should be scheduled to clarify any diagnosed disability in the right shoulder, to include rotator cuff related pathology, and to obtain a medical opinion as to whether the current disability is related to the Veteran’s active duty service. The Veteran indicates he began having skin problems in the 1980s on his hands, feet and chest. At his hearing before the Board, he indicated that he was prescribed topical creams and that he continues to use the same topical creams to address conditions that affect his skin today, specifically eczema. Notably, a January 2004 service treatment record indicates the Veteran might have had eczema while on a period of active duty. Although the VA examination in August 2013 only revealed contact dermatitis, the Board finds that another VA examination is warranted based on the Veteran’s lay testimony that he continues to have skin problems and to use the same topical creams he was using while on active duty. At the examination, the VA examiner should specifically note whether the Veteran has a current diagnosis of eczema. Regarding, a respiratory condition, the Veteran has a diagnosis of asthma and continues to use an inhaler. The evidence suggests a childhood history of asthma that was dormant since he was 10 years of age and resurfaced around 2002. It was indicated the Veteran was prescribed Advair in March 2004 and now using his inhaler frequently prior to any physical activity. At his hearing before the Board, he argued that he was not using an inhaler and then all of a sudden started having to because he had less air volume than he was supposed to have. In an August 2011 treatment record, the Veteran indicated he had suffered from upper-respiratory problems annually since return from Iraq in 2005. The Board finds he should be afforded a VA examination to determine whether he has an upper-respiratory condition that was at least as likely as not caused by or aggravated by active duty service, to include service in Southwest Asia and to determine whether it is at least as likely as not that asthma was aggravated beyond its natural progression during active duty service. In addition, to ensure a complete record, updated VA and private treatment records should be obtained on remand. The matters are REMANDED for the following action: 1. Ask the Veteran to identify all outstanding treatment records relevant to his service connection claims. All identified VA records should be added to the claims file. All other properly identified records should be obtained if the necessary authorization to obtain the records is provided by the Veteran. If any records are not available, or the Veteran identifies sources of treatment but does not provide authorization to obtain records, appropriate action should be taken (see 38 C.F.R. § 3.159(c)-(e)), to include notifying the Veteran of the unavailability of the records. 2. Schedule the Veteran for a VA examination to obtain an opinion regarding the nature and etiology of his bilateral pes planus. The claims file must be made available to and by reviewed by the examiner. Following review of the claims file and physical examination of the Veteran, the examiner should respond to the following: a. Is it is at least as likely as not (50 percent probability or greater) that the Veteran’s pes planus had onset during or is otherwise related to any period of active duty service, to include periods of ACDUTRA in the Reserves? The examiner should note the Veteran’s arguments that he acquired pes planus on account of training over a period of years in combat boots and that he worked a desk job that was not physically demanding when not on active duty/ACDUTRA. b. If pes planus is found to pre-exist active duty service, was pes planus clearly and unmistakable not aggravated by service? That is, is it clear and unmistakable that any in-service increase in severity was as a result of the natural progression of the condition? The examiner is asked to provide a rationale for any opinions provided as the Board is precluded from making any medical findings. 3. Schedule the Veteran for a VA examination to address the nature and etiology of any right knee disability, to include osteoarthritis. The claims file must be provided to the examiner for review. Following a review of the record, and physical examination of the Veteran, the examiner is requested to address the following: a. Provide a current diagnosis for any right knee disabilities present. b. Is it is at least as likely as not (50 percent probability or greater) that any right knee disability had onset in or is otherwise related to the Veteran’s periods of active duty, to include periods of ACDUTRA in the Reserves? The examiner should note the Veteran’s arguments that he hiked 10-50 miles per week when on active duty and that his knee pain started as a result of physical training and he took over-the-counter medications prior to initially seeking treatment. The examiner is asked to provide a rationale for any opinions provided as the Board is precluded from making any medical findings. 4. Schedule the Veteran for a VA examination to address the nature and etiology of any right shoulder disability, to include rotator cuff tear or pathology, degenerative joint disease and/or impingement syndrome. The claims file must be provided to the examiner for review. Following a review of the record, and physical examination of the Veteran, the examiner is requested to address the following: a. Provide a current diagnosis for any right shoulder disabilities present. b. Is it is at least as likely as not (50 percent probability or greater) that any right shoulder disability had onset in or is otherwise related to the Veteran’s periods of active duty, to include periods of ACDUTRA in the Reserves? The examiner should note that it appears a suspected rotator cuff tear was noted during a period of ACDUTRA in August 2011 and that the Veteran argues his current condition was caused by using the right arm to throw his back pack across his back over the course of many years of service. The examiner is asked to provide a rationale for any opinions provided as the Board is precluded from making any medical findings. 5. Schedule the Veteran for a VA skin examination. The claims file must be reviewed by the examiner in conjunction with the examination. All indicated tests and studies should be performed. The examiner should note notations of skin abnormalities in the 1980s and a diagnosis of eczema in January 2004, during a period of active duty, along with the Veteran’s contention that he still uses the same topical creams to treat his skin conditions today as he did during service. Following a review of the claims file and examination of the Veteran, the examiner should provide an opinion as to whether any diagnosed skin condition, to include, eczema, if present, is at least as likely as not (50 percent probably or greater) causally or etiologically related to active duty service/periods of ACDUTRA or that any skin condition currently present had initial manifestation in service. The examiner is asked to provide a rationale for any opinions provided as the Board is precluded from making any medical findings. 6. Schedule the Veteran for a VA respiratory examination. The claims file must be reviewed by the examiner in conjunction with the examination. All indicated tests and studies should be performed. The examiner should note that the Veteran’s indication that his asthma symptoms appeared to resurface in 2002 and that he has suffered annually from upper-respiratory concerns since return from Iraq in 2005. Following review of the claims file and physical examination of the Veteran, the examiner should respond to the following: a. Provide a diagnosis of any respiratory conditions present. b. Is it is at least as likely as not (50 percent probability or greater) that any current respiratory condition had onset in or is otherwise related to a period of active duty service, to include periods of ACDUTRA in the Reserves? The examiner should note the Veteran’s arguments that asthma was dormant for many years prior to resurfacing in 2002. c. If a respiratory condition is found to pre-exist active duty service, was that condition clearly and unmistakable not aggravated by service? That is, is it clear and unmistakable that any in-service increase in severity was as a result of the natural progression of the condition? d. Finally, if any of the Veteran’s respiratory symptoms cannot be attributed to a known clinical diagnosis, is it at least as likely as not that the Veteran’s symptoms are the result of an undiagnosed illness or medically explained chronic multisymptom illness etiologically related to service in Southwest Asia? The examiner is asked to provide a rationale for any opinions provided as the Board is precluded from making any medical findings. 7. After undertaking the development above, the claim should be readjudicated. If the benefits sought are not granted, the Veteran and his representative should be furnished a supplemental statement of the case and be given an appropriate period to respond thereto before the case is returned to the Board, if in order. Nathan Kroes Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Boyd Iwanowski, Counsel