Citation Nr: 19191981 Decision Date: 12/06/19 Archive Date: 12/06/19 DOCKET NO. 14-33 212 DATE: December 6, 2019 ORDER Entitlement to a rating in excess of 10 percent for a right wrist strain status post fracture (right wrist condition) is denied. Entitlement to a rating in excess of 10 percent for left foot degenerative joint disease status post 5th metatarsal fracture with mild swelling and achilles heel spurring (left foot condition) is denied. New and material evidence not having been received, the issue of service connection for asthma is not reopened. New and material evidence not having been received, the issue of service connection for bilateral costochondritis is not reopened. New and material evidence having been received, the issue of service connection for a right foot condition is reopened. REMANDED Entitlement to service connection for a right foot condition is remanded. Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), claimed as due to exposure to Japanese encephalitis vaccine, and/or secondary to asthma, arthritis of multiple joints, bilateral carpal tunnel syndrome, bilateral costochondritis, or sinus infections, is remanded. FINDINGS OF FACT 1. The Veteran is receiving the maximum evaluation for his right wrist condition, as ankylosis of the right wrist is not shown. 2. The Veteran’s left foot condition is reasonably shown to have been manifested by pain throughout; it is not shown to have been manifested by symptoms or impairment more than moderate (i.e., moderately severe or severe). 3. The claim for service connection for asthma was previously denied in an August 2003 rating decision. The Veteran did not timely appeal that decision and it is therefore final. 4. Evidence added to the record since the August 2003 rating decision is cumulative and redundant of the evidence of record at the time of such decision and does not raise a reasonable possibility of substantiating the Veteran’s claim for service connection for asthma. 5. The claim for service connection for bilateral costochondritis was previously denied in a May 2008 rating decision. The Veteran did not timely appeal that decision and it is therefore final. 6. Evidence added to the record since the May 2008 rating decision is cumulative and redundant of the evidence of record at the time of such decision and does not raise a reasonable possibility of substantiating the Veteran’s claim for service connection for bilateral costochondritis. 7. The claim for service connection for a right foot condition was previously denied in a May 2008 rating decision. The Veteran did not timely appeal that decision and it is therefore final. 8. Evidence added to the record since the May 2008 rating decision is not cumulative or redundant of the evidence of record at the time of such decision and raises a reasonable possibility of substantiating the Veteran’s claim for service connection for a right foot condition. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 10 percent for a right wrist condition have not been met. 38 U.S.C. § 1155, 5107 (b) (2012); 38 C.F.R. § 4.71a, Diagnostic Code 5215 (2017). 2. The criteria for a rating in excess of 10 percent for a left foot condition have not been met. 38 U.S.C. §§ 1155, 5107 (b) (2012); 38 C.F.R. § 4.71a, Diagnostic Code 5283-5279 (2017). 3. The August 2003 rating decision that denied service connection for asthma is final. 38 U.S.C. § 7104 (b) (2012); 38 C.F.R. § 20.1103 (2017). 4. New and material evidence has not been received to reopen the claim of entitlement to service connection for asthma. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156 (a) (2017). 5. The May 2008 rating decision that denied service connection for bilateral costochondritis is final. 38 U.S.C. § 7104 (b); 38 C.F.R. § 20.1103. 6. New and material evidence has not been received to reopen the claim of entitlement to service connection for bilateral costochondritis. 38 U.S.C. § 5108; 38 C.F.R. § 3.156 (a). 7. The May 2008 rating decision that denied service connection for a right foot condition is final. 38 U.S.C. § 7104 (b); 38 C.F.R. § 20.1103. 8. New and material evidence has been received to reopen the claim of entitlement to service connection for a right foot condition. 38 U.S.C. § 5108; 38 C.F.R. § 3.156 (a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the Army National Guard from March 1984 to May 1984, and on active duty from February 1985 to June 1992. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Denver, Colorado. The Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge in September 2019. A transcript of the hearing is of record. Increased Rating 1. Entitlement to a rating in excess of 10 percent for a right wrist strain status post fracture (right wrist condition) The Veteran’s right wrist condition is currently rated under 38 C.F.R. § 4.71a, Diagnostic Code 5215. Diagnostic Code 5215 provides for the assignment of a 10 percent disability rating with dorsiflexion less than 15 degrees or palmar flexion limited in line with forearm. The Board observes that the 10 percent rating is the maximum rating provided under Diagnostic Code 5215. Diagnostic Code 5214 (wrist, ankylosis of), which is the only other diagnostic code which specifically references the wrist, is not appropriate for application in this case because there is no evidence of ankylosis in the record. In a June 2011 VA treatment record, it was noted that the Veteran’s wrists had full range of motion with no swelling. In a September 2012 VA treatment record, the Veteran noticed that over the last month or two, he had increase morning stiffness and pan with motion in his wrists bilaterally. Upon examination, there was pain with passive forced flexion of the wrists bilaterally and no swelling at the wrists. The VA physician noted a diagnosis of psoriatic arthritis with returning symptoms and disease activity after long hiatus from DMARD therapy. In a November 2012 VA treatment record, the Veteran said that his wrists were hurting him more on the right more than the left. He said he did not have any side effects from the medication, but felt it was not working. He said that his wrists hurt him most in the morning and then during certain activities. It was noted that the Veteran was very stoic and was unwilling to admit much pain. In an August 2013 VA treatment record, it was noted that bilateral wrist films were without significant arthropathy. In an October 2013 VA examination, the Veteran said that since his last examination in 2008, his right wrist pain had progressed. He said that he had more right wrist pain in the winter. The Veteran reported constant pain and said that he dropped things 2 to 3 times per week. The Veteran said that he felt like he was holding it, but then would lose his grip. He said that if he lifted more than 10 pounds he had increased pain in his wrist. He also said that if he made a weird movement while sleeping he would wake up 2 to 3 times per week. He stated that he used a hand brace, but stopped using it about 3 years ago. He said that after 10 minutes of typing or handwriting he would experience an increase in wrist pain. The Veteran said that starting about 3 months ago, he started receiving injections every 2 weeks for the pain; he said this had not helped much. The Veteran reported flare-ups once per month exhibited by pain that would last a week. Upon examination, range of motion was palmar flexion 80 degrees or greater with objective evidence of painful motion at 70 degrees or greater, and dorsiflexion at 65 degrees with objective evidence of painful motion at 60 degrees. The Veteran was able to perform repetitive-use testing with 3 repetitions with no additional limitation in range of motion. The Veteran reported functional loss as pain on movement. There was localized tenderness or pain on palpation of the joints/soft tissue. There was no ankylosis or any joint replacement and/or surgical procedures. In a March 2014 VA treatment record, the Veteran reported that he continued to have right wrist pain characterized as a constant ache. Upon examination, there was no synovitis and the Veteran had full range of motion. It was noted that the Veteran had stable right wrist arthralgia. In a May 2014 VA treatment record, the Veteran was noted to be receiving treatment for his arthritis. The Veteran reported improvement in psoriasis with multiple plaques resolving and improved wrist/hand arthritis. Upon examination, the Veteran did not have any synovitis and he had full range of motion. In a July 2014 VA treatment record, it was noted that the Veteran’s wrists had full range of motion. In an April 2017 VA treatment record, it was noted that the Veteran’s right wrist swelled every now and then. In an August 2017 VA treatment record, it was noted that the “last time” the right wrist was swelling every other month but since the last visit there were no issues. In the August 2018 VA examination, the Veteran stated that his wrist pain was intermittent and felt like a “pulling tendon.” It occurred about every 2 weeks and typically lasted for about 3 days. These episodes appeared to occur randomly and the Veteran did not associate them with any particular activity. The Veteran said that when present, there was also diffuse swelling about the wrist and it was painful to flex the fingers. He said that a wrist orthosis was helpful but that he did not currently have one. Cortisone injections were helpful for a few months but it was unclear exactly what was injected. The Veteran did not appreciate any benefit from therapy and denied any surgery. The Veteran did not report any flare-ups. The Veteran described functional loss as finger flexion was difficult during painful episodes that occurred for about 3 days every 2 weeks. Upon examination, range of motion was normal; however, pain was noted on palmar flexion and dorsiflexion. There was no evidence of pain with weight-bearing. There was objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue described as Eichoff is positive. There was no evidence of crepitus. The Veteran was able to perform repetitive use testing with at least 3 repetitions without additional loss of function or range of motion after 3 repetitions. The Veteran was not examined immediately after repetitive use over time; however, the examiner stated that that the examination was neither medically consistent or inconsistent with the Veteran’s statements describing functional loss with repetitive use over time. The examiner was unable to say without mere speculation whether pain, weakness, fatigability or incoordination significantly limited functional ability with repeated use over a period of time because the Veteran was not examined after repeated use over time. The examiner stated that neither the remote nor current imaging supported a diagnosis of remote wrist fracture and that portion of the diagnosis was not continued. The examiner said that the Veteran was diagnosed with psoriatic arthropathy in 2008, and this was more likely than not the cause of the intermittent episodes of swelling and difficulty with finger flexion. Trauma did not cause psoriatic arthritis, so these symptoms were completely unrelated to the service-connected condition. The pain and examination findings present today were all attributable to the service-connected condition. The examiner noted that there was pain when the joint was used in non-weight-bearing, and the opposing joint was not undamaged. In a January 2019 VA treatment record, it was noted that the Veteran’s wrists showed no synovitis, had full range of motion, and no tenderness. At the September 2019 Board hearing, the Veteran stated to look at his grip strength and numbness. Overall, the Board finds that as stated above, with respect to the applicable rating criteria, the Veteran is currently assigned a 10 percent disability rating under Diagnostic Code 5215. A 10 percent disability rating is the highest schedular rating available. As such, the Board is unable to grant a higher schedular rating under these criteria. While higher disabilities ratings are contemplated for ankylosis of the wrist under Diagnostic Code 5214, the evidence does not show that the Veteran’s right wrist has been manifested by symptoms consistent with ankylosis at any time during the course of the appeal, even upon consideration of the actual degree of functional impairment due to factors such as pain, weakness, fatigability, incoordination, and lack of endurance. 38 C.F.R. § 4.45; DeLuca v. Brown, 8 Vet. App. 202 (1995). The Board has considered whether this claim warrants referral for consideration of an extraschedular rating. Referral to the Director of the Compensation and Pension Service for consideration of a potential extraschedular rating is warranted in exceptional cases where a case presents “such an exceptional or unusual disability picture with such related factors as marked interference with employability or frequent periods of hospitalization such as to render impractical the application of the regular schedular standards.” 38 C.F.R. § 3.321 (b). In Thun v. Peake, 22 Vet. App. 111 (2008), the Court articulated a three-step inquiry for determining whether referral for extraschedular consideration is warranted. If the RO or Board determines that (1) the schedular evaluation does not contemplate the claimant’s level of disability and symptomatology, and (2) the disability picture exhibits other related factors such as marked interference with employment or frequent periods of hospitalization, then (3) the case must be referred to an authorized official to determine whether, to accord justice, an extraschedular rating is warranted. The Board finds that here the first Thun element (of those listed above) is not satisfied. The Veteran has reported his service-connected right wrist condition is manifested by signs and symptoms such as pain, and a reduced range of motion, which impair his ability to hold things, all of which (with related functional impairment) are contemplated by the regular schedular criteria. Therefore, the scheduler criteria are not inadequate, and referral for extraschedular consideration is not indicated. Notably, there is no indication that the Veteran was not able to maintain employment due to his right wrist condition, and there are no records of hospitalization for his condition. In fact, the August 2018 VA examination showed improved right wrist functioning, exhibited by normal range of motion. In summary, the Board concludes that a rating greater than 10 percent for the right wrist condition is not warranted. 2. Entitlement to a rating in excess of 10 percent for left foot degenerative joint disease status post 5th metatarsal fracture with mild swelling and achilles heel spurring (left foot condition) The Veteran’s left foot condition has been assigned a 10 percent rating under Diagnostic Codes 5283-5279. Diagnostic Code 5283 relates to malunion or nonunion of the tarsal or metatarsal bones, and Diagnostic Code 5279 relates to metatarsalgia. Under Diagnostic Code 5279, a 10 percent rating is assigned for metatarsalgia, unilateral or bilateral. 38 C.F.R. § 4.71a. The Board notes that this is the only and highest schedular rating under this Diagnostic Code. Under Diagnostic Code 5283, a 10 percent rating is assigned for manifestations of malunion or nonunion of the tarsal or metatarsal bones that are moderate; a 20 percent rating is assigned for moderately severe; and a 30 percent rating is assigned for severe. A Note to Code 5283 provides that a 40 percent rating will be assigned where there is an actual loss of use of the foot. 38 C.F.R. § 4.71a. Under Diagnostic Code 5284, a 10 percent rating is assigned for other foot injury that is moderate; a 20 percent rating for moderately severe; and a 30 percent rating for severe. A Note to Code 5284 provides for a 40 percent rating where there is an actual loss of use of the foot. 38 C.F.R. § 4.71a. In an October 2013 VA examination, the examiner noted diagnoses of metatarsalgia and mild degenerative joint disease of the left foot status post metatarsal fracture with mild swelling and Achilles heel spurring. The Veteran said that since his last examination in 2007, his left foot pain had increased and stayed mildly swollen. He said that he was seen in podiatry last month and they changed the foot brace. He said he used a Gel Cast to sleep at night. The Veteran reported constant left foot pain and said that if he walked more than 2 blocks he would get a black and blue discoloration in the left foot. He said this occurred about 1 to 2 times per month, which resolved in a week. The Veteran said he received injections every 2 weeks for the pain, but this had not helped much. The Veteran could stand for 45 minutes and would then get increased left foot pain, and said that sitting helped. He could walk 2 blocks and then would get swelling and increased pain. He could not run due to the pain. He could climb 2 flights of stairs but had increased pain in his left foot and could lift up to 10 pounds but would get increased pain. There were no incapacitating episodes of doctor prescribed bedrest. Upon examination, there was no Morton’s neuroma. There was metatarsalgia on the left foot. There were no hammer toes, hallux valgus, hallux rigidus, pes cavus, malunion or nonunion of tarsal or metatarsal bones, or any other foot injuries. There was no evidence of bilateral weak foot. The examiner noted that there was no decrease in range of motion anticipated with flares of left foot pain or after repetitive motion. The Veteran used a brace constantly. In a February 2014 VA treatment record, the Veteran reported increased pain in his left ankle and foot over the past year. The Veteran said the gauntlet ankle brace provided some stability, but did not alleviate his pain. The Veteran could not ambulate more than 1/2 a block before his pain was 8 out of 10. The Veteran said that he wore a soft ankle brace at night because if he rolled on his ankle it was painful. He denied wearing any inserts or orthotics, and said that the pain radiated up the front and sides of his legs. He said that he did not like to be dependent on pain medication. In an April 2014 VA treatment record, the Veteran reported pain in the bottom of his left foot after walking for more than 10 minutes in his loafers. He denied trying any shoe inserts. It was determined that his left foot pain had improved. In an August 2018 VA examination, the examiner noted diagnoses of metatarsalgia and left foot pain status post 5th metatarsal fracture. The Veteran described his left foot pain as intermittent and like a “pulling tendon.” The Veteran said that this could be provoked by standing for longer than 20 minutes or walking further than 1 mile. He said the pain was relieved by rest and non-weightbearing. The Veteran said he appreciated the benefit from an ankle support orthosis, but that it had already worn out. The Veteran denied any inserts but the examiner noted that a recent podiatry note indicated that Powerstep inserts greatly helped. The Veteran said that physical therapy made the pain worse. The Veteran did not report any flare-ups. The Veteran reported functional loss as being unable to stand in place for longer than 20 minutes or walk further than 1 mile without pain. Upon examination, the Veteran had pain on use of the left foot, which was accentuated on use. There was also pain on manipulation of the left foot, which was accentuated on manipulation. There was no indication on swelling on use or characteristic callouses. It was noted that the Veteran used orthotics. There was no extreme tenderness of plantar surfaces on one or both feet and the Veteran did not have decreased longitudinal arch height of one or both feet on weight-bearing. There was no objective evidence of marked deformity of one or both feet or marked pronation of one or both feet. The weight-bearing line did not fall over or medial to the great toe and there was no lower extremity deformity other than pes planus, causing alteration of the weight-bearing line. There was no inward bowing of the Achilles tendon of one or both feet or marked inward displacement and severe spasm of the Achilles tendon on manipulation of one or both feet. The examiner noted that the Veteran had metatarsalgia on the left side. The examiner also noted there was pain on physical exam with functional loss noted as lack of endurance. There was pain, weakness, fatigability, or incoordination that significantly limited functional ability during flare-ups or when the foot was used repeatedly over a period of time described as being unable to stand in place for longer than 20 minutes or walk further than 1 mile without left foot pain. There was no functional loss during flare-ups or when the foot was used repeatedly over a period of time. The examiner concluded that there was no evidence on current imaging of degenerative joint disease in the left foot; therefore, the prior diagnosis was changed to left foot pain status post 5th metatarsal fracture. In a February 2019 VA treatment record, the Veteran reported persistent medial heel pain to the left foot despite trying self massage, stretching daily, and icing daily. The Veteran said he felt mild relief with topical gel and a brace. The Veteran also reported left “sub 5th met” head pain presenting recently, described as achy and dull. At the September 2019 Board hearing, the Veteran testified that he received injections for pain in his left foot and physical therapy. Overall, the Board finds that a rating in excess of 10 percent for the left foot condition is not warranted. The record shows that the left foot condition was manifested by metatarsalgia (but not by moderately severe or severe foot injury) throughout. The 2013 and 2018 VA examiners found that the Veteran experienced pain. Further, the Veteran reported that he received injections and physical therapy for pain. However, there is no indication that the Veteran’s left foot condition is more than moderate in severity. In fact, the August 2018 VA examiner re-characterized the Veteran’s diagnosis finding that the Veteran did not suffer from degenerative joint disease, suggesting an improvement in the Veteran’s condition. The Board has considered whether an additional (or higher) rating is warranted under other potentially applicable codes. However, Diagnostic Code 5276 is not applicable as there is no evidence of flat foot. In addition, only a left foot condition is service-connected. Therefore, Diagnostic Code 5277 for bilateral weak foot is not applicable. As neither pes cavus nor hallux valgus have been diagnosed, Diagnostic Codes 5278, 5280, and 5281, do not apply. Regarding Codes 5283 and 5284, the Veteran’s symptoms or impairment related solely to his service-connected left foot condition are not shown to be moderately severe or severe, so as to warrant a higher rating. The Veteran regularly reported left foot pain, but though the October 2013 and August 2018 examiners noted regular foot pain that could increase in intensity with walking or standing and contribute to functional loss, but did not describe the symptoms as moderately severe or severe. In sum, the Board finds the left foot condition presented throughout is mainly one of pain, which is adequately contemplated by a 10 percent rating. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Yancy v. McDonald, 27 Vet. App. 484, 495 (2016); Doucette v. Shulkin, 38 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Service Connection 3. New and material evidence not having been received, the issue of service connection for asthma is not reopened The Veteran seeks to reopen his claim for service connection for asthma. The Board must consider the question of whether new and material evidence has been received because it goes to the Board’s jurisdiction to reach the underlying claim and adjudicate the claim de novo. Barnett v. Brown, 83 F.3d 1380 (Fed. Cir. 1996). If the Board finds that no such evidence has been offered, that is where the analysis must end, and what the RO may have determined is irrelevant. Id. The claim for entitlement to service connection for asthma may be reopened if new and material evidence is submitted. Manio v. Derwinski, 1 Vet. App. 140 (1991). New 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 last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156 (a) (2017). In determining whether evidence is new and material, the credibility of the new evidence is presumed. Justus v. Principi, 3 Vet. App. 510 (1992). The RO denied the claim in August 2003, based on the finding that the medical evidence of record failed to show that the Veteran had been clinically diagnosed with asthma. Also, service medical records did not indicate a diagnosis of asthma. Finally, there were no chronic residuals of vaccination. Following the Veteran’s application to reopen the claim, VA treatment records, military personnel records, VA Memorandums, VA examinations, lay statements, and a September 2019 Board hearing, were obtained. However, the Board finds that although this additional evidence is new, in that it was not previously considered, the Board further finds that it is not material to the Veteran’s claim because it does not address a missing factor in service connection. Specifically, the evidence continues to show that the Veteran does not have a diagnosed asthma condition. Thus, for these reasons, the claim for service connection for asthma is not reopened. 4. New and material evidence not having been received, the issue of service connection for bilateral costochondritis is not reopened The Veteran seeks to reopen his claim for service connection for bilateral costochondritis. The Board must consider the question of whether new and material evidence has been received because it goes to the Board’s jurisdiction to reach the underlying claim and adjudicate the claim de novo. Barnett, 83 F.3d 1380. If the Board finds that no such evidence has been offered, that is where the analysis must end, and what the RO may have determined is irrelevant. Id. The claim for entitlement to service connection for bilateral costochondritis may be reopened if new and material evidence is submitted. Manio, 1 Vet. App. 140. New 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 last prior final denial of the claim sought to be reopened, and 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, 3 Vet. App. 510. The RO denied the claim in May 2008, based on the finding that service treatment records were negative for diagnosis or treatment for bilateral costochondritis and post-service treatment records did not show that the Veteran’s costochondritis had its onset in service or was caused by service. Following the Veteran’s application to reopen the claim, VA treatment records, military personnel records, VA Memorandums, VA examinations, lay statements, and a September 2019 Board hearing, were obtained. However, the Board finds that although this additional evidence is new, in that it was not previously considered, the Board further finds that it is not material to the Veteran’s claim because it does not address a missing factor in service connection. Specifically, the evidence does not show that any bilateral costochondritis is related to service. Thus, for these reasons, the claim for service connection for bilateral costochondritis is not reopened. 5. New and material evidence having been received, the issue of service connection for a right foot condition is reopened The Veteran seeks to reopen his claim for service connection for a right foot condition. The Board must consider the question of whether new and material evidence has been received because it goes to the Board’s jurisdiction to reach the underlying claim and adjudicate the claim de novo. Barnett, 83 F.3d 1380. If the Board finds that no such evidence has been offered, that is where the analysis must end, and what the RO may have determined is irrelevant. Id. The claim for entitlement to service connection for a right foot condition may be reopened if new and material evidence is submitted. Manio, 1 Vet. App. 140. New 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 last prior final denial of the claim sought to be reopened, and 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, 3 Vet. App. 510. The RO denied the claim in May 2008, based on the finding that service treatment records were negative for diagnosis or treatment for a right foot condition. Additionally, there was no evidence that the Veteran’s right foot condition was incurred in or caused by service, or that the Veteran’s arthritis developed to a compensable (10 percent) degree within 1 year following separation from service. Following the Veteran’s application to reopen the claim, VA treatment records, military personnel records, VA Memorandums, VA examinations, lay statements, and a September 2019 Board hearing, were obtained. Specifically, at the September 2019 Board hearing, the Veteran testified that his military occupational specialty (MOS) as airborne and air serviceman included duties in service that caused repeated traumas to his right foot. The Veteran stated that due to his jump status, he incurred injuries in service. The Veteran said that there was active discouragement to report injuries. The Board finds that this additional evidence is new, in that it was not previously considered, and the Board further finds that it is material to the Veteran’s claim because it addresses a missing factor in service connection. Specifically, the Veteran asserts that his duties in service caused trauma to his right foot, suggesting a possible theory of service connection. Thus, for these reasons, the claim for service connection for a right foot condition is reopened. REASONS FOR REMAND 1. Entitlement to service connection for a right foot condition is remanded. In a claim to reopen, the duty to assist by arranging for a VA examination or obtaining a medical opinion does not attach until the previously denied claim is reopened. 38 C.F.R. § 3.159 (c)(4)(iii). In light of the foregoing reopening of the claim for service connection for a right foot condition, the Board finds that this duty to provide an examination must now be considered. Therefore, the claim must be remanded for a new opinion or VA examination, if needed, addressing whether the Veteran’s right foot condition is related to service. 2. Entitlement to service connection for posttraumatic stress disorder (PTSD), to include as due to exposure to Japanese encephalitis vaccine, and/or secondary to asthma, arthritis of multiple joints, bilateral carpal tunnel syndrome, bilateral costochondritis, or sinus infections, is remanded. In a November 2012 statement, the Veteran asserted that his PTSD was due to being a participant in a trial of Japanese enchepalitis vaccine, asthma, arthritis of multiple joints, bilateral carpal tunnel syndrome, bilateral costochondritis, and chronic sinus infections. The Board notes that the Veteran is service-connected for left foot degenerative joint disease status post 5th metatarsal fracture with mild swelling and achilles heel spurring. However, the Veteran has not been afforded a VA examination to determine whether his acquired psychiatric disorder is due to his service-connected left foot condition. Moreover, the issue of service connection for a right foot condition, claimed as arthritis, is currently being remanded, and therefore, the issue of service connection for PTSD is inextricably intertwined with this claim. Therefore, on remand, a new opinion or VA examination, if needed, addressing whether the Veteran’s an acquired psychiatric disorder is related to the Veteran’s service-connected left foot condition, should be obtained. Additionally, if it is determined that the Veteran’s right foot condition is related to service, then a new opinion or VA examination, if needed, addressing whether the Veteran’s PTSD is related to the Veteran’s right foot condition, should also be obtained. The matters are REMANDED for the following actions: 1. Obtain any outstanding VA or private treatment records. Request that the Veteran assist with locating these records, if possible. Associate these records with the claims file. 2. Then, obtain a VA opinion, or schedule a VA examination, if necessary, from an appropriate VA examiner to determine the etiology of the Veteran’s right foot condition. The claims file and a copy of this remand must be made available for review. Following a review of the pertinent evidence, the examiner must determine whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s right foot condition is related to service. A clear rationale must be provided for all opinions expressed. The examiner must consider the Veteran’s statements, specifically that his MOS in service caused trauma to his right foot as he was on jump status. If the examiner is unable to provide an opinion without resorting to mere speculation, then the examiner must state this and provide any information needed to make an opinion, if possible. 3. Also, obtain a VA opinion, or schedule a VA examination, if necessary, from an appropriate VA examiner to determine the etiology of the Veteran’s an acquired psychiatric disorder, claimed as PTSD. The claims file and a copy of this remand must be made available for review. Following a review of the pertinent evidence, the examiner must determine the following: (a) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s an acquired psychiatric disorder is caused or aggravated by the Veteran’s service-connected left foot condition. (b) If it is determined that the Veteran’s right foot condition is related to service, whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s acquired psychiatric disorder is caused or aggravated by the Veteran’s right foot condition A clear rationale must be provided for all opinions expressed. The examiner must consider the Veteran’s statements. If the examiner is unable to provide an opinion without resorting to mere speculation, then the examiner must state this and provide any information needed to make an opinion, if possible. 4. Thereafter, readjudicate the claim on appeal. If the benefit sought remains denied, issue the Veteran and his representative a supplemental statement of the case and provide a reasonable opportunity to respond before returning the matter to the Board for further appellate review. MICHAEL MARTIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Saudiee Brown, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.