Citation Nr: 20009352 Decision Date: 02/04/20 Archive Date: 02/04/20 DOCKET NO. 17-31 064 DATE: February 4, 2020 REMANDED Entitlement to service connection for a right big toe disorder is remanded. REASONS FOR REMAND The appellant served in the Oklahoma Army National Guard from March 1981 to August 1989, which included a period of active duty for training (ACDUTRA) from March 1982 to June 1982. He also served in the United States Army Reserve from September 1989 to March 1993. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2016 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The appellant testified at a hearing before the undersigned Veterans Law Judge in November 2019. A transcript of that hearing has been associated with the claims file. Upon review, the Board finds that additional development is needed prior to adjudication of the claim. As noted above, the appellant served in the Oklahoma Army National Guard, and a period of ACDUTRA was verified from March 1982 to June 1982. However, the appellant has reported that he also had a period of ACDUTRA in 1984, and the dates and type of service has not been verified. Therefore, the agency of original jurisdiction (AOJ) should attempt to verify such service. The appellant also testified that he received treatment for his big toe at Ernest Childers VA Clinic in Oklahoma in 1984 and again approximately one year prior to his 2019 hearing. As such, the AOJ should obtain any outstanding VA medical records. The Board also notes that the appellant has not been afforded a VA examination in connection with his claim. Although the medical evidence of record does not show a current diagnosis, the appellant testified at the November 2019 hearing that he is experiencing functional impairment, that he has been told that he has arthritis, and that x-rays revealed that he had broken his toe. The United States Court of Appeals (Court) has held that pain in the absence of a presently-diagnosed condition can cause functional impairment, which may qualify as a disability for VA purpose. See Saunders v. Wilkie, 886 F.3d 1356, 1368 (Fed. Cir. 2018). Therefore, the Board finds that a VA examination and medical opinion are needed to determine the nature and etiology of any right big toe disorder that may be present. Accordingly, the case 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 have provided treatment for his right big toe. After acquiring this information and obtaining any necessary authorization, the AOJ should obtain and associate these records with the claims file. Any outstanding VA medical records should also be obtained and associated with the claims file, to include any medical records and x-ray reports from the Ernest Childers Clinic, including, but not limited to, the years 1984, 2018, and 2019. 2. The AOJ should also request verification of the dates the appellant served in the Oklahoma Army National Guard, to include whether he served on active duty, ACDUTRA or inactive duty for training (INACDUTRA) in 1984. The AOJ should also determine whether he had any federalized service in 1984. The AOJ should also ensure that the appellant’s complete service treatment and personnel records have been obtained for his service in the Oklahoma Army National Guard from March 1981 to August 1989 and in the United States Army Reserve from September 1989 to March 1993. 3. After the above development has been completed, the appellant should be afforded a VA examination to determine the nature and etiology of any right big toe 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 the appellant’s service treatment records, post-service medical records, and assertions. The examiner should note that the appellant is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the appellant, the examiner should provide a fully reasoned explanation. The examiner should also note that, although a March 1981 medical history report indicates that the appellant had three stitches in his right toe prior to service, a right toe disorder was not noted upon his enlistment. The examiner should identify any current right big toe disorders. If the appellant does not have a current diagnosis associated with his reported symptoms, the examiner should provide an explanation. The examiner should also state whether there is any functional impairment caused by pain. Evidence of pain alone that causes functional impairment, even without a specific diagnosis or identifiable disease, may constitute a disability for VA purposes. For each diagnosis identified or any functional impairment resulting from pain, the examiner should provide an opinion as to whether it is at least as likely as not that the disorder manifested in or is otherwise causally or etiologically related to a period of qualifying active service, to include any injury or symptomatology therein. (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 conclusion is so evenly divided that it is as medically sound to find in favor of a certain conclusion as it is to find against it.) A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Because it is important “that each disability be viewed in relation to its history [,]” 38 C.F.R. § 4.1, copies of all pertinent records in the appellant’s claims file, or in the alternative, the claims file, must be made available to the examiner for review. 4. After completing these actions, the AOJ should conduct any other development as may be indicated. J.W. ZISSIMOS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Rideout-Davidson, 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.