Citation Nr: 20026257 Decision Date: 04/16/20 Archive Date: 04/16/20 DOCKET NO. 15-16 824 DATE: April 16, 2020 ORDER Entitlement to service connection for a foot condition manifested by foot pain and cramps is denied. Entitlement to service connection for carpal tunnel syndrome is denied. REMANDED Entitlement to service connection for headaches, to include as due to the Veteran's service-connected back disorder or posttraumatic stress disorder is remanded. FINDINGS OF FACT 1. The preponderance of the evidence of record is against a finding that the Veteran's foot condition, manifested by foot pain and cramps, is causally related to his military service. 2. The preponderance of the evidence of record is against a finding that the Veteran's carpal tunnel syndrome is causally related to his military service. CONCLUSIONS OF LAW 1. The criteria for service connection for a foot condition, manifested by foot pain and cramps, have not been met. 38 U.S.C. § 1101, 1110, 1131, 1154; 38 C.F.R. § 3.303, 3.304. 2. The criteria for service connection for carpal tunnel syndrome have not been met. 38 U.S.C. § 1101, 1110, 1131, 1154; 38 C.F.R. § 3.303, 3.304 REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1979 to August 1982, from June 1983 to October 1983, and from February 1984 to November 1984. The issues were remanded by the Board in December 2015 in order to afford the Veteran a videoconference hearing. The Veteran testified before the undersigned at an April 2018 videoconference hearing. A transcript of that hearing is of record. The claims were again remanded in August 2018 for further development. With respect to the Veteran's claims decided herein, VA has met all statutory and regulatory notice and duty to assist provisions. See 38 U.S.C. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126; 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326; see also Scott v. McDonald, 789 F.3d 1375 (Fed. Cir. 2015). Service Connection Entitlement to service connection for a foot condition manifested by foot pain and cramps The Veteran contends that he has a foot condition related to his military service. To prevail on a direct service connection claim, there must be competent evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). The question for the Board is whether the Veteran has a foot condition that is etiologically related to an in-service disease or injury. The Board finds that competent, credible, and probative evidence is against a finding that the Veteran has a foot condition related to his military service. The Veteran's service treatment records (STRs) do not reflect complaints of, or treatment for, a foot condition. The Veteran was afforded a VA medical examination in August 2012. The VA examiner concluded that the Veteran did not have a foot condition. The Veteran was provided another examination in October 2019. The examiner concluded that the Veteran’s claimed condition is less likely than not incurred in or caused by his military service. The examiner noted the Veteran with bilateral foot pain, status post right toe amputation, and a history of diabetic peripheral neuropathy. The examiner noted the Veteran’s non-service-connected diabetes as having been uncontrolled since 2005. In a February 2020 VA medical examination report, the examiner noted that the Veteran does not have a foot disability related to his military service. The examiner noted the Veteran with no complaints or treatment for a foot condition in service. While noting the Veteran with a diagnosis of amputation of the right great toe; the examiner concluded it is unrelated to the specific claim of disability manifested by foot pain and cramps. The examination further noted the Veterans symptoms of burning and tingling sensation in the clinical setting of longstanding diabetes with suboptimal control is consistent with a diagnosis of diabetic neuropathy involving both feet. Based on the above, the Board finds service connection for a foot condition is not warranted. Entitlement to service connection for carpal tunnel syndrome The Veteran contends that he has a carpal tunnel syndrome related to his military service. To prevail on a direct service connection claim, there must be competent evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). The question for the Board is whether the Veteran has carpal tunnel syndrome that is etiologically related to an in-service disease or injury. The Board finds that competent, credible, and probative evidence is against a finding that the Veteran has carpal tunnel syndrome related to his military service. The Veteran's service treatment records (STRs) do not reflect complaints of, or treatment for, carpal tunnel syndrome. The Veteran was provided another examination in October 2019. The examiner concluded that the Veteran’s claimed carpal tunnel syndrome is less likely than not incurred in or caused by his military service. The examiner noted the Veteran with no in-service complaints or treatment for carpal tunnel syndrome. Additionally, the examiner noted the Veteran with bilateral carpal tunnel syndrome diagnosed in 2005 that is not relieved with injections. The examiner explained that medical literature states patients with carpal tunnel syndrome as well as peripheral neuropathy for diabetic patients’ symptoms would not be expected to be totally relieved by carpal tunnel release since some of their symptoms reflect non-entrapment mechanism. In a February 2020 VA medical opinion, the examiner concluded that the Veteran’s claimed carpal tunnel syndrome is less likely than not related to his military service. The examiner explained there was not treatment or complaints of a wrist or hand condition. The examiner further noted that an October 1984 in-service examination which reflects a negative answer regarding neuritis or a hand and wrist condition. Based on the above, the Board finds service connection for carpal tunnel syndrome is not warranted. REASONS FOR REMAND Entitlement to service connection for headaches, to include as due to the Veteran's service-connected back disorder or posttraumatic stress disorder is remanded. As mentioned above, the claim was remanded by the Board in August 2018 for further development. A VA medical examination and opinion was obtained December 2019. The December 2019 examination report noted the Veteran with a diagnosis of headaches with acute intermittent tension. However, in the accompanying December 2019 medical opinion, the examiner concluded that the Veteran did not have a chronic headache condition despite the diagnosis and subjective complaints of such. As the December 2019 VA examination is inconsistent in regard to the Veteran's claimed headache condition, the Board finds that a supplemental opinion on the issue is necessary prior to adjudicating the claim. As such, an opinion resolving the inconsistent findings and diagnoses is appropriate here. The matters are REMANDED for the following action: 1. Obtain a supplemental opinion in regard to the claim for service connection for headaches. If an opinion cannot be provided without an examination, schedule the Veteran for such examination with an appropriate clinician. The examiner is requested to provide the following opinions: a.) Whether it is at least as likely as not (50 percent or greater) that the Veteran has a headache condition related to, or aggravated by, military service. b.) Whether it is at least as likely as not that the Veteran has a headache condition related to, or aggravated by, his service connected PTD; and c.) Whether it is at least as likely as not that the Veteran has a headache condition related to, or aggravated by, his service connected back disability. The examiner must review all medical evidence associated with the claims file. A complete rationale for any opinion expressed should be included in the examination report. M. H. HAWLEY Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Brandon A. Williams, 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.