Citation Nr: 21004915 Decision Date: 01/28/21 Archive Date: 01/28/21 DOCKET NO. 19-26 454 DATE: January 28, 2021 ORDER The claim of entitlement to service connection for mumps is dismissed. The claim of entitlement to service connection for chest pains is dismissed. The claim of entitlement to service connection for heart murmur is dismissed. The claim of entitlement to service connection for hypertension is dismissed. The claim of entitlement to service connection for residuals of prostate cancer is dismissed. The claim of entitlement to a finding of total disability based on individual unemployability (TDIU) is dismissed. Service connection for cervical spine disability is denied. Service connection for diabetes mellitus is denied. Service connection for residuals of gonorrhea is denied. Service connection for recurrent gastritis is granted. REMANDED Entitlement to service connection for left thumb disability is remanded. Entitlement to service connection for right foot disability, to include residuals of bunionectomy and residuals of cold injury, is remanded. Entitlement to service connection for acquired psychiatric disability, to include anxiety and depression, is remanded. Entitlement to service connection for disability manifested by chronic boils is remanded. FINDINGS OF FACT 1. In July 2019, prior to the promulgation of a decision in the appeal, the Board received notification from the Veteran that a withdrawal of the appeal for service connection for mumps, chest pains, heart murmur, hypertension, and residuals of prostate cancer; and for entitlement to TDIU benefits, is requested. 2. The Veteran’s cervical spine disability was not manifest during active service, and is not attributable to service. 3. The Veteran’s diabetes mellitus was not manifest on active duty service or within the first post-service year; is not otherwise shown to be related to service, to include exposure to herbicides. 4. Episodes of gonorrhea in active duty were acute and transitory, and the Veteran has not been diagnosed with residuals of gonorrhea. 5. Currently diagnosed gastritis had its onset in active duty service. CONCLUSIONS OF LAW 1. The criteria for withdrawal of the claims of entitlement to service connection for mumps, chest pains, heart murmur, hypertension, and residuals of prostate cancer; and for entitlement to TDIU benefits, by the Veteran have been met. 38 U.S.C. § 7105(b)(2), (d)(5); 38 C.F.R. § 20.205. 2. Cervical spine disability was not incurred in or aggravated by service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. Diabetes mellitus was not incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1112, 1113, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 4. Residuals of gonorrhea were not incurred in or aggravated by service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303. 5. The criteria for service connection of recurrent gastritis are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran was a member of the Army Reserve who had a period of initial active duty training from March 1957 to September 1957. He then served on active duty with the U.S. Army from October 1958 to November 1966. He timely appealed these matters from December 2015 and January 2018 rating decisions. In October 2020, the Veteran testified before the undersigned at a virtual hearing. During the hearing, the undersigned granted the Veteran’s request for a 60-day abeyance to submit additional evidence directly to the Board. In November 2020, the Veteran submitted additional evidence, which consisted of VA records and private treatment records. As the Veteran has submitted this evidence, no waiver of initial RO consideration is required. All available records identified by the Veteran as relating to each of his claims decided below have been obtained, to the extent possible. The record does not otherwise indicate any existing pertinent evidence that has not been obtained. Examination reports and opinions are thorough and adequate for the Board to render the following decisions in the Veteran’s appeal. 38 U.S.C. § 5103A(a)(2). Dismissal The Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105. An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 20.204. Withdrawal may be made by the Veteran or by his authorized representative. 38 C.F.R. § 20.204. In the present case, via July 2019 correspondence, the Veteran seeks to withdraw the appeal for service connection for mumps, chest pains, heart murmur, hypertension, and residuals of prostate cancer; and for entitlement to TDIU benefits. The Board finds the request to be fully informed. There remain no allegations of errors of fact or law for appellate consideration as to each of those issues. Accordingly, the Board does not have jurisdiction to review the appeal for service connection for mumps, chest pains, heart murmur, hypertension, and residuals of prostate cancer; and for entitlement to TDIU benefits. Those claims are dismissed. Service Connection Service connection will be granted if it is shown that the Veteran suffers from a disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty, during active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. In order to establish service connection on a direct basis, the record must contain competent evidence of: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Lay assertions may serve to support a claim for service connection by establishing the occurrence of observable events or the presence of disability or symptoms of disability that are subject to lay observation. 38 U.S.C. § 1153(a); 38 C.F.R. § 3.303(a); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); see also Buchanan v. Nicholson, 451 F. 3d 1331, 1336 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). Some chronic diseases, such as diabetes mellitus, may be presumed to have been incurred in service, if they become manifest to a degree of ten percent or more within the applicable presumptive period. 38 U.S.C. §§ 1101(3), 1112(a); 38 C.F.R. §§ 3.307(a), 3.309(a). For those listed chronic conditions, a showing of continuity of symptoms affords an alternative route to service connection. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F. 3d 1331 (Fed. Cir. 2013). The applicable presumptive period is one year from separation. Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. When service connection is established for a secondary condition, the secondary condition shall be considered a part of the original condition. 38 C.F.R. § 3.310(a). With specific regard to Army Reserve service, service connection may be granted for disability resulting from either disease or injury incurred in, or aggravated while performing, active duty training (ACDUTRA). With respect to inactive duty training during Army Reserve service, service connection may only be granted for injury so incurred or aggravated, or for an acute myocardial infarction, a cardiac arrest, or a cerebrovascular accident which occurred during such training. 38 U.S.C. §§ 101 (24), 106, 1110, 1131; 38 C.F.R. § 3.6. In this case, the Veteran was presumed sound at service entry. Clinical evaluation at entry in October 1958 was normal, and no disability was recorded. Nor is there medical evidence of any disability prior to active service, except for systolic murmur, which was noted at time of examination for Army Reserve enlistment in February 1957. The Board is within its province to make a determination as to whether the evidence supports a finding of service incurrence. See Barr v. Nicholson, 21 Vet. App. 303, 307 (2007). Cervical Spine Private records, dated in September 2015, reveal MRI scans of cervical spine with clear evidence of moderate bilateral foraminal narrowing at C6-C7, greater on left; and mild remote wedge compression deformity of C7 vertebral body. Chronic left cervical radiculopathy, which was moderate and stable, was noted in November 2015. The Veteran underwent C6-C7 anterior cervical discectomy and fusion in March 2016. His service treatment records do not reflect any findings or complaints of cervical spine disability, nor is there evidence of trauma or injury to the Veteran’s cervical spine. X-rays taken of cervical spine in October 1962 revealed no bone or joint abnormality. Clinical evaluation of the Veteran’s spine was normal at separation examination from active service in November 1966, and at enlistment examination for Army Reserve service in April 1980. The Veteran has not since reported in the context of his claim that he experienced any cervical spine disability in service. Here, the in-service element has not been met. In October 2020, the Veteran testified that he did not hurt his neck in service; and that a recent carotid artery blockage could happen to anyone. To date, the Veteran submitted no evidence or information linking active service to the currently diagnosed cervical spine disability. While he may fervently believe in such a connection, as a layperson the Veteran lacks the competence to render a nexus opinion on such a complex medical question. Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). No medical professional has indicated even a possible link between current disability and active service. In the absence of evidence, there cannot be even equipoise, and there can be no resolution of doubt. The Veteran still ultimately bears some burden of production. 38 U.S.C. § 5107(a); Cromer v. Nicholson, 455 F.3d 1346 (Fed. Cir. 2006). As there is no evidence to support any finding of a nexus between service and current cervical spine disability, entitlement to the benefit sought is not warranted. Diabetes Mellitus The Veteran seeks service connection for diabetes mellitus, which he contends is due to exposure to herbicides in active service. For Veterans exposed to tactical herbicides, service connection may be presumed for certain listed diseases, including diabetes mellitus. Exposure is presumed for those who served in Vietnam from January 1962 to May 1975. 38 C.F.R. §§ 3.307, 3.309. This includes Veterans who served in the 12-nautical-mile territorial sea of the Republic of Vietnam. 38 U.S.C. § 1116A. In this case, the Veteran never served in the Republic of Vietnam. He contends that he was exposed to herbicides in Korea. His personnel records show service in Korea from July 1959 to July 1960. VA made a formal finding in October 2016 that there was a lack of information to verify herbicide exposure in Vietnam, Thailand, or along the demilitarized zone (DMZ) in Korea; and indicated that the Veteran’s service in Korea was not along the DMZ border. Historical records reveal that herbicides had been used along the DMZ border in Korea from April 1968 to July 1969. Significantly, because the Veteran was not in Korea during that timeframe, exposure to herbicides in active service is not demonstrated. Moreover, the Veteran’s service treatment records do not reflect any findings or complaints of elevated blood sugar. Clinical evaluation of the Veteran’s endocrine system was normal both at the time of his separation examination from active service in November 1966, and at the time of his enlistment examination for Army Reserve service in April 1980. The Veteran has not since reported in the context of his claim that he experienced diabetes mellitus in service. Here, again, the in-service element has not been met. Nor is there evidence of diabetes mellitus within one year of separation from active duty service; hence, service connection on a presumptive basis is not warranted. VA records, dated in August 2004, show a past medical history of known diabetes for ten years. His diabetes mellitus was monitored by a private physician in January 2015. To date, the Veteran submitted no evidence or information linking active service to the currently diagnosed diabetes mellitus. While he may fervently believe in such a connection, as a layperson the Veteran lacks the competence to render a nexus opinion on such a complex medical question. Kahana, 24 Vet. App. at 435. No medical professional has indicated even a possible link between current disability and active service. In the absence of evidence, there cannot be even equipoise, and there can be no resolution of doubt. The Veteran still ultimately bears some burden of production. 38 U.S.C. § 5107(a); Cromer, 455 F.3d at 1350-1351. As there is no evidence to support any finding of a nexus between service and current diabetes mellitus, entitlement to the benefit sought is not warranted. Residuals of Gonorrhea On a “Report of Medical History” completed for Air Borne examination in October 1960, the Veteran reported venereal disease. The examiner at the time noted gonorrhea, four months ago, treated, and non-symptomatic. Clinical evaluation of the Veteran’s genitourinary system at the time was normal. Service treatment records show a diagnosis of acute urethritis due to gonorrhea in December 1962. The Veteran was treated twice for gonorrhea in March 1965, noted as persistent. He was again treated for gonorrhea in August 1965. Residuals of gonorrhea were noted neither at the Veteran’s separation examination from active service in November 1966, nor at his enlistment examination for Army Reserve service in April 1980. In October 2020, the Veteran testified that he contracted gonorrhea in service and was given medication for treatment; and that he no longer had problems with gonorrhea. Recent VA records show no treatment for residuals of gonorrhea, or even complaints of current gonorrhea or symptomatology. Here, there is no evidence of current residuals of gonorrhea. The concept of continuity does not apply because gonorrhea is not listed as a chronic disease under 38 C.F.R. § 3.309, and is not shown to be such by current medical evidence. Walker, 708 F.3d at 1338-39. No current disability is demonstrated. To the extent that the Veteran asserts a nexus to active service, he is competent to report symptoms of gonorrhea both in service and after service. He is not, however, competent to diagnose residuals of gonorrhea. In this case, there is no showing of current residuals of gonorrhea. The evidence weighs against granting service connection for residuals of gonorrhea. The benefit-of-the-doubt rule does not apply, and the claim must be denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Gastrointestinal Tract Service treatment records show that the Veteran reported stomach trouble of a few days’ duration in October 1961, described as mild cramps. Examination was negative, except for gas-filled colon. He again reported stomach pains for several days in September 1963, and reported that he also seemed nervous. The assessment was anxiety reaction. Medication was prescribed, and symptoms improved the following day. The Veteran reported some vague epigastric distress and anxiety in October 1963. In addition to prescribed medication, treatment consisted of following a bland diet and avoiding gastric stimulants. The Veteran vomited and fainted during physical training in June 1964; he was assigned to quarters. In September 1964, the Veteran had recurrence of stomach cramps associated with “nerves,” dating back to time when he took two KMnO4 tablets by mistake. The impression was anxiety. He again complained of vague chest and upper abdominal distress, similar to what he experienced before when he swallowed some “for external use only” medicine. The examiner noted that the Veteran appeared as being under pressure, though he denied it; his abdomen was soft. He had “shakes” in hands and lips. Medication was prescribed, and a mental hygiene appointment was recommended. The Veteran presented to the Emergency Room in May 1966 with severe stomach pain, which had been intermittent for six months. He reported poisoning about six months earlier with medication. Examination revealed that the Veteran smelled of ethanol. He admitted drinking too much that evening and now had severe epigastric pain. Following examination, the impression was alcoholic gastritis. Medication was prescribed. On a “Report of Medical History” completed at separation in November 1966, the Veteran reported stomach trouble; the examiner’s notations are illegible. Clinical evaluation of the Veteran’s abdomen and viscera was normal at separation examination from active service in November 1966, and at enlistment examination for Army Reserve service in April 1980. Army Reserve records show complaints of nervous stomach in April 1982. Post-service records show that the Veteran underwent a barium swallow in July 2005, and the impression was persistent Zenker’s diverticulum. In September 2008, the Veteran reported having nausea and “upset stomach” just after waking up, which resolved later in the day. The assessment then was gastroesophageal reflux disease and Zenker’s diverticulum. In August 2013, the Veteran reporting having a “different” type of abdominal pain in the right lower quadrant moving up into the right subcostal region, which lasted all day and was a deep sharp-type pain. He had a long history of abdominal pain and continued taking medication daily for gastritis. He underwent endoscopic and fiberoptic examinations, and assessments were gastritis and abdominal pain. Mild diverticulosis was noted in September 2013. The Veteran again complained of gastroesophageal reflux disease in February 2015. A November 2015 VA examination report includes diagnosis and date of diagnosis as acute alcohol gastritis, 1960. The Veteran reported that he mistakenly consumed “some poison” in active duty service, and experienced some stomach problem—that is, “they had to flush [his] stomach with charcoal.” He did not require hospitalization, and subsequently continued to experience stomach pain. He had not been provided diagnoses other than gastroesophageal reflux disease. The Veteran continued to take medication. His stomach condition did not impact his ability to work. Following examination in November 2015, the examiner opined that the Veteran’s stomach condition was less likely than not attributable to active duty service. In support of the opinion, the examiner reasoned that gastric injury may occur to those exposed to concentrated solutions of KMnO4 (potassium permanganate), resulting in ulceration or hemorrhage or perforation; and that chronic ingestion may result in neurological effects similar to manganism. Most ingestions of diluted solutions were benign, and mild irritation was self-limited. Multiple tests in 2003 revealed no esophageal abnormality, but did reveal some mild gastritis; and helicobacter revealed no episodes of reflux. The examiner noted that the Veteran also was diagnosed with alcohol gastritis and anxiety; and that subsequent tests have been reported as normal, with no etiology of claimed stomach pain. The examiner concluded that, most likely, the Veteran’s ingestion of KMnO4 did not have any long-term effects. A pathology report in October 2017 was consistent with reflux esophagitis. The Veteran required medication daily for management of gastroesophageal reflux disease. In October 2020, the Veteran testified that he had problems both with his stomach and his feet in active duty service and sought treatment for both at the same time. He was given liquid in a bottle and drank it with a quart of water; he started throwing up. He had drunk some type of poison, which was meant for external use on feet. The Veteran also testified that he was treated in active duty service for a nervous stomach and indigestion. He later was diagnosed with gastroesophageal reflux disease and diverticulitis. He testified that he had problems ever since service, and that he continued to take medications for gastritis and heartburn. The Veteran’s testimony of in-service and post-service abdominal pain are consistent with his service treatment records and private treatment records, which the Board finds credible and persuasive. The Veteran had a long history of abdominal pain, both during service and after service. He was treated for mild gastritis in active duty service. Endoscopic and fiberoptic examinations in August 2013 also revealed gastritis. Here, the Board acknowledges the November 2015 VA opinion, in which the examiner reasoned that ingestion of poison in active service was self-limited and did not have long-term effects. The examiner noted that multiple tests did not reveal the etiology of the Veteran’s abdominal pain. However, the examiner failed to acknowledge the Veteran’s report of longstanding recurring symptoms of gastritis following his separation from active service. Given the nature of gastritis, the Veteran’s complaints of abdominal pain both during and after service, and evidence of current gastritis, the Board finds that the Veteran’s recurrent gastritis had its onset in active service. Such is consistent with the Veteran’s reports of symptomatology and required medications, as well as documented treatment records. Service connection is warranted for recurrent gastritis which had its onset in service. REASONS FOR REMAND Left Thumb Here, the Veteran has reported onset of left thumb pain in active service. His entry examination in October 1958 was normal, and no disability was recorded. Service treatment records show complaints of swelling on dorsum of left hand in September and October 1963. There was a semi-firm tumor fixed to underlying structures between and overlying tendon to thumb and index finger, just behind snuff box region. The impression was ganglion, and surgery was scheduled. He again reported left thumb trouble in May 1964, and slight swelling was noted; treatment consisted of applying heat. A left wrist ganglion was noted in June 1964, and an appointment made with the orthopedic clinic. A growth on left wrist was noted on report of medical history completed at separation examination from active service in November 1966. Post-service records show complaints of left thumb pain in January 2008. The Veteran’s left thumb had been injected approximately ten-to-twelve months earlier, but had gotten to the point of worsening pain localized at base of the thumb. X-rays in January 2008 revealed stage III carpal metacarpal joint osteoarthritis. The Veteran received additional injections in January 2008 and in April 2008, and underwent surgical intervention in October 2008. Hand therapy followed surgery. The Veteran no longer experienced severe pain as previously, but he did report some pain and sensitivity over the dorsal aspect of the thumb in June 2009 associated with tenderness over the plate. Once fusion completed and healed, he underwent removal of multiple implants of left thumb in September 2009. Left thumb impairment was noted in November 2015. The Veteran could not oppose the left thumb to the left small finger. Decreased strength and decreased coordination also were noted, and carpal tunnel syndrome of left wrist was indicated in December 2015. The Veteran testified in October 2020 that the cyst in his left thumb never went away; and that if physicians had “cut down in there, then [he] wouldn’t have been able to use the whole hand ….” He testified that he suffered from carpal tunnel syndrome in service, had surgery after service, and that the bump had been there since service. Additional surgery made the thumb better. The Board finds the Veteran’s testimony to be credible and consistent with the circumstances of his service as shown by service treatment records. 38 C.F.R. § 3.303. Under these circumstances, an examination or medical review, as appropriate, is needed to determine whether the Veteran has a current left thumb disability thatither had its onset during service or is related to his active service. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c)(4). Right Foot Here, the Veteran has reported onset of right foot pain in active service. His entry examination in October 1958 was normal, and no foot disability was recorded. Service treatment records show complaints of pain in both feet in January 1964. There was continued pain in the anterior region of both ankles with use of new boots. Examination showed thickening, discoloration, and lichenification along tendons of shin on anterior surface of both ankles. The impression was chronic irritation. Treatment consisted of wearing low quarter shoes for two weeks. The Veteran reported no pain in areas of thickened, lichenified skin in anterior joint line in February 1964. Medicated ointment was applied, and the Veteran was to continue wearing low quarter shoes for two weeks. He again complained of pain in both feet in April 1964. Clinical evaluation of feet was normal at separation examination from active service in November 1966. The Veteran reported no foot trouble during Army Reserve service in April 1980. Post-service records show bunionectomy of right foot with good alignment in August 2000. In July 2003, the Veteran reported having foot surgery two years ago and continuing to have problems. More recent records show a diagnosis of right foot drop in March 2020. The Veteran was given a right AFO brace to stabilize the ankle joint and to improve ambulation. The Veteran testified in October 2020 that he had swollen feet while serving in Germany. He testified that he had problems with his boots and was given bigger boots. His foot problems did not go away, and he continued to have pain. After service, he had a bone cut out of his right foot, which was a sidebone in foot and big toe; and a wire was inserted. Pain had not gone away, and problems continued in the right foot. The Veteran did not walk straight and fell three times in the last week; his foot condition affected balance. The Board finds the Veteran’s testimony to be credible and consistent with the circumstances of his service as shown by service treatment records and lay testimony. 38 C.F.R. § 3.303. The Veteran also testified that he had suffered frostbite while serving in Germany. His personnel records show assignments in Germany from July 1963 to October 1965. Under these circumstances, an examination or medical review, as appropriate, is needed to determine whether the Veteran has a current right foot disability, to include residuals of bunionectomy and residuals of frostbite, that either had its onset during service or is related to his active service. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c)(4). Anxiety and Depression Here, the Veteran has reported onset of acquired psychiatric disability, to include anxiety and depression, in active service. His entry examination in October 1958 was normal, and no psychiatric disability was recorded. Service treatment records show complaints of stomach pains for several days in September 1963, and that the Veteran seemed nervous. The assessment was anxiety reaction. The Veteran was prescribed medication. His symptoms improved the next day, and anxiety resolved. In October 1963, he had some vague epigastric distress and anxiety, and was noted as doing well the following day. In September 1964, the Veteran had recurrence of stomach cramps associated with “nerves,” dating back to time when Veteran took two KMnO4 tablets by mistake. The impression was anxiety. On a “Report of Medical History” completed at separation in November 1966, the Veteran reported nervous trouble. Clinical evaluation of psychiatric system at the time was normal. The Veteran again reported nervous trouble at enlistment for Army Reserve service in April 1980. The examiner noted mild anxiety, without history of antisocial personality. He was again treated for complaints of extreme anxiety and depression in April 1982. Post-service records reveal a review of systems showing depression and sleep disturbances in October 2017. General examination at the time revealed that the Veteran’s affect was normal; he was awake, alert, and oriented times three. A treating physician in May 2020 noted that the Veteran was under a huge degree of stress, and was prevented from participating in therapy. The Veteran struggled to improve his physical and mental wellbeing in an extremely stressful social environment, which had been ongoing for several years. In October 2020, the Veteran testified that he was nervous all over and had anxiety in service; and that he had the same problem ever since. As shown above, service connection has been awarded for recurrent gastritis. The Board cannot make a fully informed decision on the issue of service connection for an acquired psychiatric disability, to include anxiety and depression, because no VA examiner has opined whether the claimed disability is part and parcel of, or related to recurrent gastritis; or is otherwise related to active duty service. The Board cannot resolve this matter without further medical clarification. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c)(4). Boils Here, the Veteran has reported onset of disability manifested by chronic boils in active service. During Army Reserve service in August 1957, the Veteran completed a “Report of Medical History” and reported boils. The examiner at the time noted boils, none since age six or seven. Clinical evaluation of skin was normal. The Veteran’s entry examination for active duty service in October 1958 was normal; no skin disability was recorded, and the Veteran was presumed sound. On a “Report of Medical History” completed for Air Borne examination in October 1960, the Veteran reported boils; the examiner noted boils, non-symptomatic. Clinical evaluation of skin was normal. Boils were neither reported nor noted at the Veteran’s separation examination from active duty service in November 1966, nor at his enlistment examination for Army Reserve service in April 1980. Recent VA records show that treatment for boils in December 2014 and in January 2015, and note a history of boils in the past. In June 2015, the Veteran filed a claim for service connection for chronic boils. He testified in October 2020 that something in his chest was cut out, and it was not a boil. Under these circumstances, an examination or medical review, as appropriate, is needed to determine whether a disability manifested by chronic boils clearly and unmistakably preexisted the Veteran’s active duty service and was not aggravated by service; or whether the Veteran has a disability manifested by chronic boils that either had its onset during service or is related to his active service. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c)(4). The matter is REMANDED for the following action: 1. Obtain updated VA treatment records for the period from September 2019 to the present. 2. Schedule a VA examination for claimed left thumb disability. The claims file must be reviewed in conjunction with examination. The examiner must identify all current left thumb disabilities. The examiner must opine as to whether any currently diagnosed left thumb disability had its onset in active service; or is at least as likely as not caused or aggravated by service, to include any residuals of left ganglion cyst noted in service. Lay reports of symptoms since service should also be discussed. If other causes are more likely, those should be noted. A full and complete rationale for all opinions expressed is required. 3. Schedule a VA examination for claimed right foot disability, to include residuals of bunionectomy and residuals of frostbite. The claims file must be reviewed in conjunction with examination. The examiner must identify all current right foot disabilities. The examiner must opine as to whether any currently diagnosed right foot disability, to include residuals of bunionectomy and residuals of frostbite, had its onset in active service; or is at least as likely as not caused or aggravated by service, to include irritation from wearing boots as noted in service and from cold injury as asserted by the Veteran. Lay reports of symptoms since service should also be discussed. If other causes are more likely, those should be noted. A full and complete rationale for all opinions expressed is required. 4. Schedule a VA examination for claimed acquired psychiatric disability, to include anxiety and depression. The claims file must be reviewed in conjunction with examination. The examiner must identify all current psychiatric disabilities. The examiner must opine as to whether any currently diagnosed psychiatric disability, to include anxiety and depression, had its onset in active service; is at least as likely as not caused or aggravated by service, to include recurrent stomach cramps and anxiety reaction as noted in service; or is part and parcel of the service-connected recurrent gastritis. Lay reports of symptoms since service should also be discussed. If other causes are more likely, those should be noted. A full and complete rationale for all opinions expressed is required. 5. Schedule a VA examination for claimed chronic boils. The claims file must be reviewed in conjunction with examination. The examiner must identify all current disabilities manifested by chronic boils. The examiner must opine as to whether a disability manifested by chronic boils clearly and unmistakably preexisted the Veteran’s service; and if so, whether the Veteran’s chronic boils were clearly and unmistakably not aggravated by service. If the examiner finds either that chronic boils did not clearly and unmistakably preexist service, or were not clearly and unmistakably aggravated by service, then the examiner must opine as to whether a disability manifested by chronic boils had its onset in active service; or is at least as likely as not caused or aggravated by service, to include non-symptomatic boils noted in October 1960. Lay reports of symptoms since service should also be discussed. If other causes are more likely, those should be noted. A full and complete rationale for all opinions expressed is required. 6. Then, readjudicate the claims on appeal. If any benefit sought remains denied, issue an appropriate supplemental statement of the case and return the appeal to the Board. WILLIAM H. DONNELLY Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Mary C. Suffoletta 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.