Citation Nr: 21005124 Decision Date: 01/29/21 Archive Date: 01/29/21 DOCKET NO. 18-11 949 DATE: January 29, 2021 ORDER Entitlement to service connection for a bilateral foot disability, claimed as blisters, cracks and rashes, is denied. REMANDED Entitlement to service connection for macular degeneration, bilateral eyes, is remanded. FINDING OF FACT The preponderance of the evidence is against finding that a chronic left or right foot disability manifested by blisters, cracks, and rashes, began during active service or is otherwise etiologically related to an in-service injury or disease. CONCLUSION OF LAW The criteria for entitlement to service connection for a bilateral foot disability, claimed as blisters, cracks and rashes have not been met. 38 U.S.C. §§ 1101, 1110, 1131; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1990 to April 1991. He served on active duty for training (ACDUTRA) from July 1984 to October 1984. He had additional service in the Army Reserves and the Army National Guard of Georgia. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a March 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In May 2019 the Veteran provided testimony before the undersigned Veterans Law Judge at a Travel Board hearing. A transcript of the hearing is of record. In November 2019, the Board remanded the case for further development. 1. Entitlement to service connection for a bilateral foot disability, claimed as blisters, cracks and rashes Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). In the absence of proof of a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Active military service includes any period of ACDUTRA during which the individual concerned was disabled from a disease or injury incurred or aggravated in line of duty and any period of inactive duty training (INACDUTRA) during which the individual concerned was disabled from an injury incurred or aggravated in line of duty. 38 U.S.C. § 101 (24); 38 C.F.R. § 3.6 (a). ACDUTRA is full-time duty in the Armed Forces performed by Reserves for training purposes. 38 U.S.C. § 101 (22); 38 C.F.R. § 3.6 (c). INACDUTRA is duty other than full-time duty prescribed for Reserves. 38 U.S.C. § 101 (23); 38 C.F.R. § 3.6 (d). The Veteran contends that he has a chronic disability of the feet, manifested by blisters, cracks, and rashes, that had its onset during a period of ACDUTRA in April 1985. There is a treatment record dated in April 1985 that notes treatment for pink, well-healing blisters on each foot. A December 1987 periodic examination noted normal skin and feet. On the Veteran’s report of medical history completed in March 1991, he denied skin diseases and foot trouble. The March 1991 separation examination noted normal feet. Skin examination noted only eczema in the gluteal cleft. An April 2013 VA new patient physical examination did not include any foot or skin complaints. Skin examination noted no rash, itching, scaling, or flaking. There was early stasis dermatitis of both lower legs; otherwise negative skin examination. No feet abnormalities were noted. The Veteran submitted a buddy statement in April 2016 from R.S., who reported he had known the Veteran since junior high school and served in the National Guard with him. R.S. remembered the Veteran receiving treatment for foot problems in service and having significant loss of physical activity in the years after service as a result of his foot issues. VA treatment records dated from 2017 to 2019 show ongoing treatment for scaling rash on both feet that the Veteran reported had been present since 1986. The Veteran declined recommended punch biopsies in 2019. The Veteran submitted a disability benefits questionnaire in August 2019 that noted he had tinea pedis and dermatitis that the Veteran reported had been present since service in the 1980s. A VA examination was conducted in October 2020. The Veteran’s reported history was that “in about 1988, he was at Ft. Irwin and he developed a foot rash. He was treated at the center there. The rash has continued. He saw a dermatologist who did not know what type of rash it was. He has been tried on pills and creams with no change in the rash. The pill caused loss of taste. The dermatologist wanted him to have a punch biopsy of the rash but that has not been done yet. The skin also cracks and it is painful to stand.” The examiner noted dermatitis of uncertain type, with cracking of the skin and dry flaky skin all over the bottoms of feet and in the web spaces of the toes. The examiner opined that the claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. “It is not known exactly what the cause of the rash is. He was unable to undergo a recommended punch biopsy so it is not known what the rash cause actually is. Clearly it has not responded to anything given to him for T pedis or anything else. There was no skin rash noted on his separation exam on his feet. Therefore, it is less likely than not that the single blister on each foot is the cause of his current problem.” The examiner further stated that he had “reviewed the transcript of a hearing in 2019 and a remand dated 11/21/19. He was seen once in 1985 for a blister on each [foot]. His separation exam on 3/13/91 did not notice any skin rash on his feet. Therefore it is less likely than not that the single blister on each foot is related to the dermatological problem he currently has on his feet.” Although lay persons are competent to provide opinions on some medical issues, the potential relationship between the Veteran’s current dermatitis of the left and right foot and his periods of service is complex in nature and falls outside the realm of common knowledge of a lay person. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). There is no indication that the Veteran or R.S. possess the medical knowledge to attribute his current dermatitis to service and any specific duties therein. Similarly, although the Veteran believes the blisters noted on his feet on one occasion in service in 1985 are related to his current bilateral foot dermatitis, he is not competent to provide a nexus between any current foot condition and his military service because he does not have the requisite medical training or expertise to do so. Jandreau, supra. The Board finds the VA medical opinion, which is competent evidence, persuasive. The opinion is persuasive because the examiner reviewed the Veteran’s service records which did not include any foot complaints other than blisters. The examiner noted that the service treatment records did not include any findings of foot rash, and that the service separation examination in March 1991 noted normal skin and foot examinations. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302 (2008). The August 2019 DBQ’s notation that the Veteran’s foot rash had been present since the 1980s was based on the Veteran’s reported history rather than any first-hand knowledge of the examiner. Thus, that statement is of limited value. The objective record shows that the Veteran was noted to have healing blisters on his feet in April 1985. A December 1987 periodic examination did not note any feet or skin problem. The Veteran denied skin and foot problems at separation in March 1991, and the examination at that time did not show foot/skin abnormalities. The post-service April 2013 VA physical examination also did not include any foot/skin complaints or findings. While the 2017-2019 VA treatment records include the Veteran’s report of a more than 30-year history of foot scaling and rashes, that history is not consistent with the objective record. Accordingly, service connection for a bilateral foot disability, claimed as blisters, cracks and rashes, is denied. REASONS FOR REMAND 1. Entitlement to service connection for macular degeneration, bilateral eyes is remanded. The Veteran contends that he has bilateral macular degeneration that he believes resulted from exposure to UV light in service, specifically “low light conditions, operating in dark, working starlight scopes, working -- and when we got in the Bradley [Fighting Vehicle], we was in infrared sighting and stuff like that, so by the time I got out of the military, I was wearing glasses and -- and/or contacts, and my eyesight had degenerated.” A July 2013 VA treatment record noted macular changes vs. early macular degeneration. The Veteran submitted a statement dated in August 2019 from a VA doctor of optometry who noted he had macular degeneration that at least as likely as not was caused by his military service; she did not provide a rationale for that conclusion. The Board previously remanded the case for an examination and opinion. A VA examiner in December 2020 diagnosed dry eyes. The examiner stated that the Veteran did not have macular degeneration. The examiner checked the box for “the claimed condition was less likely than not incurred in or caused by inservice injury, event, or illness.” In the rationale section, the examiner merely stated “no macula degeneration is present OU.” VA must ensure that an opinion is adequate. See Barr v. Nicholson, 21 Vet. App. 303 (2007). The Court has held that the current disability requirement for a service connection claim is satisfied if the claimant has a disability at the time the claim is filed or during the pendency of that claim. See McClain v. Nicholson, 21 Vet. App. 319 (2007). Since the December 2020 examiner did not address whether the macular degeneration diagnosed in 2019, or the dry eyes diagnosed on the December 2020 examination, were related to service, an addendum opinion is needed. The matters are REMANDED for the following action: Request that the VA examiner who examined the Veteran in December 2020 provide an addendum opinion addressing the following: a) Is at least as likely as not that the macular degeneration of either eye noted by the VA optometrist in August 2019 is related to a verified period of active service, to include exposure to UV or infrared light in service, as from starlight scopes? b) Is at least as likely as not that the dry eyes condition noted on VA examination in December 2020 is related to a verified period of active service, to include exposure to UV or infrared light in service, as from starlight scopes? A rationale for all opinions expressed should be provided. D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. G. Mazzucchelli, 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.