Citation Nr: 21064648 Decision Date: 10/21/21 Archive Date: 10/21/21 DOCKET NO. 16-31 578 DATE: October 21, 2021 ORDER Entitlement to service connection for left foot disability is denied. Entitlement to service connection for a right foot disability is denied. Entitlement to service connection for a right eye disability is denied. FINDINGS OF FACT 1. The weight of the most probative evidence of record is against finding a left foot disability began during active service or is otherwise related to an in-service injury or disease. 2. The weight of the most probative evidence of record is against finding a right foot disability began during active service or is otherwise related to an in-service injury or disease. 3. The weight of the most probative evidence of record is against finding a right eye disability began during active service or is otherwise related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for left foot disorder are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for right foot disorder are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for right eye disorder are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran has active service from July 1969 to January 1970, and various periods of reserve training from 1970 to 1974 (06/18/2019 Military Personnel Record, pg. 23). This case is before the Board of Veterans' Appeals (Board) from December 2014 (eye) and November 2015 (feet) rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran appeared before the undersigned Veterans' Law Judge at a January 2019 hearing. In June 2019 and June 2021, the Board remanded these matters to the RO for additional development, specifically VA examinations. July 2021 VA examinations were obtained. Finding there has been substantial compliance with the Board's remand directives in accordance with Stegall v. West, 11 Vet. App. 268, 271 (1998), the Board may proceed with appellate review. Service Connection 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). 1. Left foot disorder with chronic sores, blisters, and sensitive/thickened skin foot. 2. Right foot disorder with chronic sores, blisters, and sensitive/thickened skin foot disorder. The Veteran contends he has a chronic bilateral foot condition related to service, that requires help walking (1/08/2021 Notification Letter, pg. 3). The Veteran has a current diagnosis of gout, meeting the first element for service connection. His right foot was diagnosed in January 2016 and his left foot was diagnosed in December 2015 (07/21/2021 C&P Exam, pg. 2). With regard to whether in-service incurrence or aggravation of a disease or injury occurred, the Veteran's service treatment records from June 1970 reveal a complaint of spreading lesions on the feet, diagnosed as purulent blisters (02/02/2007 STR Medical, pg. 20). In a report of medical history associated with a May 1972 examination, the Veteran reported foot trouble. During the Veteran's hearing, however he denied that his feet bothered him in service. In response to direct questions, he explained that his feet bothered him after a fall from a truck while on active duty (1/04/2019 Hearing Transcript, pg. 4). He did no pursue treatment at the time because his back problems were a bigger priority. The Board finds the evidence regarding an in-service foot injury or onset of a foot condition is varied, and in some cases contradictory. Nonetheless, the Board finds the evidence to be at least in equipoise. Resolving doubt in favor of the Veteran, the Board finds the second element for service connection has been met. The Board next turns to whether there is a causal relationship or nexus between the current disability and the in-service disease or injury. Post-service, a January 2016 treatment note of record describes right foot cellulitis and a February 2016 treatment note reveals a complaint and treatment for right foot redness and swelling (7/11/2016 CAPRI, pgs. 46 and 74). The Veteran was afforded a July 2021 VA examination for foot conditions. The July 2021 examiner provided a negative nexus opinion that the Veteran's claimed foot condition was less likely than not (less than 50 percent probability) incurred in or caused by in-service injury, event, or illness. The examiner explained that medical literature supports that most cellulitis conditions resolve quickly with antibiotic therapy, which supports that the cellulitis diagnosed in 2016 is unrelated to the blisters diagnosed during service in 1970, and the unspecified foot symptoms in 1972. Review of available medical records documents antibiotic treatment in 1970 with no follow-up treatment or additional complaints. Cellulitis was not diagnosed during the July 2021 examination. Despite the Veteran's lay statements, the examiner opined any cellulitis was unrelated to the blisters noted in service in June 1970. The examiner also discussed the Veteran's current gout diagnosis and opined that the gout is unrelated to service. The Board also notes that the Veteran's diagnosis with gout was in 2015, decades post-service (07/21/2021 C&P Exam). The Board acknowledges and has considered that the Veteran believes he has a current foot disability that began or was caused by his active service. While a lay person is competent to testify as to their recollections and beliefs, the record does not show that the Veteran has the medical training or credentials to diagnose foot conditions or provide nexus opinions. The issue is medically complex, as it requires medical knowledge and training. As such, the Board finds diagnoses and nexus opinions to be outside the competence of the Veteran. The Board finds the medical evidence of record to be more reliable as to the Veteran's diagnoses than his lay statements. Consequently, the Board assigns more probative weight to the medical evidence of record. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24 Vet. App. 428 (2011). After considering the most probative evidence of record, the Board concludes that, while the Veteran has a current diagnoses of a foot disorder, and has complained of current foot pain that causes him trouble walking, the preponderance of the evidence is against finding that any foot condition began during active service, or is otherwise related to an in-service injury, event, or disease. The Board has considered that during his hearing, the Veteran acknowledged he did not seek medical attention after falling out of the truck and he hurt his feet at that time. Although complaints of feet trouble and blisters are included in his service treatment record, the Board finds the May 1972 physician finding that all complaints were insignificant and that the Veteran was found qualified for retention highly probative weighing against the Veteran's claim (02/02/2007 STR Medical, pg. 32). Additionally weighing against the Veteran's claim are the service treatment record annotations, from June 1970 to June 1974, that the Veteran was consistently found physically qualified for retention in the reserves, with affirmative statements that no material change in his physical condition was noted (02/02/2007 STR Medical, pgs. 30, 32, 35 to 43). Taken in conjunction with the negative nexus opinion of record, that was based on an in-person examination and an accurate review of the Veteran's record, the Board concludes the most probative evidence of record does not suggest the Veteran's current feet disability was associated with his active service. In light of the foregoing, the Veteran's claims of entitlement to service connection for a left and right foot disorder are denied. 3. Right eye disorder. The Veteran contends he was exposed to blast from a hand grenade that kicked up dust and heat, impacting his right eye (1/04/2019 Hearing Transcript, pg. 6). The Veteran has current diagnoses of right eye retinal scarring status post retinal detachment repair, and right eye pseudophakia (07/13/2021 C&P Exam). His active problem list reveals myopia, astigmatism, presbyopia, dry eye syndrome, and retinoschisis (12/09/2014 CAPRI, pg. 2). Based on the foregoing, the Board finds the Veteran has current diagnoses of right eye disability, to include retinal scarring status post retinal detachment repair, and right eye pseudophakia, meeting the first element of service connection. With regard to in-service incurrence or aggravation of a disease or injury, the Veteran described exposure to blast from a hand grenade that kicked up dust and heat and impacted his right eye. Although the service treatment record does not reveal treatment for his eyes, in a report of medical history associated with a May 1972 examination, the Veteran reported eye trouble (02/02/2007 STR Medical, pg. 32). The July 2021 VA examiner accepted the Veteran's report that a training grenade blast in 1970 blew him against a wall and noted the Veteran's report of eye problems in May 1972 (07/13/2021 C&P Exam, pg. 2). The Board notes the Veteran is competent to describe his memory of experiences during service. Additionally, the July 2021 examiner did not cite a medical reason to find the Veteran's statements were not credible. Accordingly, the Board finds the evidence of an in-service injury to the Veteran's eye is at least in equipoise, meeting the second element for service connection. The question remaining for the Board is whether there is a nexus between the Veteran's in-service injury and his current diagnosis for his right eye. The Veteran's service treatment record reveals a May 1972 complaint of eye trouble. At that time, the physician noted that the complaints made by the Veteran had been reviewed and all positive answers were found insignificant. The Veteran was found qualified for retention (02/02/2007 STR Medical, pg. 32). Additionally, service treatment records reveal that from June 1970 to June 1974, the Veteran was consistently found physically qualified for retention in the reserves, with affirmative statements that no material change in his physical condition was noted (02/02/2007 STR Medical, pgs. 30, 32, 35 to 43). The Veteran was afforded a July 2021 VA examination for his eye. After an in-person examination and review of claims folder, the examiner opined 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. The examiner considered the Veteran's diagnoses, lay statements about his injury and recollections as to his treatment, and the report of eye problems in May 1972. The examiner explained the Veteran's report of being told to use artificial tears would not be a treatment for a retinal detachment (07/13/2021 C&P Exam, pg. 2). The examiner also noted the first mention of a retinal detachment is a partial retinal detachment in April 2013, with the status post retinal detachment repair in February 2015. The Board finds the foregoing suggests the Veteran's currently diagnosed eye disorder did not manifest until decades after his service. The Board acknowledges that the appellant believes that his current right eye disability is related to or was caused by service, to include dust having been kicked up during a blast from a hand grenade. While a lay person is competent to testify as to their recollections or beliefs, the record does not show that the appellant has the medical training or credentials to diagnose an eye disability or provide a nexus opinion. Diagnosing eye disabilities and formulating nexus opinions are medically complex, requiring medical knowledge and specialized training. As such, the Board finds diagnoses and nexus opinions to be outside the competence of the Veteran. The Board finds the medical evidence of record to be more reliable as to the Veteran's diagnosis than his memory or belief. Consequently, the Board assigns more probative weight to the medical evidence of record. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24 Vet. App. 428 (2011). Again, weighing against the Veteran's claim are the service treatment record annotations from June 1970 to June 1974, showing that he was consistently found physically qualified for retention in the reserves, with affirmative statements that no material change in his physical condition was noted (02/02/2007 STR Medical, pgs. 30, 32, 35 to 43). Taken in conjunction with the July 2021 negative nexus opinion of record, based on an in-person examination and an accurate review of the Veteran's record, the Board concludes the most probative evidence of record does not suggest the Veteran's current right eye disorder was associated with his active service, to include injury as described by the Veteran. Accordingly, the Veteran's service connection claim for a right eye disorder is denied. Eric S. Leboff Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P. A. Myers 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.