Citation Nr: 21065693 Decision Date: 10/27/21 Archive Date: 10/27/21 DOCKET NO. 17-26 156 DATE: October 27, 2021 REMANDED Service connection for a skin disability, to include as due to in-service exposure to herbicide agents or as secondary to a service-connected disability, is remanded. Service connection for bilateral pes planus is remanded. Service connection for bilateral plantar fasciitis is remanded. Service connection for benign paroxysmal positional vertigo, claimed as light headedness and dizziness, to include as secondary to a service-connected disability, is remanded. REASONS FOR REMAND The Veteran had active service from September 1967 to September 1969, with additional service in the Reserves. In April 2019, the Board of Veterans' Appeals (Board) remanded these issues for the Regional Office (RO) to obtain VA medical opinions for the Veteran's disabilities. Unfortunately, as those opinions are problematic, another remand is necessary. The Board regrets the additional delay. Generally, when VA provides an examination or obtains an opinion, the examination or opinion must be adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). Here, as discussed further below, the Board finds that the November 2019 VA medical opinions provided for the Veteran's disabilities are inadequate because they are speculative and are not supported by adequate rationales. Skin Disability The Veteran contends he has a skin disability that is related to his active service, to include his conceded exposure to herbicide agents when he served in Vietnam. Alternatively, he asserts that his skin disability is secondary to a service-connected disability. The Veteran has current diagnoses of eczema and psoriasis. See November 2019 VA Examination Report For Skin Conditions. The VA examiner negatively opined that the Veteran's skin conditions are not related to his military service, stating that the Veteran's service treatment records (STRs) are silent for complaints, treatment, or diagnosis of a skin condition. Regarding exposure to herbicide agents, she stated that medical literature is inconclusive about a relationship between Agent Orange and the increased risk for eczema or psoriasis. She concluded that she was unable to provide a positive opinion for service connection without resorting to speculation. The examiner did not provide an opinion regarding secondary service connection, stating that the Veteran does not attribute his skin disabilities to a specific service-connected disability. Other than stating that the Veteran's STRs are silent for complaints, treatment, or diagnosis for a skin condition, the examiner did not provide a rationale for her opinion regarding direct service connection. The Board notes that a lack of complaints or treatment in service, alone, is not an adequate reason for denying the Veteran service connection. In addition, the examiner noted that she was unable to provide a positive opinion without resorting to speculation, without stating whether this is due to limited medical knowledge in this area, or without stating what, if any, information is necessary to give a more conclusive opinion. Thus, a remand is necessary for the RO to obtain an addendum medical opinion regarding the etiologies of the Veteran's skin disabilities. Bilateral Pes Planus and Bilateral Plantar Fasciitis The Veteran contends his bilateral pes planus and bilateral plantar fasciitis are related to his active service. His STRs, including his entrance and separation physical examinations and histories are silent for any bilateral pes planus or bilateral plantar fasciitis. At the November 2019 VA examination for foot conditions, the examiner diagnosed the Veteran with bilateral pes planus and bilateral plantar fasciitis. She opined that these disabilities are not related to the Veteran's service. Regarding direct service connection for bilateral pes planus and bilateral plantar fasciitis, she stated that she could not offer a positive opinion because the Veteran's STRs are silent for complaints and treatment for these disabilities. Again, the Board notes that a lack of complaints and treatment in the Veteran's STRs, alone, is not an adequate reason for denying the Veteran service connection. With regard to pes planus, the examiner acknowledged that it is not a congenital defect, but a disease that developed in the Veteran's adult life. However, she noted that she could not state, without speculation, how pes planus developed. She concluded that pes planus did not clearly and unmistakably exist prior to service, but she speculated that it was not aggravated beyond its natural progression by an in-service event. Due to the speculative nature of the examiner's opinions regarding the Veteran's bilateral pes planus and bilateral plantar fasciitis, and other noted deficiencies, a remand is necessary to obtain addenda medical opinions regarding the etiologies of the Veteran's bilateral pes planus and bilateral plantar fasciitis. Benign Paroxysmal Positional Vertigo The Veteran contends his vertigo is related to his active service. Alternatively, he contends that it is related to a service-connected disability. He did not specify a service-connected disability to which his vertigo could be related. The Veteran has a current diagnosis of benign paroxysmal positional vertigo. See November 2019 VA Examination Report. Again, the examiner stated that she could not offer a positive nexus opinion without resorting to speculation. She opined that the Veteran's vertigo was not related to his military service, referring to the lack of complaints and treatment for symptoms in the Veteran's STRs. She also opined that the Veteran's vertigo was not secondary to a service-connected disability, noting that the only service-connected disability that is somewhat related to vertigo is tinnitus and that tinnitus does not cause vertigo. The examiner stated that she could not conclude whether the Veteran's vertigo was aggravated by a service-connected disability. The Board finds that this is not an adequate opinion on which to decide the Veteran's claim. Notably, the lack of complaints and treatment for vertigo and related symptoms in service cannot be the sole reason for denying the Veteran service connection. His reports concerning the history of his disability and related symptoms should be considered. As such, a remand is necessary for an addendum medical opinion concerning the Veteran's vertigo. Accordingly, the matters are REMANDED for the following action: Forward the Veteran's claims file to appropriate VA clinicians to obtain addenda medical opinions concerning the nature and etiologies of the Veteran's skin disabilities, bilateral pes planus, bilateral plantar fasciitis, and benign paroxysmal positional vertigo. Relevant VA examination(s) should be scheduled if the respective clinician believes that another examination is necessary to answer the questions below. The clinician is asked to review the Veteran's claims file, including a copy of this Remand, and respond to the following. a. For the Veteran's skin disabilities: i. Opine whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran's skin disability, to include eczema and psoriasis, is related to his active service, to include his exposure to herbicide agents. In answering this question, the examiner is asked to consider and address the Veteran's lay assertions that while in the Republic of Vietnam, he was in the jungle, where he showered outside using drums of water, and that he drank the water; and also that he had a skin condition during service, which he treated with lotion, and that it got worse after discharge. The examiner should also address the Veteran's post-service private and VA treatment records documenting complaints and treatment for his skin disabilities. ii. Opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran's skin disability, to include eczema and psoriasis, was caused OR aggravated by a service-connected disability. Complete rationales must be provided for all opinions expressed. If the examiner is unable to provide an opinion, he or she must state why, addressing whether this is due to limited medical knowledge and stating (if possible) what information is necessary to give a more conclusive opinion. b. For the Veteran's bilateral pes planus: i. Opine whether the Veteran's bilateral pes planus is a congenital disease, congenital defect, or an acquired disorder. The examiner is advised that for purposes of VA compensation, a congenital defect is defined as a condition that is more or less stationary in nature, whereas a congenital disease is defined as a condition capable of improving or deteriorating. ii. If the Veteran's bilateral pes planus is a congenital defect, the examiner must opine whether it is at least as likely as not (a 50 percent or greater probability) that he experienced a superimposed injury or disease upon such bilateral pes planus during active service. If the answer is "Yes," please describe the resultant disability. iii. If the Veteran's pes planus is a congenital disease, the examiner must opine as to whether the Veteran's pes planus clearly and unmistakably existed prior to his active service and clearly and unmistakably WAS NOT aggravated during military service (i.e., please determine whether it is clear and unmistakable that there was no increase in disability during service or that it is clear and unmistakable that any increase in disability was due to the natural progress of the preexisting condition). iv. If the Veteran's pes planus is not a congenital defect or disease, the examiner must opine whether it is at least as likely as not (a 50 percent or greater probability) that such is related to an in-service injury, event, or disease. In answering the above questions regarding pes planus, the examiner is asked to consider and address the Veteran's lay assertions that he has had pes planus for several years and that he did not have any foot problems prior to entering service; his attorney's lay assertions that the Veteran did not have pes planus prior to service but "had it on discharge" and did not know what had caused it, emphasizing that it happened during service; and the Veteran's reports concerning the circumstances of his service that he believes may have caused his current bilateral pes planus. Complete rationales must be provided for all opinions expressed. If the examiner is unable to provide an opinion, he or she must state why, addressing whether this is due to limited medical knowledge and stating (if possible) what information is necessary to give a more conclusive opinion. c. For the Veteran's bilateral plantar fasciitis: i. Opine whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran's bilateral plantar fasciitis is related to an in-service injury, event, or disease. In answering this question, the examiner must consider and address the Veteran's lay assertions that he has had plantar fasciitis longer than he could remember, and that he did not have any foot problems prior to entering service. Complete rationales must be provided for all opinions expressed. If the examiner is unable to provide an opinion, he or she must state why, addressing whether this is due to limited medical knowledge and stating (if possible) what information is necessary to give a more conclusive opinion. d. For the Veteran's benign paroxysmal positional vertigo: i. Opine whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran's benign paroxysmal positional vertigo is related to an in-service injury, event, or disease. ii. Opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran's benign paroxysmal positional vertigo is caused or aggravated by a service-connected disability, to include tinnitus. Complete rationales must be provided for all opinions expressed. If the examiner is unable to provide an opinion, he or she must state why, addressing whether this is due to limited medical knowledge and stating (if possible) what information is necessary to give a more conclusive opinion. A. J. Spector Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Trowers, Associate 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.