Citation Nr: 21070843 Decision Date: 11/26/21 Archive Date: 11/26/21 DOCKET NO. 17-52 221 DATE: November 26, 2021 REMANDED Entitlement to service connection for left foot hallux valgus is remanded. Entitlement to service connection for nocturia is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from December 1984 to August 2011. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2014 rating decision issued by a Department of Veterans Affairs Regional Office (RO). The Board notes that the Veteran provided argument as to other issues not currently on appeal in the October 2017 substantive appeal. If the Veteran wishes to file as a claim as to these issues, he is advised to contact the Agency of Original Jurisdiction (AOJ). The Board notes that VA's duty to assist includes providing a medical examination and obtaining an opinion when it is necessary to make a decision on a claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159. Such development is necessary if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but (1) contains competent evidence of diagnosed disability or symptoms of disability, (2) establishes that the Veteran suffered an event, injury or disease in service, or has a presumptive disease during the pertinent presumptive period, and (3) indicates that the claimed disability may be associated with the in-service event, injury, or disease, or with another service-connected disability. 38 C.F.R. § 3.159 (c)(4); McLendon v. Nicholson, 20 Vet. App. 79, 83-86 (2006). The threshold for finding a link between a current disability and service so as to require medical examination is low. Locklear v. Nicholson, 20 Vet. App. 410 (2006); McLendon, 20 Vet. App. at 83. 1. Entitlement to service connection for left foot hallux valgus is remanded. is remanded. The Veteran generally contends that his left foot hallux valgus is related to service or had its onset in service. The Veteran's service treatment records reflect a suggestion of a hallux valgus deformity in December 2007. A subsequent VA examination in November 2012 confirms the diagnosis for hallux valgus, and finds occurring in both feet. The examination did not contain an etiology opinion. The Veteran has never been provided a VA etiology opinion regarding his left foot hallux and the record is silent for any opinions regarding etiology and/or a nexus to service. As such, the Board finds that remand is necessary as the record contains competent medical evidence diagnosing left foot hallux valgus; indication that the disease manifesting in-service or within a year of separation from service; and thereby is possibly linked to service. As the bar to meet the McLendon criteria is low, the Board find that remand is warranted to provide the Veteran with an etiology opinion regarding his left foot hallux valgus condition. See Id. 38 U.S.C. § 5103A(d)(2); 38 C.F.R. § 3.159(c)(4)(i). 2. Entitlement to service connection for nocturia is remanded. is remanded. The Veteran generally contends that his nocturia condition is related to service and that it impacts his sleep pattern. The Veteran's service treatment records indicate treatment for nocturia in October 2006, while in-service. A subsequent VA examination in November 2012 did not find frequent nighttime voiding (nocturia) but found other voiding dysfunction. Subsequent treatment records do not indicate voiding issues. As above, the Board finds that VA's duty to assist has been triggered by the evidence of record. The record reveals in-service medical treatment for nocturia. There is indication of subsequent urinary tract pathology. However, it is unclear if the Veteran presently continues to suffer from a nocturia condition. The Board finds that an examination and etiology opinion would be very helpful in adjudicating the Veteran's claim to service connection for nocturia. As the bar to meet the McLendon criteria is low, the Board find that remand is warranted to provide the Veteran with such an examination and etiology opinion. See Id. 38 U.S.C. § 5103A(d)(2); 38 C.F.R. § 3.159(c)(4)(i). The matters are REMANDED for the following action: 1. The Veteran should be given the opportunity to identify any outstanding private or VA treatment records relevant to the claims on appeal. After obtaining any necessary authorization from the Veteran, all outstanding records should be obtained, to include updated VA treatment records. For private treatment records, make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and his representative and afford him an opportunity to submit any copies in their possession. For federal records, all reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 2. Following the receipt of outstanding records, obtain an etiology opinion by an appropriate clinician to determine the nature and etiology of the Veteran's left foot hallux valgus. The examiner should review the entire claims file and note such review in the opinion. The need for further in-person examination is left to the discretion of the examiner. The examiner should respond to the following questions: (A) Does the Veteran presently suffer from a left foot hallux valgus condition? (B) If so, is it at least as likely as not (50 probability or greater) that the Veteran's current left foot hallux valgus had its onset during service or is otherwise related to service? The examiner should discuss the significance, if any, of the finding of a hallux valgus deformity in December 2007. A rationale should be provided for all opinions offered. If it is not possible to provide a specific opinion regarding the above questions, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). The medical opinion must support the conclusions reached with an analysis that is adequate to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 3. Following the receipt of outstanding records, obtain an etiology opinion by an appropriate clinician to determine the nature and etiology of the Veteran's claimed nocturia. The examiner should review the entire claims file and note such review in the opinion. The need for further in-person examination is left to the discretion of the examiner. The examiner should respond to the following questions: (A) Does the Veteran presently suffer from a nocturia condition? (B) If so, is it at least as likely as not (50 probability or greater) that the Veteran's nocturia condition had its onset during service or is otherwise related to service? The examiner should address the impact, if any, of the finding of idiopathic hematuria rule-out resolved urethritis in October 1996 and nocturia in October 2006. A rationale should be provided for all opinions offered. If it is not possible to provide a specific opinion regarding the above questions, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). The medical opinions must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. KRISTY L. ZADORA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Kashif I. Ali, 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.