Citation Nr: 21071395 Decision Date: 11/30/21 Archive Date: 11/30/21 DOCKET NO. 15-39 761 DATE: November 30, 2021 REMANDED Entitlement to service connection for a left foot fungus infection is remanded. REASONS FOR REMAND The Veteran served on active duty from July 2000 to July 2004, March 2007 to August 2007, and May 2009 to February 2013. This matter is before the Board of Veterans' Appeals (Board) on appeal from an April 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Nashville, TN. This issue was previously before the Board in September 2019 when the claim for service connection for a foot fungal infection was reopened and then remanded for additional development to include obtaining any outstanding VA and private treatment records related the claim and for a new VA examination to determine the nature and etiology of his left foot fungus infection. After the Board's September 2019 remand, the Veteran was afforded a June 2021 VA skin disease examination. The examiner indicated an in-person examination and review of available records including a March 2014 VA examination and the Veteran's April 2014 Notice of Disagreement. The March 2014 confirmed a diagnosis of onychomycosis from the Veteran's first period of service. However, the June 2021 examiner opined that the Veteran's bilateral foot fungal infection was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The Board finds this examination and medical opinion confusing. The examiner indicates that the conditions of the Veteran's Iraq deployment conditions during his first period of service were conducive to developing foot fungus, but provides no rationale in determining that the currently diagnosed onychomycosis is related to that in-service development of foot fungus. It also does not address the Veteran's contention in the June 2014 Notice of Disagreement that his foot fungus onset during his service in Iraq and had continued to get worse since then. Generally, lay evidence is probative with regard to a disease with "unique and readily identifiable features" that is "capable of lay observation." See Barr v. Nicholson, 21 Vet. App. 303, 308-09 (2007). However, a layperson cannot provide evidence as to more complex medical questions and, specifically, cannot provide an opinion as to etiology in such cases. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007); 38 C.F.R. § 3.159(a)(2). While the Veteran lacks the medical training to self-diagnose onychomycosis, as a lay person he can observe changes in the skin of his foot and report that these have continued since that time. On remand, an addendum opinion which addresses his contentions as well as the arguments of his representative including medical treatises, and provides a complete rationale for the opinion stated, should be obtained. The matters are REMANDED for the following action: Obtain an addendum opinion from the June 2021 VA examiner or, if unavailable, from another appropriate and qualified medical provider. The examiner should review the claims folder, to include 1) the March 2014 and June 2021 VA examination reports; 2) the Veteran's contention of ongoing symptomatology since his Iraq deployment during his first period of service as noted in the June 2014 Notice of Disagreement, the November 2016 VA treatment record, and the September 2015 and November 2016 private treatment record; and 3) the arguments and medical treatises noted in the Veteran's representative's November 2021 Informal Hearing Presentation. After reviewing these documents as well as the Veteran's service treatment records and remainder of the claims file, the examiner should provide an opinion as to whether it is at least as likely as not (50% or greater probability) that the Veteran's left foot fungal infection is related to his active service. The examiner is asked to address the Veteran's contentions as to continuity of symptomatology, as well as his representative's November 2021 arguments. All opinions must be supported by a complete rationale. J. Kirby Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Banks, 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.