Citation Nr: 21073446 Decision Date: 12/08/21 Archive Date: 12/08/21 DOCKET NO. 17-54 362 DATE: December 8, 2021 ORDER Service connection for a deviated septum is granted. Service connection for sinusitis is granted. Service connection for a right shoulder disability is granted. Service connection for irritable bowel syndrome (IBS), including as a qualifying chronic disability to include undiagnosed illness, is granted. Service connection for right upper extremity radiculopathy (claimed as a right elbow disorder), including as secondary to the service-connected degenerative arthritis of the cervical spine (cervical spine disability), is granted. Service connection for left upper extremity radiculopathy (claimed as a left elbow disorder), including as secondary to the service-connected cervical spine disability, is granted. Service connection for right carpel tunnel syndrome is granted. Service connection for left carpel tunnel syndrome is granted. Service connection for right foot plantar fasciitis is granted. Service connection for left foot plantar fasciitis is granted. Service connection for right hand arthritis is denied. Service connection for left hand arthritis is denied. Service connection for gastroesophageal reflux disease (GERD) is denied. REMANDED Service connection for obstructive sleep apnea (OSA) is remanded. Service connection for a lumbar spine disorder, including as secondary to the service-connected cervical spine disability, is remanded. Service connection for right lower extremity radiculopathy is remanded. Service connection for left lower extremity radiculopathy is remanded. FINDINGS OF FACT 1. The Veteran is currently diagnosed with a deviated septum; the current deviated septum was diagnosed during active service; the current deviated septum had its onset during service. 2. The Veteran has qualifying service in the Southwest Asia theater of operations during the Persian Gulf War for purposes of 38 C.F.R. § 3.320; the Veteran is currently diagnosed with sinusitis; the current sinusitis manifested within 10 years of the date of separation from active service. 3. The Veteran is currently diagnosed with degenerative arthritis in the right shoulder (right shoulder disability); symptoms of the current right shoulder arthritis were chronic in service and have been continuous since service separation. 4. The Veteran served in the Southwest Asia Theater of operations during the Persian Gulf War; the Veteran's current IBS is a medically unexplained chronic multi-symptom illness that has manifested to a compensable degree during a six-month period since service. 5. The Veteran is currently diagnosed with right upper extremity radiculopathy; the current right upper extremity radiculopathy is etiologically related to the service-connected degenerative arthritis of the cervical spine (cervical spine disability). 6. The Veteran is currently diagnosed with left upper extremity radiculopathy; the current left upper extremity radiculopathy is etiologically related to the service-connected cervical spine disability. 7. The Veteran is currently diagnosed with right hand carpel tunnel syndrome (CTS); symptoms of right hand CTS were chronic during service and have been continuous since service separation. 8. The Veteran is currently diagnosed with left hand CTS; symptoms of left hand CTS were chronic during service and have been continuous since service separation. 9. The Veteran is currently diagnosed with right foot plantar fasciitis; the current right foot plantar fasciitis was diagnosed during active service; the current right foot plantar fasciitis had its onset during service. 10. The Veteran is currently diagnosed with left foot plantar fasciitis; the current left foot plantar fasciitis was diagnosed during active service; the current left foot plantar fasciitis had its onset during service. 11. The Veteran does not have a current diagnosis for right hand arthritis. 12. The Veteran does not have a current diagnosis for left hand arthritis. 13. The Veteran is currently diagnosed with GERD; the current GERD did not have its onset during active service, and is not otherwise etiologically related to an injury or disease incurred during active duty for training (ACDUTRA) service, or to an injury incurred during inactive duty for training (INACDUTRA) service. CONCLUSIONS OF LAW 1. Resolving reasonable doubt in favor of the Veteran, the criteria for service connection for a deviated septum have been met. 38 U.S.C. §§ 101, 1110, 1131, 5103, 5103A, 5107, 7104; 38 C.F.R. §§ 3.6, 3.102, 3.159, 3.303, 3.304. 2. Resolving reasonable doubt in favor of the Veteran, the criteria for service connection for sinusitis on a presumptive basis under 38 C.F.R. § 3.320 have been met. 38 U.S.C. § 1110; 38 C.F.R. § 3.320 (86 Fed. Reg. 42732 (Aug. 5, 2021)). 3. Resolving reasonable doubt in favor of the Veteran, the criteria for service connection for a right shoulder disability have been met. 38 U.S.C. §§ 101, 1110, 1112, 1131, 1133, 5103, 5103A, 5107, 7104; 38 C.F.R. §§ 3.6, 3.102, 3.159, 3.303, 3.307, 3.309. 4. Resolving reasonable doubt in favor of the Veteran, the criteria for presumptive service connection for IBS as a qualifying chronic disability have been met. 38 U.S.C. §§ 101, 1110, 1117, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.6, 3.102, 3.159, 3.303, 3.317. 5. Resolving reasonable doubt in favor of the Veteran, the criteria for service connection for right upper extremity radiculopathy, as secondary to the service-connected cervical spine disability, have been met. 38 U.S.C. §§ 101, 1110, 1112, 1131, 1133, 5103, 5103A, 5107, 7104; 38 C.F.R. §§ 3.6, 3.102, 3.159, 3.303, 3.307, 3.309, 3.310. 6. Resolving reasonable doubt in favor of the Veteran, the criteria for service connection for left upper extremity radiculopathy, as secondary to the service-connected cervical spine disability, have been met. 38 U.S.C. §§ 101, 1110, 1112, 1131, 1133, 5103, 5103A, 5107, 7104; 38 C.F.R. §§ 3.6, 3.102, 3.159, 3.303, 3.307, 3.309, 3.310. 7. Resolving reasonable doubt in favor of the Veteran, the criteria for service connection for right hand carpel tunnel syndrome have been met. 38 U.S.C. §§ 101, 1110, 1112, 1131, 1133, 5103, 5103A, 5107, 7104; 38 C.F.R. §§ 3.6, 3.102, 3.159, 3.303, 3.307, 3.309. 8. Resolving reasonable doubt in favor of the Veteran, the criteria for service connection for left hand carpel tunnel syndrome have been met. 38 U.S.C. §§ 101, 1110, 1112, 1131, 1133, 5103, 5103A, 5107, 7104; 38 C.F.R. §§ 3.6, 3.102, 3.159, 3.303, 3.307, 3.309. 9. Resolving reasonable doubt in favor of the Veteran, the criteria for service connection for right foot plantar fasciitis have been met. 38 U.S.C. §§ 101, 1110, 1131, 5103, 5103A, 5107, 7104; 38 C.F.R. §§ 3.6, 3.102, 3.159, 3.303, 3.304. 10. Resolving reasonable doubt in favor of the Veteran, the criteria for service connection for left foot plantar fasciitis have been met. 38 U.S.C. §§ 101, 1110, 1131, 5103, 5103A, 5107, 7104; 38 C.F.R. §§ 3.6, 3.102, 3.159, 3.303, 3.304. 11. The criteria for service connection for right hand arthritis have not been met. 38 U.S.C. §§ 101, 1110, 1131, 5103, 5103A, 5107, 7104; 38 C.F.R. §§ 3.6, 3.102, 3.303, 3.304, 3.307, 3.309. 12. The criteria for service connection for left hand arthritis have not been met. 38 U.S.C. §§ 101, 1110, 1131, 5103, 5103A, 5107, 7104; 38 C.F.R. §§ 3.6, 3.102, 3.303, 3.304, 3.307, 3.309. 13. The criteria for service connection for GERD have not been met. 38 U.S.C. §§ 101, 1110, 1131, 5103, 5103A, 5107, 7104; 38 C.F.R. §§ 3.6, 3.102, 3.303, 3.304. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran, who is the appellant, served on active duty from May 1983 to August 1983, October 1986 to September 1988, January 1996 to July 1996, November 2002 to November 2006, and from October 2007 to April 2011, with various periods of ACDUTRA and INACDUTRA service with the U.S. Army Reserves. Service Connection Legal Criteria Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). "Active military, naval, or air service" includes any period of ACDUTRA during which the individual concerned was disabled or died from a disease or injury incurred in or aggravated in line of duty, or any period of INACDUTRA during which the individual concerned was disabled or died from injury incurred in or aggravated in line of duty. See 38 U.S.C. § 101(21), (24); 38 C.F.R. § 3.6(a), (d); Biggins v. Derwinski, 1 Vet. App. 474, 477 78 (1991). ACDUTRA is defined as full-time duty in the Armed Forces performed by Reserves for training purposes, and includes full-time duty performed by members of the National Guard of any State. 38 U.S.C. § 101(22); 38 C.F.R. § 3.6(c)(1). Service connection for INACDUTRA is permitted only for injuries, not diseases, incurred or aggravated in line of duty. See Brooks v. Brown, 5 Vet. App. 484, 485 (1993). VA's General Counsel has interpreted that it was the intention of Congress when it defined active service in 38 U.S.C. § 101(24) to exclude inactive duty training during which a member was disabled or died due to nontraumatic incurrence or aggravation of a disease process. See VAOPGCPREC 86-90. With any claim for service connection (under any theory of entitlement), it is necessary for a current disability to be present. See Brammer v. Derwinski, 3 Vet. App. 223 (1992); see also McClain v. Nicholson, 21 Vet. App. 319 (2007) (service connection may be warranted if there was a disability present at any point during the claim period, even if it is not currently present); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013) (when the record contains a recent diagnosis of disability immediately prior to a veteran filing a claim for benefits based on that disability, the report of diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency). Service connection may also be granted for a disability that is proximately due to or the result of a service-connected disability. See 38 C.F.R. § 3.310(a). When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. See id.; Harder v. Brown, 5 Vet. App. 183, 187 (1993). The controlling regulation has been interpreted to permit a grant of service connection not only for disability caused by a service connected disability, but for the degree of disability resulting from aggravation of a non-service-connected disability by a service-connected disability. See Allen v. Brown, 7 Vet. App. 439, 448 (1995). In other words, service connection may be granted for a disability found to be proximately due to, or the result of, a service-connected disease or injury. To prevail on the issue of secondary service causation, the record must show (1) evidence of a current disability, (2) evidence of a service-connected disability, and (3) medical nexus evidence establishing a connection between the current disability and the service connected disability. Wallin v. West, 11 Vet. App. 509, 512 (1998); Reiber v. Brown, 7 Vet. App. 513, 516-17 (1995). Service connection may be granted on a presumptive basis for a Persian Gulf veteran who exhibits objective indications of qualifying chronic disability, including resulting from undiagnosed illness, that became manifest either during active service in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent or more not later than December 31, 2021, and which by history, physical examination, and laboratory tests cannot be attributed to any known clinical diagnosis. 38 U.S.C. § 1117; 38 C.F.R. § 3.317(a)(1). In claims based on qualifying chronic disability, unlike those for direct service connection, there is no requirement that there be competent evidence of a nexus between the claimed illness and service. Gutierrez v. Principi, 19 Vet. App. 1, 8-9 (2004). Laypersons are competent to report objective non-medical indicators of illness. The term "Persian Gulf veteran" means a veteran who served on active military, naval, or air service in the Southwest Asia Theater of operations during the Persian Gulf War. 38 C.F.R. § 3.317(e)(1). Military personnel records show the Veteran served in Southwest Asia for various periods in 2005; therefore, the Veteran is a "Persian Gulf veteran" (i.e., had active military service in the Southwest Asian Theater of operations during the Gulf War) as defined by 38 C.F.R. § 3.317. A "qualifying chronic disability" for VA purposes is a chronic disability resulting from (A) an undiagnosed illness, (B) a medically unexplained chronic multisymptom illness (such as chronic fatigue syndrome (CFS), fibromyalgia, or functional gastrointestinal disorders that include IBS and dyspepsia) that is defined by a cluster of signs or symptoms, or (C) any diagnosed illness that the Secretary determines in regulation prescribed under 38 U.S.C. § 1117(d) warrants a presumption of service connection. 38 U.S.C. § 1117(a)(2); 38 C.F.R. § 3.317(a)(2)(i)(B). "Objective indications of chronic disability" include both "signs," in the medical sense of objective evidence perceptible to a physician, and other, non-medical indicators that are capable of independent verification. To fulfill the requirement of chronicity, the illness must have persisted for a period of six months. 38 C.F.R. § 3.317(a)(2), (3). Signs or symptoms that may be manifestations of undiagnosed illness include, but are not limited to, the following: (1) fatigue; (2) signs or symptoms involving skin; (3) headache; (4) muscle pain; (5) joint pain; (6) neurologic signs or symptoms; (7) neuropsychological signs or symptoms; (8) signs or symptoms involving the respiratory system (upper or lower); (9) sleep disturbances; (10) gastrointestinal signs or symptoms; (11) cardiovascular signs or symptoms; (12) abnormal weight loss; and 13) menstrual disorders. 38 C.F.R. § 3.317(b). Additionally, under 38 C.F.R. § 3.320, for veterans with qualifying service in the Southwest Asia theater of operations during the Persian Gulf War, service connection may be presumed for certain listed chronic diseases associated with exposure to fine, particulate matter, which listed diseases include: asthma, rhinitis, and sinusitis (to include rhinosinusitis). Service connection may be presumed under 38 C.F.R. § 3.320 even though there is no evidence of a listed disease during the period of service if it becomes manifest to any degree (including non-compensable) within 10 years from the date of separation. Exposure to fine, particulate matter shall be presumed under 38 C.F.R. § 3.320 for veterans with qualifying service in the Southwest Asia theater of operations during the Persian Gulf War. The Veteran is currently diagnosed with degenerative arthritis in the right shoulder, right and left upper extremity radiculopathies and right and left hand carpel tunnel syndromes (as organic diseases of the nervous system), which are "chronic diseases" under 38 C.F.R. § 3.309(a). Therefore, the presumptive provisions of 38 C.F.R. § 3.303(b) for "chronic" in-service symptoms and "continuous" post service symptoms apply for the periods of the Veteran's active service listed above. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Presumptive periods do not apply to ACDUTRA or INACDUTRA service. See Biggins, 1 Vet. App. at 447 78. Where the evidence shows a "chronic disease" in service or "continuity of symptoms" after service, the disease shall be presumed to have been incurred in service. For the showing of "chronic" disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. With chronic disease as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service-connected, unless clearly attributable to intercurrent causes. If a condition noted during service is not shown to be chronic, then generally, a showing of "continuity of symptoms" after service is required for service connection. 38 C.F.R. § 3.303(b). Additionally, where a veteran served 90 days or more of active service, and certain chronic diseases, such as arthritis and organic diseases of the nervous system, become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 C.F.R. §§ 3.307, 3.309(a). While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. Id. 1. Service connection for a deviated septum The Veteran seeks service connection for a deviated septum due to an injury in service in1988 when a tanker hatch hit him in the back of the neck, causing him to hit his face on the tanker lid. The Veteran also asserts that he sought treatment during service for recurrent sinus infections, which were caused by the deviated septum. See November 2020 Board hearing transcript. At the outset, the evidence shows a current diagnosis of a deviated septum. See November 2015 VA examination report. After a review of all the lay and medical evidence of record, the Board finds that the evidence is at least in equipoise on the question of whether the Veteran's current deviated septum had its onset during service. Several service examination reports, done prior to the period of active service from November 2002 to November 2006, reflect the Veteran's nose was found to be clinically normal. See April 1983 service treatment record; July 1983 service treatment record; October 1986 service treatment record; December 1989 service treatment record; September 1993 service treatment record. A July 2003 service examination report reflects a diagnosis of septal deviation. Other service treatment records, VA and private treatment records do not reflect any earlier treatment or diagnosis for a deviated septum. The record includes a November 2015 VA examination report that reflects the Veteran reported he was diagnosed with a deviated septum during active service in 2003, and that the VA examiner determined the Veteran is currently diagnosed with a deviated septum; however, the November 2015 VA examiner did not provide an opinion as to the etiology of the Veteran's current deviated septum and whether it is at least as likely as not related to the deviated septum diagnosed during service in July 2003. Based on this evidence, the Board finds that the evidence is at least in equipoise on the question of whether the Veteran's current deviated septum had its onset during service. Resolving reasonable doubt in the Veteran's favor, the Board finds that the current deviated septum is etiologically related to the deviated septum diagnosed during service in July 2003. Accordingly, service connection for a deviated septum is being granted on a direct basis. 2. Service connection for sinusitis The Veteran generally contends that service connection for sinusitis is warranted as he was treated for sinusitis several times during service. See January 2017 Notice of Disagreement. Initially, the Board finds that the Veteran is currently diagnosed with sinusitis. See November 2015 VA treatment record. In this case, the DD 214 Forms show the Veteran was deployed to Qatar from January 2005 to February 2005 and deployed to Iraq from September 2005 to October 2005. Therefore, service in the Southwest Asia theater of operations for 38 C.F.R. § 3.320 purposes is shown. Service treatment records reflect the Veteran consistently reported histories of sinusitis, and post-service treatment records reflect the Veteran has been continuously treated for sinusitis since service separation. See e.g., September 2001 service treatment record; March 2013 VA treatment record; May 2013 private treatment record; November 2015 VA treatment record. As shown above, the Veteran is shown to have qualifying service in the Southwest Asia theater of operations for 38 C.F.R. § 3.320 purposes. Further, the Veteran is currently diagnosed with sinusitis that manifested within the 10-year presumptive period for service connection purposes, with no intercurrent cause shown; therefore, the Board finds that the criteria for presumptive service connection for sinusitis under 38 C.F.R. § 3.320 have been met. 3. Service connection for a right shoulder disability The Veteran contends that a right shoulder disability had its onset during service. During the November 2020 Board hearing, the Veteran testified that right shoulder symptoms began in 2008 in relation to the injuries sustained that caused the service-connected cervical spine disability. Additionally, the Veteran asserts that the right shoulder disability was either caused or worsened beyond its normal progression by the service-connected degenerative arthritis of the left shoulder (left shoulder disability). Initially, the Board finds the Veteran is currently diagnosed with degenerative arthritis in the right shoulder. See November 2015 VA examination report. After a review of all the evidence of record, lay and medical, the Board finds that the evidence is at least in equipoise on the questions of whether symptoms of the right shoulder arthritis were chronic in service and have been continuous since service separation, to meet the criteria for "chronic" disease presumptive service connection for arthritis. See 38 U.S.C. § 1112 and 38 C.F.R. § 3.303(b). Service treatment records reflect the Veteran complained of right shoulder pain on numerous occasions during service. See e.g., December 2004 service treatment record (complained of cervical spine pain and right shoulder pain); January 2008 service treatment record (complained of right shoulder injury due to rucking); November 2009 service treatment record; May 2013 service examination report (noting bilateral shoulder impingement syndrome). Additionally, the Veteran credibly testified during the November 2020 Board hearing that he had experienced right shoulder pain during service and has continued to experience chronic pain in the right shoulder since service separation. Post-service private treatment records show the Veteran has been receiving treatment for right shoulder pain since service. See February 2015 private treatment record. The foregoing evidence pertains to chronic symptoms in service and continuous symptoms of right shoulder arthritis since service separation. The Veteran's statements are competent, credible, and probative. Resolving reasonable doubt in the Veteran's favor, the Board finds that, based on evidence of chronic symptoms in service and continuous post-service symptoms of right shoulder arthritis, presumptive service connection for right shoulder arthritis is warranted under 38 C.F.R. § 3.303(b). 38 U.S.C. § 5107; 38 C.F.R. § 3.102. As the criteria for presumptive service connection for a right shoulder disability based on continuous post service symptoms (38 U.S.C. § 1112 and 38 C.F.R. § 3.303(b)) are met, all other theories of service connection are rendered moot, with no remaining questions of law or fact to be decided. 38 U.S.C. § 7104. 4. Service connection for IBS The Veteran generally contends that symptoms of IBS have persisted since service separation and are the result of service in Bosnia. Initially, the Board finds the Veteran is currently diagnosed with IBS. See November 2015 VA examination report. IBS is on the list of medically unexplained chronic multisymptom illnesses subject to presumptive service connection. 38 C.F.R. § 3.317. Accordingly, nexus evidence is not required for presumptive service connection. Gutierrez, 19 Vet. App. at 10. The evidence shows symptoms of IBS are consistent with at least a (compensable) 10 percent disability rating. Under the rating schedule, IBS would be rated under irritable colon syndrome, Diagnostic Code 7319. See 38 C.F.R. § 4.114, Diagnostic Code 7319. Under Diagnostic Code 7319, a 10 percent disability rating is warranted for moderate, frequent episodes of bowel disturbance with abdominal distress. After a review of all the lay and medical evidence of record, the Board finds that the evidence is at least in equipoise on the question of whether the currently diagnosed IBS has been manifested by symptoms of moderate, frequent episodes of bowel disturbance with abdominal distress for a period of at least six months since service in the Gulf War. The November 2015 VA examination report shows that the Veteran reported increased symptoms in the morning and that he takes probiotics and Prilosec to treat his symptoms. The Veteran also reported diarrhea 6 to 7 times per day and abdominal distension several times a day. Based on the foregoing evidence, the Board finds that presumptive service connection for IBS as a medically unexplained chronic multi-symptom illness is warranted. 38 U.S.C. § 1117; 38 C.F.R. § 3.317. The grant of presumptive service connection as due to a qualifying chronic disability renders other theories of service connection moot. 5. Service connection for right upper extremity radiculopathy 6. Service connection for left upper extremity radiculopathy The Veteran generally asserts that service connection for right and left upper extremity radiculopathies (claimed as right and left elbow disorders) are warranted as symptoms had onset during active service. See November 2020 Board hearing transcript. Initially, the Board finds the Veteran is currently diagnosed with right and left upper extremity radiculopathies. See October 2016 VA examination report. After a review of all the lay and medical evidence, the Board finds that the evidence is at least in relative equipoise on the question of whether the current right and left lower extremity radiculopathies are the result of the (now) service-connected cervical spine disability. The October 2016 VA examination report shows the Veteran reported neck pain that radiates into the right and left upper extremities. Upon examination of the Veteran, the October 2016 VA examiner noted positive findings for mild right upper extremity radiculopathy and moderate left upper extremity radiculopathy involving the C6/C5 nerve roots. Further, the VA examiner opined that it is more likely than not that the Veteran's right and left upper extremity radiculopathy symptoms are the result of compression of the nerves from cervical foraminal narrowing as shown on diagnostic imagining studies. Based on the foregoing evidence, the Board finds that the evidence is at least in relative equipoise on the question of whether the current right and left upper extremity radiculopathies are the result of the service-connected cervical spine disability. Resolving reasonable doubt in favor of the Veteran, the Board finds that the criteria for service connection for right and left upper extremity radiculopathies, as secondary to the service-connected cervical spine disability, have been met. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 3.310. As service connection is being granted on a secondary basis, there is no need to discuss entitlement to service connection on any other basis, as other theories of service connection have been rendered moot, leaving no question of law or fact to decide. See 38 U.S.C. § 7104. 7. Service connection for right hand carpel tunnel syndrome 8. Service connection for left hand carpel tunnel syndrome The Veteran asserts that symptoms of right and left hand carpel tunnel syndrome began during service around the time he suffered a neck injury in 2008. See November 2020 Board hearing transcript. The Veteran testified that he started having symptoms of tingling in the wrists, which were eventually diagnosed as carpel tunnel syndrome around the time he retired from the Army Reserves in 2015. At the outset, the Board finds the Veteran is currently diagnosed with right and left hand carpel tunnel syndrome. See November 2015 VA examination report. After a review of all the evidence of record, lay and medical, the Board finds that the evidence is at least in equipoise on the questions of whether symptoms of the right and left hand CTS were chronic in service and have been continuous since service separation, to meet the criteria for "chronic" disease presumptive service connection for organic diseases of the nervous system. See 38 U.S.C. § 1112 and 38 C.F.R. § 3.303(b). Service treatment records reflect the Veteran complained of tingling in both elbows and numbness in the hands while on active duty. See January 2008 service treatment record; May 2010 service treatment record (numbness attributed to ulnar irritation). Additionally, the Veteran credibly testified during the November 2020 hearing that he had experienced wrist and elbow symptoms during service since 2008 around the time of his neck injury that occurred in January 2008. Post-service private treatment records show the Veteran has been receiving treatment for right and left hand, wrist, and elbow symptoms since service separation. A December 2014 private treatment record during a period of INACDUTRA service reflects the Veteran's symptoms were assessed as probable bilateral CTS; a nerve study subsequently confirmed borderline CTS in the right hand and moderate CTS in the left hand. See February 2015 private treatment record. The foregoing evidence pertains to chronic symptoms in service and continuous symptoms of right and left hand CTS since service separation. The Veteran's statements are competent, credible, and probative. Resolving reasonable doubt in the Veteran's favor, the Board finds that, based on evidence of chronic symptoms in service and continuous post-service symptoms of right and left hand CTS, presumptive service connection for right and left hand CTS is warranted under 38 C.F.R. § 3.303(b). 38 U.S.C. § 5107; 38 C.F.R. § 3.102. As the criteria for presumptive service connection for right and left hand CTS based on continuous post service symptoms (38 U.S.C. § 1112 and 38 C.F.R. § 3.303(b)) are met, all other theories of service connection are rendered moot, with no remaining questions of law or fact to be decided. 38 U.S.C. § 7104. 9. Service connection for right foot plantar fasciitis 10. Service connection for left foot plantar fasciitis The Veteran asserts that he developed right and left foot plantar fasciitis during active service from years of wearing boots and rucking various qualification courses with full combat loads. During the November 2020 Board hearing, the Veteran testified that he began having foot pain in 2003 and was diagnosed with plantar fasciitis. Initially, the Board finds the Veteran is currently diagnosed with right and left foot plantar fasciitis. See November 2015 VA examination report. After a review of all the lay and medical evidence of record, the Board finds that the evidence is at least in equipoise on the question of whether right and left foot plantar fasciitis had its onset during active service. Several service examination reports reflect the Veteran's feet were found to be clinically normal. See April 1983 service treatment record; July 1983 service treatment record; October 1986 service treatment record; December 1989 service treatment record; September 1993 service treatment record. A May 2003 service treatment record reflects the Veteran complained of shin pain with running that began two to three months ago. At the time, the Veteran reported a history of plantar fasciitis and that he had been wearing prescription orthotics. A July 2003 service treatment record reflects the Veteran was also diagnosed with pes planus and that the Veteran was currently being treated for plantar fasciitis. Other service treatment records during active service show the Veteran continued to seek treatment for plantar fasciitis. See e.g., February 2006 service treatment record; January 2010 service treatment record (reflecting diagnosis for plantar fasciitis). Service treatment records, VA and private treatment records do not reflect any earlier treatment or diagnosis for right and left foot plantar fasciitis. The record includes a November 2015 VA examination report that reflects the Veteran is currently diagnosed with right and left foot plantar fasciitis; however, the November 2015 VA examiner did not provide an opinion as to the etiology of the Veteran's current plantar fasciitis and whether it is at least as likely as not related to the plantar fasciitis treated and diagnosed during service. For these reasons, the Board finds that the evidence is at least in equipoise on the question of whether the Veteran's current right and left foot plantar fasciitis had its onset during service. Resolving reasonable doubt in the Veteran's favor, the Board finds that the current right and left foot plantar fasciitis are etiologically related to the plantar fasciitis diagnosed during active service. Accordingly, service connection for right and left foot plantar fasciitis is being granted on a direct basis. 11. Service connection for right hand arthritis 12. Service connection for left hand arthritis The Veteran generally asserts that service connection for right and left hand arthritis is warranted as he began experiencing arthritis symptoms in the hands during active service. See November 2020 Board hearing transcript. After a review of all the lay and medical evidence of record, the Board finds that the weight of the evidence demonstrates that the Veteran does not currently have right or left hand arthritis. VA and private treatment records do not reflect any complaints, symptoms, diagnoses, or treatment for right or left hand arthritis at any time during the relevant claims period on appeal. Instead, an April 2015 service treatment record reflects that X-rays of the right and left hands revealed unremarkable osseous mineralization, no fractures or deformities. Although joint spaces were mildly decreased in the interphalangeal joints, the diagnostic imaging studies did not reveal evidence of arthritis. In the absence of a current disability at any time during or immediately prior to the relevant claims period on appeal, the claims for service connection for right and left hand arthritis must be denied. 13. Service connection for GERD The Veteran generally contends that GERD had its onset during active service. See November 2020 Board hearing transcript. Initially, the Board finds the Veteran is currently diagnosed with GERD. See July 2017 VA treatment record. After a review of all the lay and medical evidence of record, the Board finds that the current GERD did not have its onset in, and is not otherwise etiologically related to active service, or to an injury or disease sustained during any period of ACDUTRA service or to an injury sustained during INACDUTRA service. While service treatment records reflect the Veteran had been seen and treated for IBS on numerous occasions as discussed above, service treatment records do not reflect complaints, symptoms, treatment, or diagnosis for GERD during a period of active service. See also January 2020 private medical letter (stating Veteran had been treated for diarrhea, gas, bloating, abdominal cramping diagnosed as IBS since 1996). The earliest indication of GERD appears in an April 2015 Report of Medical History completed during the Veteran's Reserve retirement examination, that shows the Veteran reported taking Omeprazole and that he has a history of GERD. A July 2017 VA treatment record shows the Veteran presented to establish care for GERD, reported a history of GERD that had been worsening over the past year, and that he had been taking Omeprazole for about two years, which would indicate the onset of GERD after the Veteran's last period of active service from October 2007 to April 2011. Furthermore, the evidence shows no injury during active service or during Reserve service that resulted in the development of GERD. Based on the foregoing, and as the record does not contain any competent medical opinion establishing a medical nexus between the current GERD and a period of active service, or to an injury or disease incurred during a period of ACDUTRA service or injury during INACDUTRA service, the Board finds that the weight of the evidence is against service connection for GERD, and the claim must be denied. REASONS FOR REMAND 14. Service connection for obstructive sleep apnea The Veteran generally asserts that OSA had its onset during active service. During the November 2020 Board hearing, the Veteran asserts that symptoms of OSA were reported during a September 2006 service examination. The record includes a November 2015 VA examination report which includes the VA examiner's opinion that it is less likely than not that the Veteran's current OSA is etiologically related to active service because the Veteran was not diagnosed with OSA until a 2015 sleep study, which was four years after active service. However, the November 2015 VA examiner did not address the September 2006 service treatment records showing the Veteran reported symptoms of snoring apnea. Accordingly, the Board finds that remand for a VA addendum opinion is needed. 15. Service connection for a lumbar spine disorder 16. Service connection for right lower extremity radiculopathy 17. Service connection for left lower extremity radiculopathy The Veteran generally asserts that a lumbar spine disability is the result of rucking during service, and/or is caused by an alleged altered gait resulting from the service-connected cervical spine disability. See November 2020 Board hearing transcript. The record does not include a VA examination or VA medical opinions on the questions of direct or secondary service connection. The record shows current diagnoses of right and left lower extremity radiculopathy; however, the etiologies of the claimed radiculopathies are unclear. Specifically, service treatment records indicate symptoms of lower extremity radiculopathy that may predate the onset of any lumbar spine symptoms and/or may be unrelated to the claimed lumbar spine disorder. See, e.g., July 2003 service treatment record. Accordingly, a remand for VA examinations and VA medical opinions may be helpful in finding these facts. These issues of service connection for a back disorder and lower extremity radiculopathies are REMANDED for the following actions: 1. Request that a VA medical professional review the electronic file and provide the VA addendum opinion requested below for the claimed obstructive sleep apnea. If the VA examiner determines that additional examination(s) of the Veteran is necessary to provide a reliable opinion as to causation, such examination(s) should be scheduled; however, the Veteran should not be required to report for another examination as a matter of course, if it is not found to be necessary. The VA examiner should provide the following opinion: Is it at least as likely as not (i.e., 50 percent probability or greater) that the current OSA had its onset during active service? The VA examiner should address the September 2006 service treatment records that reflect the Veteran reported symptoms of snoring apnea. 2. Schedule the appropriate VA examinations in order help determine the nature and etiologies of the claimed lumbar spine disorder and right and left lower extremity radiculopathies. All indicated diagnostic testing studies should be performed. The VA examiner should provide the following opinions: a) Is it at least as likely as not (i.e., 50 percent probability or greater) that the current lumbar spine disability is the result of active service, including due to rucking with full combat gear? b) Is it at least as likely as not (i.e., 50 percent probability or greater) that the current lumbar spine disorder was caused by the Veteran's service-connected cervical spine disability? c) Is it at least as likely as not (i.e., 50 percent probability or greater) that the current lumbar spine disorder was worsened beyond its natural progression by the Veteran's service-connected cervical spine disability? d) Is it at least as likely as not (i.e., 50 percent probability or greater) that the current right and/or left lower extremity radiculopathies had their onset during active service? The VA examiner should address reports of lower extremity pain involving the sciatic nerve during active service such as those shown in a July 2003 service treatment record. (Continued on the next page) e) Are the current right and/or left lower extremity radiculopathies caused or worsened by the current lumbar spine disorder? J. PARKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Choi, 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.