Citation Nr: 21074499 Decision Date: 12/15/21 Archive Date: 12/15/21 DOCKET NO. 19-26 254 DATE: December 15, 2021 REMANDED 1. Entitlement to service connection for a left breast scar is remanded. 2. Entitlement to service connection for genital herpes, and associated residuals, is remanded. 3. Entitlement to service connection for posterior orthostatic tachycardia syndrome (POTS) is remanded. 4. Entitlement to a cervical spine disability (also claimed as radiculopathy of the bilateral upper extremities) is remanded. 5. Entitlement to service connection for a left foot disability is remanded. 6. Entitlement to service connection for a bilateral knee disability is remanded. 7. Entitlement to service connection for a bilateral ankle disability is remanded. REASONS FOR REMAND The Veteran was apparently affiliated with the Army National Guard and Reserve between May 1988 and May 2005. During that 17 year interval, she had active service in the United States Army from May 1988 to February 1989, from April 1996 to December 1996, and from April 1997 to April 2000, with additional periods of active duty for training (ACDUTRA) and inactive duty for training (INACDUTRA). These matters come to the Board of Veterans' Appeals (Board) on appeal from an October 2018 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In May 2021, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the claims file. The Board notes the Veteran's complete service treatment records, specifically those as could have been maintained by her Army National Guard/Reserve units, have not been associated with the file. It does appear that records related to the Veteran's medical board proceedings, as well as active-duty treatment records, have been obtained. As such, on remand, the RO must attempt to obtain any outstanding treatment records for the Veteran's periods of Reserve/Guard service. 1. Entitlement to service connection for a left breast scar is remanded. The record reflects that the Veteran underwent left breast surgery while on active duty in July 1999. She currently seeks service connection for the left breast scar that resulted from the in-service surgery. The Board finds it necessary to remand the claim of service connection for a left breast scar for a VA examination to determine whether it is related to the in-service surgery. 2. Entitlement to service connection for genital herpes, and associated residuals, is remanded. The record indicates the Veteran acquired a sexually transmitted disease while on active duty in July 1998. She currently seeks service connection for recurring herpes that originally developed during service. The Board finds it necessary to remand the claim of service connection for genital herpes for a VA examination to confirm whether the Veteran has recurring episodes of herpes, or any associated residuals, and determine whether the claimed condition is related to her military service. 3. Entitlement to service connection for POTS is remanded. The record reflects that the Veteran was diagnosed with POTS in early 2004. She was later medically discharged from service due to this condition. Although her diagnosis was not confirmed while on active duty, service treatment records reflect that she experienced potentially related symptoms including dizziness, fatigue, and shortness of breath while on active duty. Indeed, the Veteran stated that she began to notice such symptoms in 1998 and contends that this condition was aggravated by her subsequent periods of ACDUTRA and INACDUTRA. The Board finds it necessary to remand the claim of service connection for POTS for a VA examination to determine whether the claimed condition is related to her military service. 4. Entitlement to a cervical spine disability (also claimed as bilateral upper extremity radiculopathy) is remanded. The record reflects that the Veteran injured her neck due in a skiing accident while on active duty in January 1999. Service treatment records reflect that she was diagnosed with a cervical strain at that time. She contends that this condition was aggravated by physical training during her subsequent periods of ACDUTRA and INACDUTRA. The Veteran has reported experiencing hand numbness and neck pain following separation from service. The Board finds it necessary to remand the claim of service connection for a cervical spine disability for a VA examination to confirm the presence of any neck or upper extremity conditions. Additionally, a nexus opinion is required to determine whether the claimed condition is related to her military service. 5. Entitlement to service connection for a left foot disability is remanded. The record reflects that the Veteran was diagnosed with a stress fracture of her left foot while on active duty in August 1988. She contends that this condition was aggravated by physical training during her subsequent periods of active duty, ACDUTRA, and INACDUTRA. The August 2018 VA examiner did not find any objective evidence of a current foot condition, despite the Veteran's reports of pain and stiffness, and provided a negative nexus opinion based in large part on the lack of symptomatology since separation. The Board finds it necessary to remand the claim of service connection for a left foot disability for a VA examination to confirm the whether the Veteran has any residuals of a left foot stress fracture. Additionally, a nexus opinion is required to determine whether the claimed condition is related to her military service, and consider the reports of symptoms. 6. Entitlement to service connection for a bilateral knee is remanded. The record reflects that the Veteran was has been diagnosed with degenerative arthritis of both knees. Service treatment records reflect that she first reported knee pain while on active duty in November 1988. Knee trouble was further documented during her Reserve service in May 2003. The Veteran contends that this condition was aggravated by physical training during her subsequent periods of active duty, ACDUTRA, and INACDUTRA. The August 2018 VA examiner provided a negative nexus opinion based in large measure on the lack of symptomatology since separation. The Board finds it necessary to remand the claim of service connection for a bilateral knee disability for an addendum opinion, to address the Veteran's reports of complaints. 7. Entitlement to service connection for a bilateral ankle disability is remanded. The record reflects that the Veteran was has been diagnosed with a bilateral collateral ligament sprain in both ankles in August 2018. Service treatment records reflect a right ankle injury in December 1988. The Veteran contends that she initially injured her ankles during her first period of active duty, and that these injuries were aggravated by physical training during her subsequent periods of active duty, ACDUTRA, and INACDUTRA. The August 2018 VA examiner provided a negative nexus opinion based in large part on the lack of evidence of a chronic condition during service as well as the absence of symptomatology following separation, and therefore did not fully address the Veteran's reports of symptoms. The Board finds it necessary to remand the claim of service connection for a bilateral ankle disability for an addendum opinion, as detailed below. The matters are REMANDED for the following action: 1. Contact the National Personnel Records Center, the Records Management Center, the Appellant's Guard/Reserve unit(s), or any other appropriate entity to obtain all outstanding medical records generated during the Veteran's periods of Reserve service. If any requested records are not available, or the search for any such records otherwise yields negative results, that fact must clearly be documented in the claims file. Efforts to obtain these records must continue until it is determined that they do not exist or that further attempts to obtain them would be futile. The non-existence or unavailability of such records must be verified, and this should be documented for the record. Required notice must be provided to the Veteran and her representative. 2. The Veteran should be given an opportunity to identify any outstanding private or VA treatment records relevant to her claims. After obtaining any necessary authorization from the Veteran, all outstanding records should be obtained. 3. Schedule the Veteran for an examination to determine the nature and etiology of the claimed left breast scar. All indicated studies should be conducted and all findings reported in detail. Following a review of the claims file, the examiner is requested to: Opine as to whether it is at least as likely as not (a 50 percent or greater probability) that the claimed left breast scar had its onset or is otherwise related to the Veteran's military service, to include the July 1999 surgery. All opinions provided should be supported by a rationale. 4. Schedule the Veteran for an examination to determine the nature and etiology of the claimed genital herpes, and any associated residuals. All indicated studies should be conducted and all findings reported in detail. Following a review of the claims file, the examiner is requested to: (A) Identify any disabilities present, to include recurring episodes of genital herpes and any related residuals. (B) Opine as to whether it is at least as likely as not (a 50 percent or greater probability) that any diagnosed disability had its onset or is otherwise related to the Veteran's military service, to include the July 1998 medical encounter for what appears to be a sexually transmitted disease. Regarding herpes, the examiner is advised that even though the virus was deemed to be no longer present during the appeal period, the current disability requirement for a service connection claim is satisfied if the claimant has a disability at the time the claim is filed or at any point during the pendency of that claim. All opinions provided should be supported by a rationale. 5. Schedule the Veteran for an examination to determine the nature and etiology of the claimed POTS. All indicated studies should be conducted and all findings reported in detail. Following a review of the claims file, the examiner is requested to provide an opinion addressing whether symptoms of POTS were demonstrated during a period of active service. 6. Schedule the Veteran for an examination to determine the nature and etiology of the claimed cervical spine disability and any upper extremity disabilities. All indicated studies should be conducted and all findings reported in detail. Following a review of the claims file, the examiner must identify any disabilities present, to include any conditions involving the cervical spine and upper extremities. The examiner is also requested to provide an opinion as to whether any diagnosed cervical spine or upper extremity disability, is due to the cervical spine complaints documented in 1999. 7. Schedule the Veteran for an examination to determine the nature and etiology of the claimed left foot disability. All indicated studies should be conducted and all findings reported in detail. Following a review of the claims file, the examiner must identify any left foot disabilities present. The examiner is advised that the current disability requirement for a service connection claim is satisfied if the claimant has a disability at the time the claim is filed or at any point during the pendency of that claim. The examiner is also requested to provide an opinion addressing whether any diagnosed left foot disability had its onset in or is otherwise medically related to active service. For purposes of the medical opinion only, it may be assumed the Veteran's reports of symptoms since service are accurate. 8. Send the Veteran's claims file to an appropriate examiner to provide an addendum opinion regarding the nature and etiology of the bilateral knee disability. The Veteran may be recalled for examination if deemed necessary. Following a review of the claims file, the examiner is requested to provide an opinion as to whether the Veteran's bilateral knee disability had its onset in or is otherwise medically related to service. For purposes of the medical opinion only, it may be assumed the Veteran's reports of symptoms since service are accurate. 9. Send the Veteran's claims file to an appropriate examiner to provide an addendum opinion regarding the nature and etiology of the bilateral ankle disability. The Veteran may be recalled for examination if deemed necessary. Following a review of the claims file, the examiner is requested to provide an opinion whether the Veteran's bilateral ankle disability had its onset in or is otherwise medically related to service. For purposes of the medical opinion only, it may be assumed the Veteran's reports of symptoms since service are accurate. 8. If any additional development is deemed to be necessary based on the content of any additional records obtained from military sources, including obtaining any further medical opinions, that should be accomplished. MICHAEL KILCOYNE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Erin J. Trojanowski, 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.