Citation Nr: A21020431 Decision Date: 12/22/21 Archive Date: 12/22/21 DOCKET NO. 200226-65998 DATE: December 22, 2021 ORDER Entitlement to an effective date of November 8, 2000 for the assignment of 10 percent for residuals of bunionectomy of the right foot is granted. Entitlement to an initial evaluation of 10 percent, but no higher, for dry eye syndrome is granted. REMANDED Entitlement to an evaluation in excess of 10 percent from November 8, 2000 prior to March 1, 2002 and from May 1, 2002 prior to June 21, 2006; and 20 percent from June 21, 2006 prior to April 4, 2008 and from June 1, 2008, for residuals of bunionectomy of the right foot is remanded. Entitlement to an initial evaluation in excess of 10 percent from August 15, 1997 prior to March 31, 1998 and from June 1, 1998, for residuals of spine injury with low back strain and pelvic contusion (back or lumbar spine disability) is remanded. Entitlement to service connection for cardiomegaly is remanded. Entitlement to service connection for photophobia and blurred vision is remanded. FINDINGS OF FACT 1. An October 1991 rating decision granted service connection for residuals of right foot bunionectomy and assigned a noncompensable rating and the notification letter of this decision was mailed in November 1991 to the Veteran's address of record at the time; the Veteran did not appeal this decision within its appeal period and new and material evidence was not received within that appeal period. 2. An informal claim for his right foot disability was received on November 8, 2000, which prompted VA to schedule an examination for the disability for September 2001. 3. During the period from November 8, 2000 to February 15, 2002, the Veteran's residuals of bunionectomy of the right foot manifested in moderate functional impairment and degenerative joint disease. 4. During the entire appeal period, the Veteran's dry eye syndrome was active, treated by regular application of eye drops, but resulted in no visual impairment or incapacitating episodes. CONCLUSIONS OF LAW 1. The October 1991 rating decision became final. 38 U.S.C. § 7105(c) (Supp. 1991); 38 C.F.R. §§ 3.104, 19.129, 19.192 (1991). 2. With reasonable doubt resolved in favor of the Veteran, the criteria for an effective date of November 8, 2000, but no earlier, for the assignment of a 10 percent evaluation for residuals of bunionectomy of the right foot are met. 38 U.S.C. §§ 5107(b), 5110; 38 C.F.R. § 3.400. 3. The criteria for an initial rating of at least 10 percent for the period between November 8, 2000 and February 15, 2002, for residuals of bunionectomy of the right foot are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.14, 4.27, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5099-5284. 4. The criteria for an initial 10 percent evaluation, but no higher, for dry eye syndrome are met. 38 U.S.C. § 1155 ; 38 C.F.R. §§ 3.102, 4.1-4.14, 4.21, 4.75, 4.76(a), 4.77, 4.79, Diagnostic Code 6001 (under 38 C.F.R. § 4.84a (2007)). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1981 to June 1991. Rating decisions pertinent to the issues on appeal were issued under the legacy system in November 2000, June 2001, and August 2006. The Board remanded the issues on appeal most recently in May 2013 under the legacy system. While the remand development was being conducted, the Veteran opted into the modernized review system, also known as the Appeals Modernization Act (AMA), by submitting a Rapid Appeals Modernization Program (RAMP) election form and selecting the supplemental claim lane in May 2018. The agency of original jurisdiction (AOJ) issued a RAMP supplemental claim decision in December 2019 (with a corrected rating decision in January 2020), which is the decision on appeal. In the December 2019 rating decision, the AOJ found that new and relevant evidence had been received for the claim of service connection for cardiomegaly and denied the claim based on the evidence of record at the time of that decision. As for the claim of service connection for photophobia and blurred vision, the AOJ denied the claim on its merit by implicitly re-opening the previously denied claim. The Board is bound by the favorable findings and thus may proceed to the merits of the service connection claims. 38 C.F.R. § 3.104(c). In the February 2020 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the RAMP supplemental claim decision on appeal. 38 C.F.R. § 20.301. Evidence was added to the claims file during a period of time when new evidence was not allowed. If the evidence is pertinent to the claims decided by the Board, namely the claims of increased rating for dry eye syndrome and right foot disability as well as the claim of earlier effective date for the assignment of a 10 percent rating for right foot disability, it may not consider this evidence in its decision. 38 C.F.R. § 20.300. The Veteran may file a Supplemental Claim and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. Earlier Effective Date Generally, the effective date of an evaluation and award of pension, compensation or dependency and indemnity compensation based on an original claim, a claim reopened after final disallowance, or a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110 (a); 38 C.F.R. § 3.400. Specifically, as to claims for increase, the effective date of an award of increased compensation shall be the earliest date as of which it is ascertainable that an increase in disability had occurred, if application is received within one year from such date. 38 U.S.C. § 5110 (b)(2). The pertinent provisions of 38 C.F.R. § 3.400 clarify that, except as otherwise provided, the effective date of an evaluation and award of compensation based on a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is the later. The United States Court of Appeals for Veterans Claims (Court) and VA's General Counsel have interpreted the laws and regulations pertaining to the effective date for an increase as follows: If the increase occurred within one year prior to the claim, the increase is effective as of the date the increase was "factually ascertainable." If the increase occurred more than one year prior to the claim, the award is effective the date of claim. If the increase occurred after the date of claim, the effective date is the date of increase. 38 U.S.C. § 5110 (b)(2); Harper v. Brown, 10 Vet. App. 125 (1997); 38 C.F.R. § 3.400 (o)(1),(2). 1. Effective date prior to February 15, 2002 for the assignment of 10 percent for residuals of bunionectomy of the right foot The Veteran contends that he did not receive a notification of an October 1991 rating decision which granted service connection and assigned an initial noncompensable rating for residuals of bunionectomy of the right foot. Accordingly, he argues, his claim has been pending since then and he is entitled to an earlier effective date for the assignment of a 10 percent rating. Under 38 C.F.R. § 3.104(a), a decision of the rating agency or other agency of original jurisdiction shall be final and binding as to conclusions based on the evidence on file at the time VA issues written notification in accordance with 38 U.S.C. § 5104. An unappealed decision by the Regional Office (RO) is final one year from the date notification of the determination is mailed to the claimant. 38 C.F.R. §§ 20.302, 20.1103. There is a presumption of regularity that VA properly discharged official duties by mailing a copy of a VA decision to the last known address of the claimant and the claimant's representative, if any, on the date that the decision is issued. See Woods v. Gober, 14 Vet. App. 214, 220-21 (2000); see also Mindenhall v. Brown, 7 Vet. App. 271, 274 (1994) (applying the presumption of regularity to official duties of the RO). The claimant may rebut that presumption by submitting "clear evidence to the effect that VA's regular mailing practices are not regular or that they were not followed. The burden then shifts to the Secretary to establish that the VA decision was mailed to the claimant." See Ashley v. Derwinski, 2 Vet. App. 307, 309 (1992). Absent evidence that the claimant notified VA of a change of address and absent evidence that any notice sent to the claimant at his last known address has been returned as undeliverable, VA is entitled to rely on that address. See Cross v. Brown, 9 Vet. App. 18, 19 (1996). Here, a review of the evidence of record indicates that the Veteran filed an original claim in June 1991 in California following his separation from service. VA examinations were scheduled in California as reflected in a July 1991 VA letter. In August 1991, the Veteran reported to VA that he had moved to Osceola, Indiana and he asked VA to transfer his claims file to Indiana and schedule VA examinations in Indiana. The new address reported by the Veteran is reflected in an August 1991 VA Form 21-22 as well as a subsequent scheduling request for VA examinations in October 1991, which also noted that the Veteran canceled all newly scheduled examinations and he did not want to reschedule them. Subsequently, the RO decided the claim based on the existing records at the time in an October 1991 rating decision, which granted service connection for residuals of right bunionectomy and assigned noncompensable rating. In November 1991, the RO sent a notification letter concerning this decision to the Veteran at the address in Indiana he provided earlier. No documents were associated with the claims file since the November 1991 notification letter until May 1994. In particular, there is no documentation indicating that the November 1991 VA notification letter was undeliverable or returned to VA. Thus, the Board finds that there is no clear evidence to the effect that VA's regular mailing practices were not regular or that they were not followed. Accordingly, presumption of regularity has not been rebutted, and thus, the Board concludes that the October 1991 rating decision became final because no notice of disagreement or new evidence was submitted within its appeal period. 38 C.F.R. §§ 3.104, 19.129, 19.192 (1991). The issue then is whether a claim for increased rating for residuals of bunionectomy of the right foot was associated with the claims file prior to February 15, 2002. VA amended its adjudication regulations on March 24, 2015 to require that all claims governed by VA's adjudication regulations be filed on standard forms prescribed by the Secretary, regardless of the type of claim or posture in which the claim arises. See 79 Fed. Reg. 57660 (Sept. 25, 2014). The amendments, however, are only effective for claims and appeals filed on or after March 24, 2015. As the Veteran's claim for an increased rating for right foot disability was filed prior to March 24, 2015, the amendments are not applicable in this instance. Under the former legal authority, any communication or action, indicating an intent to apply for one or more benefits under laws administered by VA, from a veteran or his representative, may be considered an informal claim. Such informal claim must identify the benefit sought. Upon receipt of an informal claim, if a formal claim has not been filed, an application form will be forwarded to the claimant for execution. If received within one year from the date it was sent to the veteran, it will be considered filed as of the date of receipt of the informal claim. 38 C.F.R. § 3.155 (a) (in effect prior to March 24, 2015). Prior to March 24, 2015, a "claim" was defined broadly to include a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. 38 C.F.R. § 3.1 (p); Brannon v. West, 12 Vet. App. 32, 34-35 (1998). Any communication indicating intent to apply for a benefit under the laws administered by the VA was considered an informal claim provided it identified, but not necessarily with specificity, the benefit sought. 38 C.F.R. § 3.155 (a). To determine when a claim was received under the relevant regulations prior to their recent amendment, the Board must review all communications that may be construed as an application or claim. Quarles v. Derwinski, 3 Vet. App. 129, 134 (1992). Any communication or action that demonstrates an intent to apply for an identified benefit may be considered an informal claim. 38 C.F.R. § 3.155 (a). The essential elements of a claim prior to March 24, 2015 are "(1) an intent to apply for benefits, (2) an identification of the benefits sought, and (3) a communication in writing." Brokowski v. Shinseki, 23 Vet. App. 79, 84 (2009). Moreover, the Federal Circuit recently reversed the Court and held in Sellers v. Wilkie, 965 F.3d 1328 (Fed. Cir. 2020) that a claim must identify the sickness, disease, or injury for which compensation is sought, with at least at a high level of generality, before VA's duty to assist in the development of the claim is triggered. The Board reviewed the evidence of record associated with the claims file after the November 1991 notification letter and prior to February 15, 2002 for any indication for an informal claim as defined above. In a statement received on November 8, 2000, the Veteran reported that he currently had physical problems in 9 areas, which included right foot as well as left foot. This triggered the RO to order an examination for right foot in June 2001, and the Veteran subsequently underwent a VA examination in September 2001, which showed moderate degenerative joint disease of the right foot. Later in January 2002, the Veteran reported that he was scheduled to have a surgery for left foot and then for right foot. Prior to November 8, 2000, the Veteran did submit various statements concerning his in-service foot injury, but he did not indicate and the medical evidence does not show any worsening current symptoms of his right foot. Indeed, the worsened condition of the right foot was first documented in the September 2001 VA examination. The claims file does not contain any formal claim for an increased evaluation for worsened right foot disability prior to February 15, 2002. However, by resolving reasonable doubt in the Veteran's favor, the Board finds that the Veteran's statement received on November 8, 2000 is an informal claim for an increased evaluation for his right foot disability because it indicated he currently had a problem with the right foot disability specifically and also because this statement led to the September 2001 VA examination for the right foot. Therefore, the date of claim for the Veteran's current appeal for the right foot evaluation is November 8, 2000. The Board considers whether the Veteran is entitled to a 10 percent evaluation for right foot prior to February 15, 2002 in the section below. Increased Rating Disability evaluations are determined by the application of a schedule of ratings, which is based on average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Separate diagnostic codes identify the various disabilities. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability is resolved in favor of the Veteran. 38 C.F.R. § 4.3. In considering the severity of a disability, it is essential to trace the medical history of the Veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2 ; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Where a claimant appeals the denial of a claim for an increased disability rating for a disability for which service connection was in effect before he filed the claim for increase, the present level of disability is the primary concern, and past medical reports should not be given precedence over current medical findings. Francisco v. Brown, 7 Vet. App. 55, 57-58 (1994). Where VA's adjudication of the claim for increase is lengthy and factual findings show distinct time periods where the service-connected disability exhibits symptoms which would warrant different ratings, different or "staged" ratings may be assigned for such different periods of time. Hart v. Mansfield, 21 Vet. App. 505, 509-510 (2007). Where the question for consideration is the propriety of the initial evaluation assigned, evaluation of the medical evidence since the grant of service connection and consideration of the appropriateness of a "staged rating" (assignment of different ratings for distinct periods of time, based on the facts found) is required. See Fenderson v. West, 12 Vet. App. 119, 126 (1999). 2. Evaluation of 10 percent, at least, for residual of bunionectomy of the right foot from November 8, 2000 to February 15, 2002 As found in the earlier effective date section above, the appeal period for the claim of increased evaluation for residuals of bunionectomy of the right foot runs from November 8, 2000 to December 10, 2019, date of the rating decision on appeal. Currently, the Veteran's right foot disability is assigned 10 percent from February 15, 2002; 100 percent from March 1, 2002 to May 1, 2002 under 38 C.F.R. § 4.30; 10 percent from May 1, 2002; 20 percent from June 21, 2006; 100 percent from April 4, 2008 under 38 C.F.R. § 4.30; and 20 percent from June 1, 2008, under Diagnostic Code 5299-5284. Hyphenated Diagnostic Codes are used when a rating under one code requires use of an additional diagnostic code to identify the basis for the evaluation assigned. 38 C.F.R. § 4.27. The use of the "99" series and a hyphenated diagnostic code reflects that there is no specific diagnostic code applicable to the Veteran's right foot disability, and it must be rated by analogy to foot injury. 38 C.F.R. § 4.20; see also Copeland v. McDonald, 27 Vet. App. 333, 337 (2015) (38 C.F.R. § 4.71a , Diagnostic Code 5284 only applies to foot disabilities for which there is not already a specific Diagnostic Code). Under Diagnostic Code 5284, for other foot injuries, a 10 percent evaluation is assigned for moderate injury, a 20 percent evaluation is assigned for moderately severe injury, and a 30 percent evaluation is assigned for severe injury. With actual loss of use of the foot, a 40 percent evaluation is assigned. The words "moderately severe" and "severe" are not defined in the rating schedule; rather than applying a mechanical formula, VA must evaluate all the evidence to the end that its decisions are equitable and just. 38 C.F.R. § 4.6. It should also be noted that use of terminology such as "slight" and "moderate" by VA examiners or other physicians, although an element of evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. 38 C.F.R. §§ 4.2, 4.6. Additionally, Diagnostic Code 5010 is also pertinent to the Veteran's right foot disability. Diagnostic Code 5010 concerns arthritis due to trauma; it requires establishment by x-ray evidence. Diagnostic Code 5010 is to be rated the same as Diagnostic Code 5003. Under Diagnostic Code 5003, degenerative or traumatic arthritis established by x-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. However, in the absence of limitation of motion, the disability is to be rated as 10 percent disabling with x-ray evidence of involvement of two or more major joints or two or more minor joint groups; and as 20 percent disabling with x-ray evidence of involvement of two or more major joints or two or more minor joint groups, with occasional incapacitating exacerbations. Disability ratings under Diagnostic Code 5003 is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added. Multiple involvements of the interphalangeal, metatarsal, and tarsal joints of lower extremities are considered a group of minor joints. 38 C.F.R. § 4.45. Based on the evidence of record, the Board finds that an evaluation of at least 10 percent is warranted for the period from November 8, 2000 to February 15, 2002. For the period from November 8, 2000 to February 15, 2002, the Veteran's service-connected right foot disability was manifested with symptoms of fused right great toe with no range of motion and moderate degenerative joint disease of the right foot, which was shown in an x ray. See September 2001 VA examination. The September 2001 examiner noted moderate functional impairment due to his foot disability. A January 2002 VA podiatry note indicates that the Veteran had heel pain and deviated right big toe with limited motion, status post surgery. The Veteran reported increased pain in the morning with the first few steps and getting back up after sitting for a while. It was noted that the Veteran opted for surgical intervention due to increased pain and inability to ambulate comfortably. The Veteran underwent exostectomy of the right digit on March 1, 2002. Thus, the Veteran's right foot disability was manifested by moderate functional impairment and limited motion due to degenerative joint disease and deformity, which is more nearly approximated by a 10 percent evaluation under either Diagnostic Code 5010 or 5284 during the period from November 8, 2000 to February 15, 2002. The issue of whether the Veteran's right foot disability warrants an evaluation in excess of 10 percent for this period is remanded since it requires an addendum opinion from a medical provider as explained below. 3. Initial evaluation for dry eye disability with eye lid cysts from June 29, 1995 to December 10, 2019 The Veteran's dry eye syndrome is currently rated noncompensable under Diagnostic Code 6001. Initially, the Board notes that VA's schedule for rating eye disabilities was revised effective December 10, 2008 and again May 13, 2018, which is during the pendency of this appeal. See 73 Fed. Reg. 66,543 (Nov. 10, 2008), 89 Fed. Reg. 15316 (Apr. 10, 2018). Where there is a change in the rating criteria during the appeal period, the Board will consider the claim in light of both the former and revised schedular rating criteria, although an increased evaluation based on the revised criteria cannot pre-date the effective date of the amendments. Under the rating criteria effective prior to December 10, 2008, Diagnostic Code 6001 was rated from 10 percent to 100 percent for impairment of visual acuity or field loss, pain, rest-requirements, or episodic incapacity, combining an additional rating of 20 percent during continuance of active pathology with minimum rating during active pathology at 10 percent. Effective December 10, 2008, Diagnostic Code 6001 provided that the disability should be evaluated under the General Rating Formula for Diagnostic Codes 6000 through 6009. The General Rating Formula for Diagnostic Codes 6000 through 6009 evaluated the disability on the basis of either visual impairment due to the particular condition or on incapacitating episodes, whichever results in a higher evaluation. Where incapacitating episodes have a total duration of at least 1 week, but less than 2 weeks, during the past 12 months, a 10 percent rating is warranted. Where incapacitating episodes have a total duration of at least 2 weeks, but less than 4 weeks, during the past 12 months, a 20 percent rating is warranted. Where incapacitating episodes have a total duration of at least 4 weeks, but less than 6 weeks, during the past 12 months, a 40 percent rating is warranted. Where incapacitating episodes have a total duration of at least 6 weeks during the past 12 months, a 60 percent rating is warranted. A note following the General Rating Formula indicates that, for VA purposes, an incapacitating episode is a period of acute symptoms severe enough to require prescribed bed rest and treatment by a physician or other healthcare provider. 38 C.F.R. § 4.79 (2017). Under the latest revised criteria effective May 13, 2018, Diagnostic Code 6001 provides that the disability should be evaluated under the General Rating Formula for Diseases of the Eye. The General Rating Formula for Diseases of the Eye indicates that the disability should be rated on the basis of either visual impairment due to a particular condition or on incapacitating episodes, whichever results in a higher evaluation. Where there are documented incapacitating episodes requiring at least 1 but less than 3 treatment visits for an eye condition during the past 12 months, a 10 percent rating is warranted. Where there are documented incapacitating episodes requiring at least 3 but less than 5 treatment visits for an eye condition during the past 12 months, a 20 percent rating is warranted. Where there are documented incapacitating episodes requiring at least 5 but less than 7 treatment visits for an eye condition during the past 12 months, a 40 percent rating is warranted. Where there are documented incapacitating episodes requiring 7 or more treatment visits for an eye condition during the past 12 months, a 60 percent rating is warranted. Note (1) indicates that, for the purposes of evaluations under 38 C.F.R. § 4.79, an incapacitating episode is an eye condition severe enough to require a clinic visit to a provider specifically for treatment purposes. Note (2) indicates that examples of treatment may include but are not limited to: systemic immunosuppressants or biologic agents; intravitreal or periocular injections; laser treatments; or other surgical interventions. 38 C.F.R. § 4.79 (2018). The evaluation of visual impairment is based on impairment of visual acuity (excluding developmental errors of refraction), visual field, and muscle function. 38 C.F.R. § 4.75 (a) under any version of the rating criteria. The amendments made no substantive changes to how visual acuity is rated. With regard to visual field and muscle function examinations, the use of a Goldmann chart was no longer required effective May 13, 2018. There are otherwise no substantive changes to how those types of visual impairment are rated. Evaluation of visual acuity is based on corrected distance vision with central fixation. 38 C.F.R. § 4.76(b)(1). The measurements for each eye are applied to the table for Impairment of Central Visual Acuity under Diagnostic Codes 6061 - 6066. The table of Ratings for Impairment of Visual Fields encompasses Diagnostic Codes 6080 - 6081. Finally, evaluation of muscle dysfunction is based on degree of diplopia, and the table of Ratings for Impairment of Muscle Function encompasses Diagnostic Codes 6090 6091. Based on the evidence of record, the Board finds that the Veteran's dry eye syndrome with eye lid cysts has not resulted in any compensable impairment of visual acuity, visual field, or muscle function. Moreover, the evidence does not indicate that the Veteran's dry eye syndrome with eye lid cysts has resulted in any incapacitating episodes as defined under either the December 2008 or May 2018 amendments. Thus, a compensable rating for his service-connected eye disability is not warranted under those criteria. However, the evidence shows that the Veteran's dry eye condition has been active during the entire appeal period, indicated by consistent report of dryness in the eyes documented since the service treatment records and, later in the appeal period, continuous use of eye drops or lubricants such as Lacri-Lube, as reflected in a May 2008 VA examination. This continuous presence of active pathology warrants a minimum of 10 percent rating under Diagnostic Code 6001 which was in effect until December 2008. A rating higher than 10 percent under that Diagnostic Code is not warranted, for the evidence does not reflect, as noted above, that his dry eye syndrome resulted in impairment of visual acuity or visual field, pain, rest-requirement, or incapacity at any time during the appeal period. The Veteran reported occasionally that his eyes would burn and feel uncomfortable due to dryness, but this symptom has been addressed by the use of eye drops. See, e.g., September 2011 VA treatment record. Since the evaluation under the oldest rating criteria is favorable to the Veteran in this case than any of the revised criteria, the Board finds that an initial 10 percent evaluation, but no higher, for the Veteran's dry eye syndrome during the entire appeal period is warranted. REASONS FOR REMAND 1. An evaluation in excess of 10 percent from November 8, 2000 prior to March 1, 2002 and from May 1, 2002 prior to June 21, 2006; and 20 percent from June 21, 2006 prior to April 4, 2008 and from June 1, 2008, for residuals of bunionectomy of the right foot An addendum opinion is required in order to evaluate the Veteran's right foot disability for the following reason. The medical evidence of record considered in the rating decision on appeal contains entries indicating that the Veteran also has pes planus, i.e., flatfoot, of the right foot. See, e.g., September 2001 VA examination. However, no examiner has provided an opinion that his pes planus of the right foot is proximately due to or aggravated beyond its natural progression by his service-connected residuals of right foot bunionectomy. Moreover, there is no opinion concerning whether symptomatology of the residual of bunionectomy of the right foot can be distinguished from that of pes planus of the right foot. Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991); Mittleider v. West, 11 Vet. App. 181, 182 (1998). Upon remand, the AOJ must obtain schedule a VA examination and obtain an addendum opinion concerning a relationship between residuals of bunionectomy and pes planus. 2. An initial evaluation in excess of 10 percent from August 15, 1997 prior to March 31, 1998 and from June 1, 1998, for back disability The evidence considered in the rating decision appeal includes relatively recent VA examination for back disability in May 2017 and August 2019. During both examinations, the Veteran reported episodes of flareups, but no estimate for range of motion during flareups was provided in the May 2017 examination. Although the August 2019 examiner reported that there was no additional loss in the range of motion during flareups, the Veteran reported that he experienced inability to perform daily activities including sports, fishing, sitting, squatting, lawn mowing, and heavy weight bearing due to pain during a flareup episode at that examination, which appears to include activities involving range of motion of the lumbar spine. As such, those examinations are not adequate for rating purpose. Sharp v. Shulkin, 29 Vet. App. 26 (2017). Thus, upon remand, a new VA examination reflecting an estimate for range of motion during flareups must be obtained. 3. Service connection for cardiomegaly The rating decision on appeal relied on a May 2017 medical opinion, which stated that the Veteran's cardiomegaly was due to hypertension because he was diagnosed with hypertension at the time when an August 1991 chest x ray showed borderline cardiomegaly. However, a review of the evidence of record indicates that the Veteran had blood pressure 118 mm Hg over 86 mm Hg at a May1991 separation examination, and a September 1999 primary care clinic physician note indicates that he was diagnosed with borderline hypertension, with blood pressure 140 mm Hg over 86 mm Hg, and atenolol was started. Without more explanation, this is not consistent with the May 2017 examiner's finding that the Veteran was diagnosed with hypertension in 1991. Nieves-Rodriquez v. Peake, 22 Vet. App. 295, 302 (2008); Monzingo v. Shinseki, 26 Vet. App. 97, 107 (2012). Upon remand, an addendum medical opinion must be obtained. 4. Service connection for photophobia and blurred vision 5. The AOJ found that the Veteran had in-service complaint of photophobia in the rating decision on appeal. However, it found that there was no current diagnosis. This is not consistent with the Veteran's report that he experiences photophobia. The Veteran is competent to report subjective symptoms such as sensitivity to light. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). The evidence of record at the time of the AOJ adjudication indicates that the Veteran had in-service incurrence and likely a current symptom of photophobia. However, a nexus opinion has not been obtained for photophobia. Upon remand, the Veteran must be scheduled a new examination to determine the etiology of the disability. See McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected residuals of bunionectomy of the right foot. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. Moreover, the examiner must provide an opinion as to whether the Veteran's pes planus or any other disability of the right foot is at least as likely as not proximately due to or aggravated beyond its natural progression by service-connected residuals of bunionectomy of the right foot. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected lumbar spine disability. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. In so doing, the examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. If it is not possible to provide a specific measurement based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment due to flare-ups based on the other evidence of record and the Veteran's statements. If it is not possible to provide a specific measurement without speculation, 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). 3. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's cardiomegaly is at least as likely as not related to service or otherwise proximately due to or aggravated beyond its natural progression by service-connected disability. The examiner must review the entire claims file, to include this remand in its entirety before rendering any opinion. 4. Schedule the Veteran for a VA examination for his claimed photophobia. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinion(s) below. The examiner must consider subjective symptoms reported by the Veteran. The examiner then must provide an opinion as to whether the Veteran's photophobia is at least as likely as not related to service or otherwise proximately due to or aggravated beyond its natural progression by a service-connected disability. The examiner must provide rationales for opinions. Emily Tamlyn Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Y. Taylor 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.