Citation Nr: 21005562 Decision Date: 02/02/21 Archive Date: 02/02/21 DOCKET NO. 09-12 630 DATE: February 2, 2021 REMANDED Entitlement to service connection for onychomycosis is remanded. REASONS FOR REMAND The Veteran had active military service from April 1966 to March 1969 and in the Army Reserves subsequently. He testified before the undersigned Veterans Law Judge during an October 2009 hearing. This matter is on appeal from a July 2008 rating decision. The case was most recently remanded by the Board of Veterans’ Appeals (Board) in February 2018 and then denied in a September 2019 decision. The Veteran thereafter appealed the Board’s decision to the United States Court of Appeals for Veterans Claims (Court). In an Order dated in August 2020, the Court granted a Joint Motion for Remand (JMR) by the Veteran and VA General Counsel, which was incorporated by reference, to vacate the Board’s decision and remand the case for readjudication in accordance with the JMR. The Board cannot make a fully-informed decision on the issue of service connection for onychomycosis because no VA examiner has opined an adequate medical opinion. The Veteran was provided a VA examination in July 2017; a negative nexus opinion was provided. The rationale was that the condition was not mentioned in service treatment records (STRs) during active duty, and that there was no clinical evidence of onset during active duty. An addendum opinion from the same examiner was obtained in January 2019. The examiner opined that it was not caused or aggravated by reserve duty; the rationale was that the condition was not mentioned in STRs during active duty, there was no clinical evidence of onset during active duty, and there was no clinical evidence of causation or aggravation by reserve duty. These opinions are not adequate as they did not consider the Veteran's lay statements of having foot fungus during active service and fungal issues during reserve service. Further, an examiner may not rely solely on the lack of contemporaneous treatment records to arrive at a negative nexus opinion. Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006). Therefore, remand for a new medical opinion is necessary. The matters are REMANDED for the following action: Obtain a medical opinion from a medical professional with appropriate expertise to determine the etiology of the diagnosed onychomycosis. The examiner is requested to review the record and offer an opinion as to whether it is at least as likely as not (i.e., probability of approximately 50 percent) that the diagnosed onychomycosis is directly related to the Veteran's period of active duty (April 1966 to March 1969); is directly related to his active duty for training (ACDUTRA) periods of reserve service (listed in DFAS documentation received in November 2016); or whether it increased in severity during such periods of ACDUTRA, and if such increase occurred, whether it was due to the natural progression of the disease, or if not, due to aggravation of the condition by his reserve ACDUTRA. The examiner is informed that aggravation is defined for legal purposes as a chronic worsening of the underlying condition versus a temporary flare-up of symptoms, beyond its natural progression. If aggravation is present, the clinician should indicate, to the extent possible, the baseline before the onset of the aggravation. The examiner must consider the Veteran’s October 2009 testimony regarding the onset of his foot fungus being during his active duty, as well as having fungal issues during reserve service. The examiner should also consider the June 2002 report of medical examination during reserve duty showing a report of athlete’s foot. The examiner is also reminded that they may not rely solely on the lack of contemporaneous treatment records in rendering an opinion. A complete rationale should be given for all opinions and conclusions expressed. A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. Barstow, 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.