Citation Nr: 21009797 Decision Date: 02/23/21 Archive Date: 02/23/21 DOCKET NO. 14-19 675 DATE: February 23, 2021 REMANDED Entitlement to service connection for flat feet is remanded. Entitlement to service connection for residuals of left inguinal hernia repair is remanded. Entitlement to service connection for residuals of right inguinal hernia repair is remanded. Entitlement to an initial rating in excess of 10 percent for left great toe degenerative changes is remanded. Entitlement to a rating in excess of 10 percent for right great toe degenerative changes is remanded. Entitlement to an initial rating in excess of 70 percent for posttraumatic stress disorder (PTSD) is remanded. Entitlement to an initial rating in excess of 10 percent for lumbar strain prior to July 2, 2012. Entitlement to a rating in excess of 20 percent for lumbar strain from July 2, 2013 to July 20, 2017, is remanded. Entitlement to a rating in excess of 40 percent for lumbar strain from July 20, 2017, is remanded. Entitlement to an initial compensable rating or hypertension prior to July 2, 2013, is remanded. Entitlement to a rating in excess of 10 percent for hypertension from July 2, 2013, is remanded. Entitlement to an initial compensable rating for hiatal hernia with reflux is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1997 to March 2001, and from May 2002 to April 2010. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2011 rating decision from a Department of Veterans Affairs (VA) Regional Office (RO). This case was previously remanded in February 2019 for VA examinations addressing nexus and current severity of the above-listed disabilities. In October 2019, Veterans Health Administration officials contacted the Veteran to schedule an examination pertaining to his lumbar spine. Internal correspondence reflect that he refused examination and reported an intent to withdrawal his appeal. However, he did not formalize a withdrawal in writing. When the case returned to the Board in February 2020, the Board observed that the Veteran had not formally withdrawn his appeal, and that the Veteran had not been scheduled for the examinations which the Board had previously determined were necessary to decide the Veteran’s claims. The Board accordingly remanded the claims to schedule the Veteran for the requested examinations, if the Veteran expressed a desire to attend these examinations. Following the Board’s remand, in March 2020, the agency of original jurisdiction (AOJ) sent a letter to the Veteran stating that they would set up examination for his disabilities if he expressed desire to attend. Review of the file reflect that the AOJ proceeded with scheduling exams for April 2020 before receiving a response from the Veteran; however, the exams were postponed due to the COVID-19 pandemic. A July 2020 correspondence with QTC indicates they were not conducting exams in the area and would reschedule. In August 2020, the AOJ sent another letter to the Veteran stating they would schedule the exams if he expressed willingness to attend. The Veteran has not responded to this letter, and he was not rescheduled for examinations. While the Veteran has not responded to the letters indicating that he desires to attend examinations pertinent to the disabilities on appeal, the Board notes that, through no fault of his own, examinations were cancelled/postponed and unable to be scheduled for examinations due to the pandemic. Additionally, it does not appear that he was contacted other than by letter. Accordingly, the Board believes that the Veteran should be afforded another opportunity to present for examinations. While on remand, the Veteran should also be provided an opportunity to submit, or provide authorization to allow VA to obtain on his behalf, the outstanding treatment records previously identified. Finally, the Veteran is advised that, should he no longer want to pursue his appeal as to any or all of the issues before the Board as he has previously indicated, such a withdrawal must be in writing and include his name, file number, and a statement that the appeal is withdrawn in its entirety, or list the issue(s) withdrawn. See 38 C.F.R. § 19.55. Appeal withdrawals should be filed with the AOJ until the case is transferred for the Board; thereafter, the withdrawal should be filed with the Board. See id. The matters are REMANDED for the following action: 1. Assist the Veteran with obtaining any outstanding treatment records pertaining to his claims, to include records from the private providers including Dr. H.D., Wilford Hall Medical Center, Taylor Burke Health Clinic, and TRICARE records. 2. Schedule the Veteran for an examination of the severity of his left and right great toe disabilities and service connection for flat feet. Great toes- 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. To the extent possible, the examiner should identify any symptoms and functional impairments due to the toes alone and discuss their effect on any occupational functioning and activities of daily living. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment 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 required), or the examiner (does not have the knowledge or training). Flat feet - The examiner must also opine as to whether the moderate flat foot noted upon entrance into service underwent worsening during service and, if so, whether such worsening exceeded the natural progression of the disorder. In forming an opinion, the examiner is to address all evidence of record, to specifically include the July 2010 VA examination report, which shows no flat foot or foot deformity, and the August 9, 2013, VA podiatry record, which shows flat foot. The complete rationale for all opinions expressed should be provided. 3. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected PTSD. 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. 4. Schedule the Veteran for an examination of the current severity of his service-connected lumbar spine disability. The examiner must test the Veteran’s active motion, passive motion, and pain with weight-bearing and without weight-bearing. The examiner must also attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. To the extent possible, the examiner should identify any symptoms and functional impairments due the back disability alone and discuss the effect of the Veteran’s back disability on any occupational functioning and activities of daily living. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment 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). The examiner is to render a retrospective opinion as to when any increase in the Veteran’s back disability first manifested. The opinion should consider not only the July 2010, July 2013, and October 2017 examination reports, but also any relevant evidence, such as statements from the Veteran. 5. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected hypertension. 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. 6. Schedule the Veteran for an examination of the current severity of his hiatal hernia with reflux. The examiner must attempt to elicit information regarding the severity, frequency, and duration of symptoms. If the examiner finds that the Veteran’s hiatal hernia has worsened since the July 2010 VA examination, the examiner is to estimate when the such worsening occurred, based on the evidence of record (to include the July 2013 DBQ) as well as the Veteran’s reported symptoms. 7. Schedule the Veteran for an examination by an appropriate clinician to identify and evaluate any current residuals of the Veteran’s in-service left and right inguinal hernia repairs (e.g., recurrent hernia, painful scar). The examiner is to address any of the Veteran’s reported symptoms (e.g., groin pain). If no residuals are present, the examiner is to make an affirmative finding to this effect. (Continued on the next page)   8. The Veteran should be informed that failure to appear for these examinations, without good cause, may cause his claim to be denied. See 38 C.F.R. § 3.655. All efforts to schedule the requested examinations should be documented in the file. A. S. CARACCIOLO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board G. E. Wilkerson, 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.