Citation Nr: 21013259 Decision Date: 03/09/21 Archive Date: 03/09/21 DOCKET NO. 16-24 101 DATE: March 9, 2021 REMANDED Entitlement to service connection for a bilateral foot disorder is remanded. Entitlement to service connection for a bilateral eye disorder is remanded. Entitlement to service connection for hypertension, to include as secondary to service-connected coronary artery disease status post myocardial infarction (CAD), is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1972 to November 1973. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued in October 2014 by a Department of Veterans Affairs (VA) Regional Office. In December 2018, the Veteran and his spouse testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. In June 2019, the Board remanded the issues on appeal, as well as a claim for service connection for a heart disorder, for additional development. In a January 2021 rating decision, the Agency of Original Jurisdiction awarded service connection for CAD. As such is a full grant of the benefit sought on appeal with respect to that issue, it is no longer before the Board. Grantham v. Brown, 114 F.3d 1156, 1158-59 (Fed. Cir. 1997). The remaining claims now return for further appellate review. 1. Entitlement to service connection for a bilateral foot disorder. In the June 2019 Remand, the Board noted that the Veteran’s January 1969 entrance examination reflected a notation of mild pes planus. Thus, the Board found that a remand was necessary to afford a VA examination so as to determine the nature and etiology of his claimed bilateral foot disorder. In this regard, the Board noted that a medical opinion was needed to identify all current foot disorders and whether any such disorders are related to service, to include whether pes planus increased in severity during service and, if so, whether there is clear and unmistakable evidence that such increase in severity was due to the natural progress of the condition. In offering such opinion, the examiner was advised that a rationale for an unfavorable opinion cannot be based solely on the absence of a foot disorder or symptoms thereof during service. On VA examination in December 2019, the VA examiner provided a diagnosis of plantar fasciitis. Of note, she found there was no evidence of pes planus and indicated that such had resolved. In addition, the VA examiner determined the Veteran’s bilateral plantar fasciitis was a new and separate diagnosis, did not pre-exist service, and was less likely than not caused by or had its onset in service. In support of such opinion, she found the service treatment records lacked objective evidence to confirm a diagnosis of, or treatment for, a bilateral foot condition during service. Further, the VA examiner noted the Veteran had been out of service for several years without supporting treatment records to show a continuity of the issues or symptoms associated with bilateral plantar fasciitis following discharge. However, while the VA examiner recorded the Veteran’s report that his bilateral foot condition started 45 years ago, which would be in 1974, i.e., the year following his separation from service, and began from standing and walking for prolonged periods of time, she did not address such report. Rather, it appears that she relied solely on the absence of a foot disorder and symptoms thereof during service, without consideration of the Veteran’s lay statements. Thus, the Board finds an addendum opinion is necessary to address such matters. 2. Entitlement to service connection for a bilateral eye disorder. In the June 2019 Remand, the Board determined that an unfavorable June 2014 VA opinion was inadequate to decide the Veteran’s claim and thus remanded the claim in order to obtain an addendum opinion addressing the nature and etiology of his claimed bilateral eye disorder. In offering such opinion, the examiner was advised that a rationale for an unfavorable opinion cannot be based solely on the absence of an eye disorder or symptoms thereof during service. On VA examination in January 2020, the VA examiner diagnosed glaucoma, with an onset in 2015, and pseudophakia, which were implanted after removal of the Veteran’s cataracts in 2011. He reviewed the record, noting that the January 1969 enlistment examination did not reflect cataracts or glaucoma at the time of the Veteran’s entrance to service, and found that neither disorder pre-existed service and there was no evidence that he was diagnosed with such disorders during service or immediately after service. The VA examiner explained that glaucoma is not congenital or developmental but, rather, is a hereditary/familial condition. Pseudophakia means that a cataract (which is developmental and not congenital) took place by surgery removal with an intraocular lens implanted. Finally, although the Veteran wore glasses for myopia since the age of 14, the VA examiner explained that such was hereditary in families, not congenital, and a refractive error was unrelated to the currently diagnosed eye conditions. However, as the January 2020 VA examiner relied solely on the absence of an eye disorder or symptoms thereof during service, without consideration of the Veteran’s lay statements regarding his in-service symptoms and duties as a medical technician, the Board finds an addendum opinion is necessary to address such matters. 3. Entitlement to service connection for hypertension, to include as secondary to service-connected CAD. In the June 2019 Remand, the Board found a VA examination and opinion were necessary to determine the etiology of the Veteran’s hypertension, to include whether such was related to his stressful duties as a counselor. In offering such opinion, the examiner was advised that a rationale for an unfavorable opinion cannot be based solely on the absence of hypertension or symptoms thereof during service. On VA examination in December 2019, a diagnosis of hypertension was confirmed. The VA examiner recorded the Veteran’s report that such condition started 45 years ago and was found on an employment examination following his discharge from service. He observed that elevated blood pressure with a reading of 136/84 was noted on the Veteran’s January 1969 enlistment examination, but found it significant that there was no confirmed diagnosis of hypertension. Additionally, the VA examiner determined the Veteran’s blood pressure was consistently within normal limits in all other service treatment records, to specifically include those dated in 1970, 1972, and 1973. He also found there was no evidence of diagnosed hypertension or hypertension medication during or within one year of service. Thus, the VA examiner ultimately concluded it is less likely than not that the Veteran’s hypertension had its onset in, or is otherwise related to, service, to include as due to the Veteran’s stressful duties as a counselor. However, while the VA examiner recorded the Veteran’s report that his hypertension started 45 years ago, which would be in 1974, i.e., the year following his separation from service, was found on an employment examination following his discharge from service, and was manifested by symptomatology very similar to his current symptoms, he did not address such report. Rather, it appears that he relied solely on the absence of documented evidence of hypertension during and within the year following service, without consideration of the Veteran’s lay statements. Moreover, although another VA examiner provided an opinion, with rationale, that the Veteran’s hypertension is not caused by his now service-connected CAD in December 2020, he did not address whether such disorder is aggravated by his CAD. Consequently, the Board finds an addendum opinion is necessary to address such matters. The matters are REMANDED for the following actions: 1. Forward the record, to include a copy of this Remand, to the VA examiner who conducted the December 2019 VA examination, or an appropriate substitute if unavailable, for an addendum opinion as to the etiology of the Veteran’s current bilateral foot disorder, diagnosed as plantar fasciitis. After review of the record, the clinician should offer an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran’s bilateral plantar fasciitis had its onset in or is otherwise related to his military service, to include running? In this respect, the clinician must address the medical history recorded at the December 2019 VA examination, which indicates the Veteran’s report that his bilateral foot condition started 45 years ago, which would be in 1974, i.e., the year following his separation from service, and began from standing and walking for prolonged periods of time. In offering any opinion, the clinician must address the Veteran’s statements regarding the onset and continuity of symptomatology of his bilateral foot disorder. He or she is advised that the rationale for an unfavorable opinion cannot be based solely on the absence of documented evidence of a foot disorder or symptoms thereof during or after service. A rationale should be provided for any opinion offered. 2. Forward the record, to include a copy of this Remand, to the VA examiner who conducted the January 2020 VA examination, or an appropriate substitute if unavailable, for an addendum opinion as to the etiology of the Veteran’s current bilateral eye disorder, diagnosed as glaucoma and cataracts (currently pseudophakia). After review of the record, the clinician should offer an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran’s glaucoma and/or cataracts (currently pseudophakia) had its onset in, or is otherwise related to, the Veteran’s military service, to include his in-service duties working as a medical technician with microscopes? In offering any opinion, the clinician must address the Veteran’s statements regarding the onset and continuity of symptomatology of his bilateral eye disorder. He or she is advised that the rationale for an unfavorable opinion cannot be based solely on the absence of documented evidence of a eye disorder or symptoms thereof during or after service. A rationale for any opinion offered should be provided. 3. Forward the record, to include a copy of this Remand, to the VA examiner who conducted the December 2019 VA examination or offered the December 2020 opinion, or an appropriate substitute if unavailable, for an addendum opinion as to the etiology of the Veteran’s current hypertension. Following a review of the record, the examiner should address the following inquiries: (A) Is it at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran’s hypertension had its onset in, or is otherwise related to, his military service, to include his stressful duties as a counselor or manifested within one year of his separation from service? In this respect, the clinician must address the medical history recorded at the December 2019 VA examination, which indicates the Veteran’s report that his hypertension started 45 years ago, which would be in 1974, i.e., the year following his separation from service, was found on an employment examination following his discharge from service, and was manifested by symptomatology very similar to his current symptoms. (B) It is at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran’s hypertension is aggravated by his service-connected CAD? For any aggravation found, the clinician should state, to the best of his or her ability, the baseline of symptomatology and the amount, quantified if possible, of aggravation beyond the baseline symptomatology. In offering any opinion, the clinician must address the Veteran’s statements regarding the onset and continuity of symptomatology of his hypertension. He or she is advised that the rationale for an unfavorable opinion cannot be based solely on the absence of documented evidence of hypertension or symptoms thereof during or after service. A rationale for any opinion offered should be provided. A. JAEGER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. M. Celli, 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.