Citation Nr: 21022375 Decision Date: 04/15/21 Archive Date: 04/15/21 DOCKET NO. 16-46 517 DATE: April 15, 2021 ORDER Service connection for a bilateral foot disorder is denied. REMANDED Service connection for a right knee disorder. Service connection for right carpal tunnel syndrome (CTS). Service connection for a right wrist disorder, to include a ganglion cyst. Service connection for hemorrhoids.   FINDING OF FACT A bilateral foot disorder is not shown. CONCLUSION OF LAW The criteria for service connection for a bilateral foot disorder are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January 1995 to January 2001. The case is on appeal from a December 2015 rating decision. In May 2019, the Veteran testified at a Board hearing. In September 2019, the Board granted service connection for sleep apnea, and remanded service connection claims for a right ankle disorder; hyperhidrosis; a scar of the right thigh; residuals of skin cancer of the left cheek/nose; a bilateral foot disorder; a right knee disorder; right CTS; a right wrist disorder, to include a ganglion cyst; and hemorrhoids, for additional development. By a November 2020 rating decision, service connection was granted for a right ankle disability; hyperhidrosis; a scar of the right thigh; and a scar of the left side of the nose and a scar on the left side of the cheek status post basal cell carcinoma surgery. This represents a full grant of the benefits sought with respect to those issues. The Board has limited the discussion below to the relevant evidence required to support its finding of fact and conclusion of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008). Service connection for a bilateral foot disorder. Legal Criteria Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303. A veteran seeking compensation under these provisions must establish three elements: “(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service.” Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Analysis Pursuant to the Board’s September 2019 remand, the Veteran was afforded a VA foot examination in November 2020. The examination report reflects that the Veteran does not have a disorder of either foot, noting he denied having any active chronic issues of the right or left foot and stated his bilateral foot claim is related to compartment syndrome of the bilateral lower legs with pain on plantar flexion. Further, the October 2020 VA muscles and peripheral nerves examination reports reflect that the Veteran has had no injury to a muscle group of either foot, that there is no nerve impairment of the lower extremities, and that sensation testing for light touch in the feet/toes was normal. In this case, and although the Veteran’s service treatment records (STRs) reflect complaints of bilateral heel pain in the plantar fascia, as well as blisters, in May 1995, and even though a separation examination report is unavailable, see September 2015 Correspondence, the evidence does not reflect a current bilateral foot disorder. The evidence does not support a finding that the Veteran has had separate and distinct pathology related to the right or left foot at any time during the rating period on appeal. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The Board acknowledges that a “disability” for VA purposes includes functional impairment, even in the absence of underlying pathology. See Saunders, 886 F.3d at 1356 (holding that pain alone may constitute a disability, even without an identifiable underlying pathology, provided that such pain is productive of functional impairment). However, in this case, and although the October 2020 muscles VA examination report notes inability to plantar flex after prolonged walking due to compartment syndrome of the bilateral lower legs, the Veteran specifically denied functional impairment of either foot. The Board notes that the rating for the Veteran’s service-connected right ankle disability contemplates limited plantar flexion. See 38 C.F.R. § 4.71, Diagnostic Code 5271. As a bilateral foot disorder or functional impairment is not shown at any time during the rating period on appeal, service connection cannot be granted for a bilateral foot disorder under any theory of entitlement. As such, the Board finds the preponderance of the evidence is against the claim and thus, the benefit-of-the-doubt doctrine does not apply. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Therefore, service connection for a bilateral foot disorder is not warranted. Although the Board is remanding other claims for additional development, remand is not necessary for this issue, as there is no reasonable possibility that further assistance would substantiate the claim. See 38 C.F.R. § 3.159(d). REASONS FOR REMAND 1. Service connection for a right knee condition. 2. Service connection for CTS of the right wrist. 3. Service connection for a right wrist disorder, to include a ganglion cyst. 4. Service connection for hemorrhoids. Pursuant to the Board’s September 2019 remand, the Veteran was afforded VA examinations in October 2020. The examiner diagnosed right knee arthritis and patellofemoral pain syndrome, bilateral CTS, and hemorrhoids, and opined that it is less than likely that the conditions are related to service. See October 2020 VA examinations and opinions. In addition, an in-service ganglion cyst of the wrist was noted to be acute only. See October 2020 VA wrist and peripheral nerves opinions. However, the Board finds that the opinions are not completely adequate. In that respect, the October 2020 VA wrist examination report states that the in-service ganglion cyst was on the left wrist rather than the right wrist. However, the Veteran’s STRs include a record which appears to be dated in April 1999 reflecting complaints of a painful “R wrist” for two days, a finding of “R wrist” mild pain to palpation, and an assessment of possible ganglion cyst. In addition, and although symptoms were noted to be subjective only, records in December 2015 reflect a ganglion cyst of the right wrist. See December 2015 Medical Treatment Record – Non-Government Facility. Additionally, the opinion with respect to the right knee does not address the Veteran’s STRs noting numbness down the back of the knees in June 1999. Further, all of the opinions were based, at least in part, on a lack of reference to the conditions in the Veteran’s STRs, and/or the unavailability of a separation examination, and it is not clear whether the examiner fully considered the Veteran’s lay statements, to include of having injured his right knee on two occasions during service, of hemorrhoids having had their onset during service due to strenuous activity and excessive sweating, and of having had right knee and right wrist symptoms, as well as hemorrhoids, since service. A medical opinion based solely on the absence of documentation in the service treatment records or that fails to take into account lay statements is inadequate. See Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006) (VA examiner’s opinion inadequate that relied on the absence of contemporaneous medical evidence). Thus, the Board finds that remand for addendum opinions is warranted. The matters are REMANDED for the following action: Return the claims file to the VA examiner who conducted the October 2020 examinations. If the October 2020 examiner is not available, the claims file should be provided to an appropriate medical professional to render the requested opinions. The need for another examination (or telehealth interview, records request, etc. if an in-person examination is not feasible) for a right knee disorder; right CTS, a right wrist disorder, to include a ganglion cyst, and hemorrhoids, is left to the discretion of the medical professional offering the addendum opinions. The clinician should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that a right knee disorder, including arthritis and patellofemoral pain syndrome, right CTS, a right wrist disorder, including a ganglion cyst, and which may include pain alone that rises to the level of functional impairment, or hemorrhoids, had its onset during or within the initial year after service or is otherwise related to an in-service injury, event, or disease. (Continued on the next page)   The opinions should reflect adequate consideration of the relevant evidence, to include service records reflecting duties as a desk sergeant, as well as a painful right wrist assessed as a possible ganglion cyst, and numbness down the back of the knees in June 1999; December 2015 records reflecting a ganglion cyst of the right wrist; and the Veteran’s statements of having injured his right knee during service, of hemorrhoids having their onset during service due to excessive sweating, and of having right knee and right wrist symptoms, as well as hemorrhoids, since service. Rationale for all opinions expressed should be provided. If the clinician is unable to provide the requested opinions without resort to speculation, it must be so stated, and he or she must provide the reasons why an opinion would require speculation. RYAN T. KESSEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. 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.