Citation Nr: 22014728 Decision Date: 03/14/22 Archive Date: 03/14/22 DOCKET NO. 17-10 823A DATE: March 14, 2022 ORDER Entitlement to service connection for insomnia is granted. REMANDED Entitlement to service connection for a left ankle disability is remanded. Entitlement to service connection for a right ankle disability is remanded. Entitlement to a compensable disability rating for rhinitis is remanded. Entitlement to a compensable disability rating for h. pylori infection (claimed as gastroesophageal reflux disease (GERD)) is remanded. Entitlement to a compensable disability rating for dyshidrotic eczema which includes rashes on the Veteran's hands, feet, and groin is remanded. FINDING OF FACT The evidence shows that the Veteran was diagnosed and treated for insomnia in service, has a current diagnosis of insomnia for which he has been treated by VA, and reports continuity of symptomatology since service. CONCLUSION OF LAW The criteria for entitlement to service connection for insomnia have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active-duty military service from April 2010 to March 2014, including service in Southwest Asia. Entitlement to service connection for insomnia The Veteran seeks service connection for insomnia, which he asserts had its onset in service. The Board notes that the Veteran has a current diagnosis of insomnia and has been treated by VA, including with cognitive behavioral therapy and medication, for the problem and it has not resolved. The record shows that in March 2014, concurrent with the Veteran's separation from service, he was diagnosed by a private provider with insomnia and was prescribed medication. (See STR, 05/20/2014.) He has been treated regularly for insomnia since service separation and reports continuous complaints of insomnia since he was in service in Afghanistan. Generally, to establish a right to compensation for a present disability, a Veteran must show: (1) a present disability; (2) an 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, the so-called "nexus" requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). All three elements must be established by competent and credible evidence in order that service connection may be granted. In this instance, the elements of service connection have been established, with a diagnosis of present disability, a diagnosis of the same disability in service, and evidence of continuity of symptomatology since service separation. The claim of service connection is granted. REASONS FOR REMAND Entitlement to service connection for a left ankle disability Entitlement to service connection for a right ankle disability The Veteran was provided VA examinations related to all of his service-connection claims in January and February 2015. (See C&P Exam, 02/13/2015.) The examiner at the time found no evidence of any pathology related to the Veteran's right ankle claim and concluded that the left ankle bursitis that had been diagnosed in service resolved based on a lack of current diagnosis for left ankle pain. The record shows that the Veteran has been treated for complaints of bilateral ankle pain at VA on multiple occasions since that examination and has been provided with a TENS unit to treat ankle pain by VA providers. (See CAPRI, 12/23/2021; Hearing Testimony, 09/02/2021.) In addition, the Veteran's service treatment records show that he was diagnosed and treated in service for pes planus (flat feet) and plantar fasciitis. Under the provisions of Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009), VA has a duty to consider other possible diagnosis which may be related to the condition claimed by the Veteran. Therefore, the Board finds that a new VA examination and opinion is necessary and should include both current symptoms and treatment as well as disabilities affecting both the Veteran's feet and ankles. In addition, the Veteran has testified and provided written statements that he was given multiple light duty profiles in service related to his foot and ankle pain. It appears that not all of these records are included in the claims file. The AOJ should obtain copies of the Veteran's complete personnel records in an effort to include any outstanding records of light duty profiles in the claims file for consideration by examiners. Entitlement to a compensable disability rating for rhinitis Entitlement to a compensable disability rating for h. pylori infection (claimed as GERD) Entitlement to a compensable disability rating for dyshidrotic eczema The record shows that the Veteran was provided VA examinations in January and February 2015 which offered opinions as to whether the Veteran's claimed conditions were related to service. The Agency of Original Jurisdiction (AOJ) then issued a rating decision in February 2015 granting service connection and awarding noncompensable (0 percent) disability ratings for the above conditions. In reviewing the record, the Board notes that the examination report lacks all of the specific findings regarding the disabilities which are used to assign the appropriate disability ratings. As such, they are inadequate for the Board's purposes and new examinations and opinions must be obtained on remand, with specific findings to address the concerns discussed below in the Remand instructions. The matters are REMANDED for the following action: 1. Request and obtain from the appropriate federal records custodian the Veteran's complete service personnel records, with special attention to any light duty profile. The AOJ should make as many attempts to obtain this information as necessary unless additional attempts are determined to be futile. In the event that the records cannot be obtained, the Veteran and his representative should be duly notified in accordance with 38 C.F.R. § 3.159 (e). 2. After outstanding service personnel records have been obtained, afford the Veteran an appropriate VA examination to address his claim of service connection for disabilities of the right and/or left ankle. The examiner should review the service medical records, the Veteran's written statements, his testimony at the Board hearing, and records of treatment at VA since service separation. The examiner should provide an opinion as to whether the Veteran has a disability of one or both ankles or feet to include plantar fasciitis and pes planus which was at least as likely as not (probability 50 percent or greater) incurred in or otherwise the result of his military service. In addressing this question, the examiner should note if the Veteran's symptoms in service and since service separation are due to pes planus. If so, opinions should be provided as to (a) whether pes planus clearly and unmistakably existed prior to service, (b) whether the condition worsened in service (to include increased symptomatology), and (c) if so worsened, whether such worsening was beyond the normal course of the condition. The examiner is asked to provide a rationale or statement of reasons for each opinion provided. The examiner is asked to cite specific records in the evidence and any medical treatises or research which informed the opinion. 3. Afford the Veteran an appropriate VA examination to determine the current nature and severity of his service-connected rhinitis. The examiner should specifically review in-service medical records and current treatment records, as well as statements and history provided by the Veteran. The examiner is asked to address the differences in symptomatology between chronic sinusitis and chronic rhinitis and any relationship between the two conditions. The examiner should consider and address the November 2018 surgery at VA and the significance of the findings related to the procedure. The examiner is asked to provide a rationale or statement of reasons for each opinion provided. The examiner is asked to cite specific records in the evidence and any medical treatises or research which informed the opinion. 3. Afford the Veteran an appropriate VA examination to address the current nature and severity of his gastrointestinal disability, both with respect to h. pylori infection and GERD. The examiner should explain the relationship, if any, between h. pylori infection and GERD. The examiner should also address the Veteran's symptoms in service and the evidence of the service treatment records to determine if the service-connected disability should be recharacterized to include GERD. The examiner should consider and address the nature of the Veteran's symptoms in light of the rating criteria associated with ulcers as well as gastritis. The examiner is asked to provide an opinion regarding the Veteran's anemia and vitamin B12 deficiencies shown in VA and private treatment records and whether these constitute impairments of health due to the service-connected condition and treatment for symptoms. The examiner is asked to provide a rationale or statement of reasons for each opinion provided. The examiner is asked to cite specific records in the evidence and any medical treatises or research which informed the opinion. 4. Afford the Veteran an appropriate VA examination to address the current nature and severity of his service-connected skin disability, listed as dyshidrotic eczema. The examiner should consider the factors involved in providing disability ratings under the General Rating Formula for the skin at 38 C.F.R. § 4.118. In particular, the examiner should address the percentage of skin affected and the percentage of exposed skin affected, as well as the need for medication to include topical medication and immunosuppressive drugs and other treatment. The examiner is asked to ascertain based on the medical records and the Veteran's statements the usual areas affected by the skin disability, including the groin, shoulders, hands, and feet, regardless of whether active lesions are present at the time of the examination. The examiner is asked to provide a rationale or statement of reasons for each opinion provided. The examiner is asked to cite specific records in the evidence and any medical treatises or research which informed the opinion. Eric S. Leboff Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Cheryl E. Handy 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.