Citation Nr: 24016552 Decision Date: 04/17/24 Archive Date: 04/17/24 DOCKET NO. 19-18 890A DATE: April 17, 2024 REMANDED Service connection for a gynecological disability is remanded. Service connection for a bilateral foot disability is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1991 to May 1996. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2018 rating decision by the Department of Veterans Affairs (VA). This case was remanded in June 2023; it has since been re-assigned to the undersigned. After reviewing the evidence of record, and in light of Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009), the Board has recharacterized the issue of service connection for bilateral plantar fasciitis to encompass any bilateral foot disability. The Board notes that the Veteran submitted a VA Form 10182 in October 2019, which included the issue of service connection for gynecological disability. However, the VA Form 10182 is untimely to opt-in to the modernized review system for the issue service connection for gynecological disability as it was received more than 60 days following the issuance of the July 2019 Statement of the Case and more than one year following the issuance of the July 2018 rating decision on appeal. 38 C.F.R. § 3.2400 (c)(2). 1. Service connection for a gynecological disability is remanded. The Veteran was afforded a VA examination in July 2018; however, for the reason stated below, the Board finds that the VA opinion provided is inadequate. The examiner opined that the Veteran's diagnosed chronic and recurrent vaginosis was less likely than not incurred in or caused by the claimed in service injury, event or illness. The rationale stated that review of her service treatment records showed no gynecological diagnosis or treatment except for inflammatory pelvic disease and the wet mount and pap smear tests were negative. Also, she was treated for low back pain throughout service on several occasions which was most likely related to her congenital condition. The examiner did not explain why the Veteran's current diagnosis is not related to her inservice inflammatory pelvic disease. Further, the examiner did not address the notes of gynecological treatment and of an infection in the service medical records or the Veteran's provided history during the examination that her symptoms began during service in 1992 as severe vaginal discomfort, chronic yeast infections, and pain during sexual activity, and has gotten worse over the years. In light of these inadequacies, the Board finds that a new examination and opinion is necessary. VA treatment records state that the Veteran was seen at a private clinic. As relevant outstanding private treatment records have been identified, a remand is required to allow VA to obtain authorization and request these records. See July 2002, July 2007, August 2010, April 2012 VA Treatment Records. 2. Service connection for a bilateral foot disability is remanded. The Veteran was not afforded an examination for her bilateral foot claim. Service treatment records show complaints of bilateral foot pain. See October 1991 Service Treatment Records. The Veteran and fellow service members reported that she had foot and leg pain in service. See May 2003 Veteran Statement; May 2017 Buddy Statement. Following service, the Veteran has been seen for complaints of bilateral foot symptoms, including pain, and treatment notes indicate nerve pain in the feet; small fiber predominant sensory polyneuropathy; trigger band distortions in the left calf, right calf, right foot and left foot region; and chronic joint pain involving bilateral feet most probably symptoms are radicular and dermatomal in nature with underlying degenerative arthritis. See November 2017, August 2018, December 2018, August 2019 VA Treatment Records; January 2019, February 2019, June 2019, July 2019, September 2019, November 2019 Private Treatment Records. In light of these medical findings and reports of in-service and post-service bilateral foot pain, a VA examination is necessary in order to determine whether she has a current bilateral foot disability related to service. The matters are REMANDED for the following action: 1. The AOJ should obtain, if possible, records of relevant private evaluations and treatment the Veteran has received. The Veteran must assist in the matter by identifying her private healthcare providers, including the gynecological treatment records, and by submitting releases for VA to obtain any private records identified. 2. The AOJ should arrange for a VA examination with a gynecologist to determine the nature and likely cause of any gynecological disability. The examiner should review the claim file (including this remand) and note such review was conducted. Based on review of the record and examination of the Veteran with all necessary diagnostic testing, the examiner should provide an opinion with detailed rationale that responds to the following: (a.) Please identify, by diagnosis, all gynecological disabilities during the appeal period (from April 2018). (b.) For each gynecological disability diagnosed, is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that such disability was either incurred in or otherwise related to the Veteran's military service? Please explain why. The examiner must specifically consider the Veteran's description of her in-service and post-service symptoms and documented in-service complaints and treatment dated January 1991, January 1992, August 1992, September 1993, and May 1995. A complete rationale must be provided for all opinions expressed. When providing the requested opinions, the examiner is asked to state whether the evidence is in approximate balance or nearly equal in the Veteran's favor. If the examiner cannot provide a requested opinion without resorting to speculation, it must be so stated, and the examiner must provide the reasons why that opinion would require speculation. The examiner must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the examiner must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. 3. The AOJ should arrange for a VA examination of the Veteran to determine the nature and likely cause of any bilateral foot disability. The examiner should review the claim file (including this remand) and note such review was conducted. Based on review of the record and examination of the Veteran with all necessary diagnostic testing, the examiner should provide an opinion with detailed rationale that responds to the following: (a.) Please identify, by diagnosis, all disabilities of the feet during the appeal period (from April 2018). If there is no disability diagnosed, the examiner should state whether there is pain with functional impairment. (b.) For each disability of the feet diagnosed, or for pain with functional impairment, is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that such disability was either incurred in or otherwise related to the Veteran's military service? Please explain why. (c.) For each disability of the feet, or for pain with functional impairment, is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) proximately due to the service-connected spine disability? (d.) For each disability of the feet, or for pain with functional impairment, is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) aggravated, i.e., worsened beyond its natural progression, by the service-connected spine disability? The examiner must specifically consider the Veteran's description of her in-service and post-service symptoms and the documented in-service complaints of bilateral foot pain. A complete rationale must be provided for all opinions expressed. When providing the requested opinions, the examiner is asked to state whether the evidence is in approximate balance or nearly equal in the Veteran's favor. If the examiner cannot provide a requested opinion without resorting to speculation, it must be so stated, and the examiner must provide the reasons why that opinion would require speculation. The examiner must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the examiner must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. 4. If upon completion of the above action the appeal remains denied, the case should be returned to the Board after compliance with appellate procedures. E. I. VELEZ Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Meawad 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.