Citation Nr: A24041663 Decision Date: 07/29/24 Archive Date: 07/29/24 DOCKET NO. 210526-163344 DATE: July 29, 2024 ORDER Service connection for bronchitis pursuant to the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 (PACT Act) is granted. Service connection for a left knee disability is denied. Service connection for a right knee disability is denied. Service connection for Morton's neuroma of the left foot to include chronic foot pain is denied. Service connection for a thoracolumbar disability is denied. Service connection for left shin splints is denied. Service connection for right shin splints is denied. REMANDED Service connection for headaches is remanded. Service connection for Morton's neuroma of the right foot, to include chronic foot pain, is remanded. Service connection for bronchitis prior August 10, 2022, is remanded. FINDINGS OF FACT 1. The Veteran has a current diagnosis of chronic bronchitis and served on active duty in Iraq after September 11, 2001. 2. The Veteran's left and right knee disabilities did not begin during active service and are not otherwise related to an in-service injury or disease. 3. The Veteran's Morton's neuroma of the left foot did not begin during active service and is not otherwise related to an in-service injury or disease 4. The Veteran's intravertebral disc syndrome with lumbar strain and radiculopathy did not begin during active service and are not otherwise related to an in-service injury or disease. 5. The Veteran's left and right shin splints did not begin during active service and are not otherwise related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for chronic bronchitis are met. 38 U.S.C. §§ 1110, 1119, 1120, 5107; 38 C.F.R. §§ 3.102, 3.303; the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act, Pub. L. No. 117-168 § 3373, 136 Stat. 1759 (2022). 2. The criteria for service connection for a left knee disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for a right knee disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for service connection for Morton's neuroma of the left foot have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 5. The criteria for service connection for a thoracolumbar disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 6. The criteria for service connection for left shin splints have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 7. The criteria for service connection for right shin splints have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1982 to August 1982 and from July 1983 to December 2005. The rating decision on appeal was issued in April 2021 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies. In the May 2021 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the agency of original jurisdiction (AOJ) decision on appeal. 38?C.F.R. § 20.301. The Veteran has confirmed service in the Southwest Asia theater of operations. Specifically, September 2004 military personnel records show the Veteran provided expert nursing care to over 500 combat trauma casualties during deployment in combat operations to Camp Falluja, Iraq, "a dangerous combat zone, under frequent enemy fire." VA's Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA), in part, describes VA's duties to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C. §§ 5100, 5102, 5103, 5103A; 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a). The VCAA applies to the instant claim. VA is required to notify the claimant and his or her representative of any information, and any medical or lay evidence, not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide. 38 U.S.C. § 5103(a); 38 C.F.R. § 3.159(b); Quartuccio v. Principi, 16 Vet. App. 183 (2002). The duty to notify in this case was satisfied by a letter or letters sent to the Veteran in a form entitled "Notice to Veteran of Evidence Necessary to Substantiate a Claim for Veterans Disability Compensation and Related Compensation Benefits." The Veteran certified receipt of such notice in his October 2020 claim submitted under the Fully Developed Claim program. 38 U.S.C. §§ 5102, 5103, 5103A (2012); 38 C.F.R. § 3.159 (2016); Scott v. McDonald, 789 F.3d 1375 (Fed. Cir. 2015). The VCAA also requires VA to make reasonable efforts to help a claimant obtain evidence necessary to substantiate his claim. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c), (d). This "duty to assist" contemplates that VA will help a claimant obtain records relevant to his claim, whether or not the records are in Federal custody, and that VA will provide a medical examination or obtain an opinion when necessary to make a decision on the claim. 38 C.F.R. § 3.159(c)(4). In that regard, the Veteran's service treatment records, private treatment records, and lay statements have been associated with the record. In February 2021, VA afforded the Veteran an examination and in April 2021 VA obtained a medical etiological opinion with respect to each of his claims. The VA examiner reviewed the evidence of record, considered the Veteran's history and statements, and rendered a medical opinion based upon the facts of the case and the examiner's knowledge of medical principles. Therefore, the Board finds that the Veteran has been provided an adequate medical examination in conjunction with his claim. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). As there is no indication that any failure on the part of VA to provide additional notice or assistance reasonably affects the outcome of this case, the Board finds that any such failure is harmless. See Mayfield v. Nicholson, 19 Vet. App. 103 (2005), rev'd on other grounds, Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006). 1. Service connection for bronchitis pursuant to the PACT Act. The Veteran is presumed exposed to burn pits and other toxins (BPOT) and there is evidence of a current disability presumed due to such exposure under the PACT Act. BPOT exposure is presumed for veterans who served in specific locations on or after specific dates. 38 U.S.C. § 1119. Here, the Veteran served in Iraq and Kuwait from March 2004 to September 2004. Accordingly, the Veteran is presumed exposed to BPOT under 38 U.S.C. § 1119. Certain enumerated diseases will be presumed related to service for veterans with in-service toxic exposure, to include BPOT. 38 U.S.C. § 1120. Chronic bronchitis is one of those enumerated diseases, and a February 2021 VA medical examination report shows that the Veteran has a current diagnosis of such. Id. Accordingly, service connection is warranted for chronic bronchitis on a presumptive basis given the Veteran's presumed BPOT exposure. See 38 U.S.C. §§ 1119, 1120. This issue is granted pursuant to the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxins Act of 2022 (PACT Act). 2. Service connection for a left knee disability 3. Service connection for a right knee disability The Veteran asserts that his condition began in n 1990 with a twisted knee after prolonged running and continued thereafter. See February 2021 VA knee disability benefits questionnaire (DBQ). Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a current diagnosis of bilateral knee strain, and evidence shows that he twisted his left knee in January 1996, the evidence of record persuasively weighs against finding that the Veteran's bilateral knee strain began during service or is otherwise related to an in-service injury, event, or disease. Service treatment records following the January 1996 knee injury indicate the Veteran's condition improved near the end of January 1996, although he still had pain while climbing stairs. Treatment continued in February 1996. An orthopedic consultation record of that date shows a diagnosis of left knee sprain with medial meniscus involvement. There was no further notation of treatment. The reports of medical history and report of medication examinations in August 2005 (separation) show the Veteran denied knee trouble and the clinical evaluation of the lower extremities was normal. In the August 2004 post-deployment health assessment, the Veteran stated that his health was excellent and that he did not have any concerns about his health. The Veteran was not diagnosed with knee strain until the February 2021 VA examination, years after separation from service. The February 2021 VA examiner opined in April 2021 that the Veteran's bilateral knee disability is not related to an in-service injury, event, or disease, including to the Veteran's left knee strain in service. The rationale was, while the Veteran had complaint of his knee and shin splints in service, there is insufficient clinical evidence that this became a chronic condition specifically due to service. The Veteran's separation examination was without any mention of any knee and/or leg complaint and/or diagnosis. The current condition of knee strain is a recent diagnosis, and a pattern of chronicity has not been established. The examiner's opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). It is more persuasive than the Veteran's assertions that his knee pain continued from the January 1996 injury because it cites to the persuasive evidence that the separation examination did not report any knee issues. Indeed, the Veteran denied knee trouble on the report of medical history at separation. Further, following the 1996 twisting injury to one knee, he went on to serve over eight more years, including time in a combat zone. Thus, the persuasive weight of the evidence is against a finding that the left knee sprain did not resolve. Furthermore, there was no instance of injury or treatment for the right knee in service. Thus, the evidence is against the in-service component of service connection for the right knee. The Veteran argues in his May 2016 statement that the VA examination clearly shows the condition began in 1990. However, the Board finds that the VA examiner's statement regarding the condition beginning in 1990 was not a statement drawing a conclusion that the condition began in 1990. Rather, the VA examiner was reporting what the Veteran stated about how the condition began. The examiner's statement was reported under the "history" section. What is clear is the examiner's opinion that refers to the intervening lack of chronicity of the condition. The Board finds the separation examination and report of medical history are more credible and probative than the Veteran's later statements that the condition began in 1990 and continued. The separation examination and report of medical history are documents recorded at the time of the events they record. Thus, they are more reliable evidence than the statements by the Veteran made years after the events that he reports about. The Board acknowledges that on August 10, 2022, the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxins Act of 2022 (PACT Act) was enacted. Section 303 of this law provides that, if a Veteran submits a claim for service connection with evidence of disability and evidence of participation in a toxic exposure risk activity (TERA), then VA shall obtain a medical opinion as to whether it is at least as likely as not that there is a nexus between the disability and the toxic exposure risk activity. 38 U.S.C. § 1168. While the VA has an obligation to provide a VA examination for a qualifying service connection claim which cannot be otherwise granted where there is evidence of a TERA, sub-regulatory guidance has specified four situations in which an exception applies including physical trauma. In this case, although the record indicates the Veteran was exposed to burn pits and other toxins during his active service, sub-regulatory guidance indicates a TERA opinion is generally not required for service connection claims for physical trauma. VBA Letter 20-22-10, Exception to TERA Examination and Medical Opinion Requirement (December 22, 2022). Thus, the Board finds that an exception to the TERA examination requirements applies, and an additional examination is not warranted on this basis. See 38 U.S.C. § 1168 (b); VBA Letter 20-22-10, 10-13, Processing Claims Involving the PACT Act, 87 Fed. Reg. 78,543 (Dec. 22, 2022). For the foregoing reasons, the persuasive weight of the evidence is against the claim. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc). 4. Service connection for Morton's neuroma of the left foot to include chronic foot pain. The Veteran asserts that his condition began in 1985 and for which he had surgery in 1998. with a twisted knee after prolonged running and continued thereafter. See February 2021 VA knee disability benefits questionnaire (DBQ). The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a current diagnosis of Morton's neuroma of the left foot, the evidence does not show and in-service incurrence, and it persuasively weighs against finding that the left foot neuroma began during service or is otherwise related to an in-service injury, event, or disease. Service treatment records for November 1991 show the Veteran had Morton's neuroma of the right foot. There is no evidence of Morton's neuroma of the left foot during service. The reports of medical history and reports of medication examination in February 1995, January 2000, and August 2005 (separation) show the Veteran denied foot trouble and the clinical evaluation of the feet was normal. In the August 2004 post-deployment health assessment, the Veteran stated that his health was excellent and that he did not have any concerns about his health. The Veteran was not diagnosed with left foot Morton's neuroma until the February 2021 VA examination, years after separation from service. The February 2021 VA examiner opined in April 2021 that the Veteran's current bilateral Morton's neuroma is not related to an in-service injury, event, or disease, including to the instance of right Morton's neuroma in service. The rationale was, while the veteran had complaint of the right Morton's neuroma in service, there is insufficient clinical evidence that this became a chronic condition specifically due to service. The Veteran's separation examination was without any mention of feet complaint and/or diagnosis. The current condition of Morton's neuroma is a recent diagnosis, and a pattern of chronicity has not been established. The examiner's opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). It is more persuasive than the Veteran's assertions that left foot Morton's neuroma is related to service because it cites to the persuasive evidence that the separation examination did not report any knee issues. Indeed, the Veteran denied foot trouble on numerous reports of medical history, including the one at separation. Furthermore, there was no instance of injury or treatment for the left foot in service. Thus, the evidence is against the in-service component of service connection for the left foot. The Veteran argues in his May 2016 statement that the VA examination shows the condition began in 1985 and he had surgery in 1998. However, the Board finds that the VA examiner's statement regarding the condition's onset refers to the right foot and was not a statement drawing a conclusion that the condition began in 1985. Rather, the VA examiner was reporting what the Veteran stated about how the condition began. The examiner's statement was reported under the "history" section. What is clear is the examiner's opinion that refers to the intervening lack of chronicity of the condition. The Board finds the reports of medical history and reports of examination are more credible and probative than the Veteran's later statements that the condition began in 1985 and continued. The examinations and reports of medical history are documents recorded at the time of the events they record. Thus, they are more reliable evidence than the statements by the Veteran made years after the events that he reports about. The Board acknowledges that on August 10, 2022, the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxins Act of 2022 (PACT Act) was enacted. Section 303 of this law provides that, if a Veteran submits a claim for service connection with evidence of disability and evidence of participation in a toxic exposure risk activity (TERA), then VA shall obtain a medical opinion as to whether it is at least as likely as not that there is a nexus between the disability and the toxic exposure risk activity. 38 U.S.C. § 1168. While the VA has an obligation to provide a VA examination for a qualifying service connection claim which cannot be otherwise granted where there is evidence of a TERA, sub-regulatory guidance has specified four situations in which an exception applies including physical trauma. In this case, although the record indicates the Veteran was exposed to burn pits and other toxins during his active service, sub-regulatory guidance indicates a TERA opinion is generally not required for service connection claims for physical trauma. VBA Letter 20-22-10, Exception to TERA Examination and Medical Opinion Requirement (December 22, 2022). Thus, the Board finds that an exception to the TERA examination requirements applies, and an additional examination is not warranted on this basis. See 38 U.S.C. § 1168 (b); VBA Letter 20-22-10, 10-13, Processing Claims Involving the PACT Act, 87 Fed. Reg. 78,543 (Dec. 22, 2022). For the foregoing reasons, the persuasive weight of the evidence is against the claim. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc). 5. Service connection for a thoracolumbar disability. The Veteran asserts that his disability began in 1989. He stated that the condition was caused by field exercises, carrying stretchers during duty in 2004. See February 2021 VA back disability benefits questionnaire (DBQ). The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a current diagnosis of intervertebral disc syndrome (IVDS) and lumbar strain with bilateral radiculopathy, the evidence of record persuasively weighs against finding that the Veteran's spine disability began during service or is otherwise related to an in-service injury, event, or disease. Service treatment records do not show any complaints of or treatment for back pain or a back disability. The reports of medical history and reports of medication examinations in December 1992, February 1995 and August 2005 (separation) show the Veteran denied recurrent back pain and the clinical evaluation of the spine was normal. In the August 2004 post-deployment health assessment, the Veteran stated that his health was excellent and that he did not have any concerns about his health. The Veteran reported back pain at an October 2020 private medical provider visit, but no back disability was diagnosed. He denied having back pain at a November 2020 private medical provider visit. The Veteran was not diagnosed with a back disability until the February 2021 VA examination, years after separation from service. The February 2021 VA examiner opined in April 2021 that the Veteran's spine disability is not related to an in-service injury, event, or disease. The rationale was, while the veteran had complaints of his back in service, there is insufficient clinical evidence that this became a chronic condition specifically due to service. The Veteran's separation examination was without any mention of back complaint and/or diagnosis. The current back condition is a recent diagnosis, and a pattern of chronicity has not been established. The examiner's opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). It is more persuasive than the Veteran's assertions that his back pain began in service because it cites to the persuasive evidence that the separation examination did not report any knee issues. Indeed, the Veteran denied recurrent back pain on several reports of medical history including the one at separation. Thus, the persuasive weight of the evidence is against a finding that any back pain he did have in service did not resolve. The Veteran argues in his May 2016 statement that the VA examination clearly shows the condition began in 1989 and carried through to 2004. However, the Board finds that the VA examiner's statement regarding the condition beginning in 1989 was not a statement drawing a conclusion that the condition began in 1989. Rather, the VA examiner was reporting what the Veteran stated about how the condition began. The examiner's statement was reported under the "history" section. What is clear is the examiner's opinion that refers to the intervening lack of chronicity of the condition. The Board finds the separation examination and report of medical history, as well as the other examinations and medical history reports, are more credible and probative than the Veteran's later statements that the condition began in 1989 and continued. The service treatment records are documents recorded at the time of the events they record. Thus, they are more reliable evidence than the statements by the Veteran made years after the events that he reports about. The Board acknowledges that on August 10, 2022, the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxins Act of 2022 (PACT Act) was enacted. Section 303 of this law provides that, if a Veteran submits a claim for service connection with evidence of disability and evidence of participation in a toxic exposure risk activity (TERA), then VA shall obtain a medical opinion as to whether it is at least as likely as not that there is a nexus between the disability and the toxic exposure risk activity. 38 U.S.C. § 1168. While the VA has an obligation to provide a VA examination for a qualifying service connection claim which cannot be otherwise granted where there is evidence of a TERA, sub-regulatory guidance has specified four situations in which an exception applies including physical trauma. In this case, although the record indicates the Veteran was exposed to burn pits and other toxins during his active service, sub-regulatory guidance indicates a TERA opinion is generally not required for service connection claims for physical trauma. VBA Letter 20-22-10, Exception to TERA Examination and Medical Opinion Requirement (December 22, 2022). Thus, the Board finds that an exception to the TERA examination requirements applies, and an additional examination is not warranted on this basis. See 38 U.S.C. § 1168 (b); VBA Letter 20-22-10, 10-13, Processing Claims Involving the PACT Act, 87 Fed. Reg. 78,543 (Dec. 22, 2022). For the foregoing reasons, the persuasive weight of the evidence is against the claim. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc). 6. Service connection for left shin splints 7. Service connection for right shin splints The Veteran asserts that his condition began in n 1990 with a twisted knee after prolonged running and continued thereafter. See February 2021 VA knee disability benefits questionnaire (DBQ). He reported that treatment in the past was shin splint taping. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a current diagnosis of bilateral shin splints, and evidence shows that the Veteran was diagnosed with right shin splints in service, the evidence of record persuasively weighs against finding that the Veteran's current bilateral shin splints began during service or are otherwise related to an in-service injury, event, or disease. Service treatment records for May 1992 show the Veteran reported right lower tibia pain for two weeks and was diagnosed with shin splints. Treatment was taping the lower extremity with cloth tape, Motrin, and light duty. There was no further notation of treatment. The reports of medical history and report of medication examinations in August 2005 (separation) show the Veteran denied symptoms related to the legs, bones, joints and other pain, and the clinical evaluation of the lower extremities was normal. In the August 2004 post-deployment health assessment, the Veteran stated that his health was excellent and that he did not have any concerns about his health. Post-service, the Veteran was not diagnosed with bilateral shin splints until the February 2021 VA examination, years after separation from service. The February 2021 VA examiner opined in April 2021 that the Veteran's bilateral knee disability is not related to an in-service injury, event, or disease, including to the Veteran's right shin splints in service. The rationale was, while the Veteran had complaint of his shin splints in service, there is insufficient clinical evidence that this became a chronic condition specifically due to service. The Veteran's separation examination was without any mention of any leg complaint and/or diagnosis. The current condition of shin splints is a recent diagnosis, according to the examiner, and a pattern of chronicity has not been established. The examiner's opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). It is more persuasive than the Veteran's assertions that his shin splint symptoms continued from the in-service injury because it cites to the persuasive evidence that the separation examination did not report any lower leg issues. Further, following the 1992 instance of right leg shin splints, he went on to serve over ten more years, including time in a combat zone. Thus, the persuasive weight of the evidence is against a finding that the right leg shin splints did not resolve. Furthermore, there was no instance of injury or treatment for the left shin in service. Thus, the evidence is against the in-service component of service connection for the left shin. The Veteran argues in his May 2016 statement that the VA examination clearly shows the condition began in 1990. However, the Board finds that the VA examiner's statement regarding the condition beginning in 1990 was not a statement drawing a conclusion that the condition began in 1990. Rather, the VA examiner was reporting what the Veteran stated about how the condition began. The examiner's statement was reported under the "history" section. What is clear is the examiner's opinion that refers to the intervening lack of chronicity of the condition. The Board finds the separation examination and report of medical history are more credible and probative than the Veteran's later statements that the condition began in 1990 and continued. The separation examination and report of medical history are documents recorded at the time of the events they record. Thus, they are more reliable evidence than the statements by the Veteran made years after the events that he reports about. The Board acknowledges that on August 10, 2022, the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxins Act of 2022 (PACT Act) was enacted. Section 303 of this law provides that, if a Veteran submits a claim for service connection with evidence of disability and evidence of participation in a toxic exposure risk activity (TERA), then VA shall obtain a medical opinion as to whether it is at least as likely as not that there is a nexus between the disability and the toxic exposure risk activity. 38 U.S.C. § 1168. While the VA has an obligation to provide a VA examination for a qualifying service connection claim which cannot be otherwise granted where there is evidence of a TERA, sub-regulatory guidance has specified four situations in which an exception applies including physical trauma. In this case, although the record indicates the Veteran was exposed to burn pits and other toxins during his active service, sub-regulatory guidance indicates a TERA opinion is generally not required for service connection claims for physical trauma. VBA Letter 20-22-10, Exception to TERA Examination and Medical Opinion Requirement (December 22, 2022). Thus, the Board finds that an exception to the TERA examination requirements applies, and an additional examination is not warranted on this basis. See 38 U.S.C. § 1168 (b); VBA Letter 20-22-10, 10-13, Processing Claims Involving the PACT Act, 87 Fed. Reg. 78,543 (Dec. 22, 2022). For the foregoing reasons, the persuasive weight of the evidence is against the claim. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc). REASONS FOR REMAND 1. Service connection for headaches is remanded. Remand is warranted to satisfy a regulatory or statutory duty, and the correction of such error has a reasonable possibility of aiding in substantiating the appellant's claim. 38 C.F.R. § 20.802(a). Remand is also warranted to correct a duty to assist error that occurred prior to the April 2021 rating decision on appeal. Prior to the rating decision on appeal, VA had evidence that the Veteran has service in the Southwest Theater of Operations. Given that headaches is listed as one of the possible signs or symptoms of undiagnosed illness and medically unexplained chronic multisymptom illnesses under 38 C.F.R. § 3.317(b), the record reasonably raised the issue of service connection under the theory of his status as a Persian Gulf War veteran. Although the AOJ obtained an April 2021 medical opinion, this medical opinion does not address the issue of headaches as connected to his environmental exposures during his service in Southwest Asia. In addition, the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act (PACT Act), that was signed into law on August 10, 2022, adds new examination requirements where toxic exposure risk activities (TERA) are implicated. Participation in a TERA may be inferred from the record based on covered service. VA is now required to provide a disability examination and/or obtain a medical opinion when a Veteran submits a claim for compensation and has: (1) evidence of a disability, and (2) participation in a TERA, but the evidence is not sufficient to establish service connection for the disability. 38 U.S.C. § 1168(a). Remand is warranted for a VA medical opinion pursuant to sections 1117 and 1168(a). 38 C.F.R. § 20.802(a) (the Board may remand for correction of any other error by the agency of original jurisdiction in satisfying a regulatory or statutory duty, if correction of the error would have a reasonable possibility of aiding in substantiating the appellant's claim). 2. Service connection for chronic bronchitis prior August 10, 2022, is remanded. Remand is warranted to satisfy a regulatory or statutory duty, and the correction of such error has a reasonable possibility of aiding in substantiating the appellant's claim. 38 C.F.R. § 20.802(a). Remand is also warranted to correct a duty to assist error that occurred prior to the April 2021 rating decision on appeal. Prior to the rating decision on appeal, VA had evidence that the Veteran has service in the Southwest Theater of Operations. Given chronic bronchitis is a disease of the respiratory system and the Veteran noted in his August 2004 post deployment health assessment that he sometimes was exposed to smoke from oil fires, burning trash or feces, and to sand/dust, the record reasonably raised the issue of service connection under the theory of his status as a Persian Gulf War veteran. Although the AOJ obtained an April 2021 medical opinion, this medical opinion does not provide address the issue of chronic bronchitis as connected to his environmental exposures during his service in Southwest Asia. 3. Service connection for Morton's neuroma of the right foot, to include chronic foot pain, is remanded. Remand is warranted to correct a duty to assist error that occurred prior to the rating decision on appeal. The Agency of Original Jurisdiction (AOJ) obtained an April 2021 medical opinion prior to the rating decision on appeal. However, this medical opinion does not provide an adequate rationale regarding whether the Veteran has any residuals of the right foot Morton's neuroma he had in service. The April 2021 examiner noted that the Veteran had right Morton's neuroma excised in 1998. The examiner found, however, that the Veteran's feet complaints are a recent diagnosis. The Board finds this examination report does not adequately consider whether there are any residuals of the Morton's neuroma from service, or whether the current foot complaints are related to the in-service neuroma, other than via chronicity. The matters are REMANDED for the following action: 1. Obtain a VA medical opinion from a qualified clinician regarding the Veteran's headache disability. The clinician must review the entire claims file, including a copy of this remand. An examination of the Veteran is only needed if deemed necessary by the clinician. The clinician is asked to address the following: (a.) Are the Veteran's headache symptoms a diagnosable disability? If the symptoms are not a diagnosable disability, are they symptoms of another disability the Veteran has? (b.) If taken together or separately, are the symptoms a diagnosable but medically unexplained chronic multisymptom illness (MUCMI), in that either the etiology or pathophysiology is unknown or inconclusive. A condition is not a MUCMI where both the etiology and pathophysiology are partially understood. The examiner should consider the evidence for the Veteran's particular circumstances in determining if there is MUCMI. (c.) Are the Veteran's symptoms/disorders due to his service, to include service in Iraq and Kuwait and exposure to fine particulate matter and toxic exposures (i.e. TERA)? (d.) Are the Veteran's symptoms/disorders due to the total potential exposure from his military deployments? Although an independent review of the claims file is required, the Board calls the clinician's attention to the Veteran's private medical treatment for headaches, including a June 2020 record where he reported headaches for "years." Provide a rationale for all opinions. 2. Obtain a VA medical opinion from a qualified clinician regarding the Veteran's chronic bronchitis disability prior to the PACT Act effective date. The clinician must review the entire claims file, including a copy of this remand. A physical examination of the Veteran is only needed if deemed necessary by the clinician. The clinician is asked to address the following: (a.) Are the Veteran's bronchitis symptoms a diagnosable disability? If the symptoms are not a diagnosable disability, are they symptoms of another disability the Veteran has? (b.) If taken together or separately, are the symptoms a diagnosable but medically unexplained chronic multisymptom illness (MUCMI), in that either the etiology or pathophysiology is unknown or inconclusive. A condition is not a MUCMI where both the etiology and pathophysiology are partially understood. The examiner should consider the evidence for the Veteran's particular circumstances in determining if there is MUCMI. (c.) Are the Veteran's symptoms/disorders due to his service, to include service in Iraq and Kuwait and exposure to fine particulate matter and toxic exposures (i.e. TERA)? (d.) Are the Veteran's symptoms/disorders due to the total potential exposure from his military deployments? Provide a rationale for all opinions. 3. Obtain an addendum opinion from an appropriate clinician regarding the Veteran's Morton's neuroma of the right foot. Identify the residuals of the right foot Morton's neuroma that the Veteran had during service and the subsequent excision of it. Are these residuals present currently? Is the current Morton's neuroma related to the in-service neuroma, regardless of whether there was chronicity of symptomatology or whether the current Morton's neuroma is a recent diagnosis. Provide a rationale for all opinions. D. Martz Ames Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Rocktashel, 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.