Case A24059525

Summary

The Veteran served in the U.S. Army from December 1981 to June 1986, including periods of active service in the Army National Guard. The Veteran appeals the denial of service connection for multiple conditions, including memory loss, GERD, eye and shoulder disabilities, spine and pelvis issues, interstitial cystitis, prostate disability, and plantar fasciitis. The Board denied these claims, finding the evidence persuasively against service connection or that the conditions were not service-related. The Board also noted that the Veteran's refractive error was not a compensable condition. However, the Board remanded claims for a psychiatric disability, a right pelvis disability with chronic pain, a general chronic pain disability, and an intestinal disability (claimed as IBS). A remand was warranted due to a pre-decisional duty to assist error concerning the psychiatric disability, specifically regarding the handling of the Veteran's diagnosed mental health conditions and outstanding treatment records. The Board noted that any evidence submitted after the AOJ decision and not considered by the Board could be submitted via a Supplemental Claim. The Board found no error in the denial of the other claims.

Rationale

Evidence persuasively against finding service connection.; No relative equipoise that disability is related to service.

Full Decision Text

Citation Nr: A24059525
Decision Date: 09/23/24	Archive Date: 09/23/24

DOCKET NO. 211213-205677
DATE: September 23, 2024

ORDER

Entitlement to service connection for a disability manifesting in memory loss and lack of concentration, separate from manifestations of a psychiatric disability, is denied.

Entitlement to service connection for gastroesophageal reflux disease (GERD) (claimed as acid reflux with nausea) is denied.

Entitlement to service connection for a left or right eye disability is denied.

Entitlement to service connection for a cervical spine disability is denied.

Entitlement to service connection for a left shoulder disability is denied.

Entitlement to service connection for a right shoulder disability is denied.

Entitlement to service connection for a lumbar spine disability is denied.

Entitlement to service connection for a left pelvis disability manifesting in chronic pain is denied.

Entitlement to service connection for interstitial cystitis is denied.

Entitlement to service connection for a prostate disability is denied.

Entitlement to service connection for bilateral plantar fasciitis is denied.

REMANDED

Entitlement to service connection for a psychiatric disability is remanded.

Entitlement to service connection for a disability manifesting in chronic pain is remanded.

Entitlement to service connection for a right pelvis disability manifesting in chronic pain is remanded.

Entitlement to service connection an intestinal disability (claimed as irritable bowel syndrome) is remanded.

FINDINGS OF FACT

1. The evidence does not reach relative equipoise that any current disability or functional impairment related to memory loss and lack of concentration, separate from manifestations of a psychiatric disability, is related to service.

2. The evidence is persuasively against finding that the Veteran's GERD is related to service.

3. The Veteran's refractive error of the eye is not a disease or injury subject to VA compensation. 

4. The evidence is persuasively against finding that the Veteran has an eye disability other than refractive error related to service.

5. The evidence is persuasively against finding that the Veteran has a cervical spine disability related to service.

6. Regarding the Veteran's left shoulder claim, the evidence does not reach relative equipoise that an event, injury, or disease occurred in service.

7. The evidence is persuasively against finding that the Veteran has a right shoulder disability related to service.  

8. The evidence is persuasively against finding that the Veteran has a lumbar spine disability related to service.

9. The evidence is persuasively against finding that the Veteran's cervical or lumbar degenerative disc disease or left or right shoulder degenerative arthritis was incurred in service, manifested within the first post-service year, is shown by continuity of symptomatology, or is otherwise related to service.

10. Regarding the Veteran's left pelvis disability claim, the evidence does not reach relative equipoise that an in-service event, injury, or disease occurred.

11. The evidence does not reach relative equipoise that the Veteran has a current cystitis disability.  

12. The evidence is persuasively against finding that the Veteran has a prostate disability related to service.

13. The evidence does not reach relative equipoise that the Veteran has a current plantar fasciitis disability related to service.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for a disability manifesting in memory loss and lack of concentration, separate from manifestations of a psychiatric disability, have not been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for entitlement to service connection for GERD have not been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for entitlement to service connection for a left or right eye disability have not been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

4. The criteria for entitlement to service connection for a cervical spine disability have not been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

5. The criteria for entitlement to service connection for a left shoulder disability have not been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

6. The criteria for entitlement to service connection for a right shoulder disability have not been met
.102, 3.303.

4. The criteria for entitlement to service connection for a cervical spine disability have not been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

5. The criteria for entitlement to service connection for a left shoulder disability have not been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

6. The criteria for entitlement to service connection for a right shoulder disability have not been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

7. The criteria for entitlement to service connection for a lumbar spine disability have not been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

8. The criteria for entitlement to service connection for a left pelvis disability manifesting in chronic pain have not been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

9. The criteria for entitlement to service connection for interstitial cystitis have not been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

10. The criteria for entitlement to service connection for a prostate disability have not been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

11. The criteria for entitlement to service connection for bilateral plantar fasciitis have not been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from December 1981 to June 1986.  He served honorably in the U.S. Army, including foreign service, and in the Army National Guard with periods of active service.  The Board thanks the Veteran for his service to our country.

The rating decision on appeal was issued in September 2021 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.

In July 2021, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of a June 2021 decision.  In September 2021, the agency of original jurisdiction (AOJ) issued the HLR decision on appeal, which considered the evidence of record at the time of the prior June 2021 decision.  Therefore, the Board may only consider the evidence of record at the time of the June 2021 decision.

In the December 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the June 2021 AOJ decision, which was subsequently subject to higher-level review.  38 C.F.R. § 20.301.  If evidence was submitted during the period after the AOJ issued the decision, which was subsequently subject to higher-level review the Board did not consider it in its decision.  38 C.F.R. §§ 20.300, 20.301, 20.801. 

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501.  If the evidence is new and relevant, VA will issue another decision on the claim[s], considering the new evidence in addition to the evidence previously considered.  Id.  Specific instructions for filing a Supplemental Claim are included with this decision. 

However, because the Board is remanding the claims of entitlement to service connection for a psychiatric disability, a right pelvis disability, a disability manifesting by chronic body pain, and an intestinal disability, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R
 a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501.  If the evidence is new and relevant, VA will issue another decision on the claim[s], considering the new evidence in addition to the evidence previously considered.  Id.  Specific instructions for filing a Supplemental Claim are included with this decision. 

However, because the Board is remanding the claims of entitlement to service connection for a psychiatric disability, a right pelvis disability, a disability manifesting by chronic body pain, and an intestinal disability, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

Service Connection

Service connection may be granted for disability due to disease or injury incurred in or aggravated by active military service.  38 U.S.C. § 1131; 38 C.F.R. §§ 3.303, 3.304.  Service connection may also be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service.  38 C.F.R. § 3.303.  To substantiate a claim of service connection, there must be evidence of: (1) a current disability; (2) a disease, injury, or event in service; and (3) a nexus or causal relationship between the claimed disability and the disease, injury, or event in service.  Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

Decisions of the Board shall consider all information and lay and medical evidence of record in a case.  38 U.S.C. § 5107(b); 38 C.F.R. § 3.303(a).  Competent lay evidence is any evidence not requiring that the proponent have specialized education, training, or experience.  Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a layperson.  38 C.F.R. § 3.159(a)(2).  This may include some medical matters, such as describing symptoms or relating a contemporaneous medical diagnosis.  Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007).  Competent medical evidence is evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions.  Competent medical evidence may include statements conveying sound medical principles found in medical treatises and statements contained in authoritative writings, such as medical and scientific articles and research reports or analyses.  38 C.F.R. § 3.159(a)(1).  Medical opinions must contain clear conclusions with a reasoned medical explanation based on supporting data.  See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007).

The claimant bears the responsibility to present and support a claim for benefits.  38 U.S.C. § 5107(a); Fagan v. Shinseki, 573 F.3d 1282, 1286 (Fed. Cir. 2009).  However, when there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant.  38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.  When all of the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether the evidence is persuasively against the claim, in which case the claim is denied.  38 U.S.C. § 5107(a); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

The benefit of the doubt doctrine, however, is not applicable based on "pure speculation or remote possibility."  Fagan, 573 F.3d at 1287.  Rather, the evidence must rise to a state of equipoise for the veteran to prevail.  See Skoczen v. Shinseki, 564 F.3d 1319, 1324 (Fed. Cir. 2009).  Indeed, the Federal Circuit rejected the idea that a veteran must be awarded benefits unless VA produces affirmative evidence refuting the claim.  See Skoczen, 564 F.3d at 1329.  Instead, the
 F.4th 776 (Fed. Cir. 2021).

The benefit of the doubt doctrine, however, is not applicable based on "pure speculation or remote possibility."  Fagan, 573 F.3d at 1287.  Rather, the evidence must rise to a state of equipoise for the veteran to prevail.  See Skoczen v. Shinseki, 564 F.3d 1319, 1324 (Fed. Cir. 2009).  Indeed, the Federal Circuit rejected the idea that a veteran must be awarded benefits unless VA produces affirmative evidence refuting the claim.  See Skoczen, 564 F.3d at 1329.  Instead, the Federal Circuit concluded that if zero evidence is produced in support of a material issue, 1) it may be that no evidence exists to support the particular issue, in which case VA can rule against the claim; or 2) VA may have failed its duty to assist.  Id.

1. Entitlement to service connection for a disability manifesting in memory loss and lack of concentration, separate from manifestations of a psychiatric disability

The Veteran contends, without specifics, that he has memory loss and lack of concentration related to military stressors and that the disability had its onset in 1986.  The Board notes that the AOJ favorably found, with respect to this issue, that the Veteran had been diagnosed with cyclothymic disorder with anxious distress and that an April 2021 VA psychiatric examination report noted chronic sleep impairment and impairment of short and long term memory as symptoms of the psychiatric disability.  The Board concludes that service connection for a disability manifesting in memory loss and lack of concentration, separate from manifestations of a psychiatric disability, is not warranted.

The Veteran's active duty service treatment records do not reflect any complaints, findings, treatment, or diagnosis of a disability manifesting in memory loss and lack of concentration.  In an April 1986 separation report of medical examination, on clinical evaluation no abnormalities were noted except a tattoo on the right upper arm; the examiner affirmatively indicated that neurologic and psychiatric evaluations were normal.  The examiner noted, "none" in the summary of defects and diagnosis.  In an April 1986 report of medical history, the Veteran denied loss of memory or amnesia.

In a March 1988 neurology note, on neurological examination the Veteran's short and remote memory was noted to be intact.  In a June 1992 VA neurology examination report, the examiner noted a normal neurologic examination.  August 1996 psychiatric testing, noted in a January 2021 VA note, noted significant difficulty with attention and concentration but stated that MMPI showed significant exaggeration of symptoms with suggestion of severe depression.

Mental status examinations from August 2019 to January 2021 noted good attention and concentration and ability to recall 3 of 3 words.   

The earliest evidence of memory loss or lack of concentration is a February 2021 review of systems in which the Veteran endorsed memory loss.  In an April 2021 VA psychiatric examination report, he reported memory loss for recent and historical events, such as gaps about his childhood.

Even assuming that the Veteran has a disability manifesting in memory and lack of concentration or functional impairment due to these symptoms, there is no evidence of an in-service event.  Further, there is no evidence indicating that any current disability or functional impairment may be related to service.  While the Veteran contends that the claimed disability had its onset in 1986, neither the Veteran nor his representative has made any assertion that he had such symptoms continuous since service; nor does the record reflect any continuity of symptomatology since service.  He never reported such symptoms during multiple neurological examinations; rather, his short and remote memory were noted to be normal in March 1988 and attention, concentration, and memory findings during mental status examinations were consistently unremarkable.  

In certain circumstances VA bears a duty to assist the veteran.  38 C.F.R. § 3.159.  VA must provide a medical examination or obtain a medical opinion if there exists (1) competent evidence of a current disability; (2) evidence of an in-service event, injury, or disease; and (3) an indication that the current disability may be associated with the veteran's service or another service-connected disability; but (4) there is otherwise insufficient competent medical evidence to decide the claim.  McLendon v. Nicholson, 20 Vet. App. 79, 86 (2006).  While the third factor creates a low threshold and evidence "indicating" that a condition "may be" associated with service need be neither medical nor competent, conclusory testimony suggesting the existence of a nexus is not sufficient; a factual basis is required.  Id. at 83; see Waters v. Shinseki, 
 evidence of a current disability; (2) evidence of an in-service event, injury, or disease; and (3) an indication that the current disability may be associated with the veteran's service or another service-connected disability; but (4) there is otherwise insufficient competent medical evidence to decide the claim.  McLendon v. Nicholson, 20 Vet. App. 79, 86 (2006).  While the third factor creates a low threshold and evidence "indicating" that a condition "may be" associated with service need be neither medical nor competent, conclusory testimony suggesting the existence of a nexus is not sufficient; a factual basis is required.  Id. at 83; see Waters v. Shinseki, 601 F.3d 1274, 1277 (Fed. Cir. 2010).  Here, however, as there is no evidence indicating that any current disability or functional impairment may be related to service, an examination is not required to satisfy VA's duty to assist.

Hence, after reviewing all the evidence of record, the Board finds that the evidence does not reach relative equipoise that any current disability or functional impairment related to memory loss and lack of concentration, apart from any psychiatric disorder, is related to service.  As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and entitlement to service connection is not warranted.  See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

2. Entitlement to service connection for GERD with nausea

The Veteran makes no specific contentions regarding GERD but generally contends that it had its onset in 1986.  The Board concludes that service connection is not warranted.

The AOJ made no favorable findings with respect to this claim.

In a June 1984 service treatment record, the Veteran complained of burning pain in the stomach which increased with excitement, loss of appetite, and soreness and burning in the stomach area.  The provider noted an assessment of acid indigestion.  Active duty service treatment records are otherwise silent for any complaints, findings, treatment, or diagnosis of reflux.  In the April 1986 separation report of medical examination, on clinical evaluation the examiner noted normal abdomen and viscera.  In an April 1986 report of medical history, the Veteran denied pain or pressure in the chest, frequent indigestion, and stomach trouble.  

The earliest notation of a gastroesophageal disorder is a January 1999 treatment note in which the Veteran complained of substernal chest pain accompanied by a sensation of chest pressure.  The provider rendered an assessment of atypical chest pain likely due to GERD but noted that in light of the Veteran's symptoms and family history, cardiac disease could not be ruled out.  A stress thallium test was ordered which later showed a possible small amount of ischemia.  An assessment of GERD was again rendered in August 2003.  In a March 2020 emergency department note, the Veteran endorsed abdominal pain, constipation, and reflux.

In a June 2021 VA examination report, the Veteran relayed that he did not recall the onset of his disorder, stating that as long as he could remember he has had heartburn after eating spicy foods and that he avoided spicy foods and took over the counter TUMS.  He stated that he never sought medical care for the symptoms.  The examiner concluded that the Veteran's GERD is less likely than not related to service.  The examiner noted that the Veteran's service treatment records do not indicate a chronic esophageal condition, to include acid reflux and stomach pains, and noted the exit examination was silent for esophageal complaints and abnormalities and did not indicate chronicity of care for such a condition.  Noting the 13-year gap between the Veteran's discharge and the 1999 notation of GERD, the examiner concluded that the current disability is less likely than not related to service.

The Board concludes that the evidence is persuasively against finding that the Veteran's GERD is related to service.  While the Veteran indicated, along with all the other claimed disabilities, that the disability had its onset in 1986, to the extent that he contends that the disability had its onset during service, the evidence is persuasively against this.  There is only one notation of acid indigestion during service and the examiner concluded that service treatment records do not indicate a chronic esophageal condition.  Furthermore, the Veteran affirmatively denied pain or pressure in the chest, frequent indigestion, and stomach trouble at separation.  Indeed, the Veteran later could not recall the onset of the disorder, stating that he had had heartburn after eating spicy foods for as long as he could remember; as it would therefore be mere speculation to assign a date of onset,
 indicated, along with all the other claimed disabilities, that the disability had its onset in 1986, to the extent that he contends that the disability had its onset during service, the evidence is persuasively against this.  There is only one notation of acid indigestion during service and the examiner concluded that service treatment records do not indicate a chronic esophageal condition.  Furthermore, the Veteran affirmatively denied pain or pressure in the chest, frequent indigestion, and stomach trouble at separation.  Indeed, the Veteran later could not recall the onset of the disorder, stating that he had had heartburn after eating spicy foods for as long as he could remember; as it would therefore be mere speculation to assign a date of onset, it would be mere speculation to conclude that the disability was continuous since service.  Moreover, the VA examiner concluded that the disability is less likely than not related to service as a chronic esophageal condition did not have its onset during service and there as a 13-year gap from discharge to the notation of GERD; the Board concludes that this opinion is probative as it is based on a review of the record and examination of the Veteran.

Hence, after reviewing all the evidence of record, the Board finds that the evidence is persuasively against the claim for service connection for GERD.  As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and entitlement to service connection is not warranted.  See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

3. Entitlement to service connection for a left or right eye disability

The Veteran makes no specific contentions regarding the claimed disability manifesting in pain and photophobia but generally contends that it had its onset in 1986.  The Board concludes that service connection is not warranted.

As an initial matter, the Board observes that, to the extent that the Veteran may experience photophobia as a manifestation of his service-connected headaches disability, the AOJ denied service connection for headaches in a September 1992 rating decision.  The Veteran included claims for both chronic headaches and photophobia in the February 2021 claim and was informed by the AOJ that VA regulations required the request to review the previous denial of service connection for headaches to be filed on the proper form.  Following receipt of the Veteran's submitted a supplemental claim in July 2021, service connection for a headaches disability was separately adjudicated (and service connection was granted in July 2022).  Accordingly, the Board concludes that the claim for eye pain and photophobia is separate from any manifestations of a tension headaches disability.

The AOJ favorably found that the Veteran has been diagnosed with a disability, nuclear sclerotic cataracts.

The Veteran's active duty service treatment records do not reflect any complaints, findings, treatment, or diagnosis of eye pain or photophobia.  The Veteran's November 1981 entrance examination notes defective vision with distant vision in the left eye of 20/40 and that the Veteran's glasses were broken.  In an April 1986 eye evaluation, the Veteran reported having headaches and blurry eyes and that his left eye was a lazy eye.  The provider noted no history of glaucoma, cataracts, eye surgery, or eye disease.  Left distant vision of 20/30 was noted and the provider noted in the disposition that a prescription for constant eyewear would be rendered.  In the April 1986 separation report of medical history, the Veteran's general eyes, ophthalmoscopic, pupils, and ocular motility clinical evaluations were normal; right distant vision and left and right near vision were 20/20 while left distant vision was 20/30 and corrected to 20/20; no defects or diagnoses were noted; and the examiner rated the Veteran's eyes as 1 in the PULHES profile.  In the report of medical history, the Veteran endorsed eye trouble but the examiner did not address the issue in the physician's summary.

In an August 1987 VA neurology consultation, the Veteran reported headaches with blurred vision.  In a March 1988 VA neurology note, the Veteran complained of headaches and blurred vision on awakening which resolved by mid-morning.  On examination, the provider noted that extraocular movements were intact, pupils were equal and reactive to light and accommodation and that there were no neurological deficits on examination.  The provider rendered an assessment of probable tension headaches of a psychogenic etiology.  In an October 1989 VA note, the Veteran again complained of headaches and blurred vision.  In a September 1991 VA eye consultation, the Veteran complained of blurry vision bilaterally, a lazy left eye, and intermittent black spots bilaterally.  The provider rendered an impression of slight anisometropia and floaters
.  In a March 1988 VA neurology note, the Veteran complained of headaches and blurred vision on awakening which resolved by mid-morning.  On examination, the provider noted that extraocular movements were intact, pupils were equal and reactive to light and accommodation and that there were no neurological deficits on examination.  The provider rendered an assessment of probable tension headaches of a psychogenic etiology.  In an October 1989 VA note, the Veteran again complained of headaches and blurred vision.  In a September 1991 VA eye consultation, the Veteran complained of blurry vision bilaterally, a lazy left eye, and intermittent black spots bilaterally.  The provider rendered an impression of slight anisometropia and floaters.  In a March 1992 VA hospital summary for an episode of major depression, the Veteran reported sustaining a head injury 4 or 5 years prior and having headaches and seeing spots in front of his eyes since then.

In a June 1992 VA examination, the Veteran complained of daily headaches sometimes lasting hours to all day without associated photophobia.  On examination, the examiner noted a normal neurologic examination.  

In a January 1999 treatment note, the Veteran complained of visual dimming occurring with increases in his respiratory rate and "black spots" in his visual field at all times; the provider concluded that visual problems were related to hyperventilation and were not accompanied by other neurological symptoms.  In a March 2006 VA telephone note, the Veteran again complained of lazy eye with blurred vision.

The first notation of photophobia was in a February 2020 optometry note, when the Veteran reported dryness and itchiness in the eyes for a few months, that his vision seemed a lot more blurry, more floaters, flashes of light for about 3 or 4 months, and that his eyes hurt in fluorescent light settings.  The provider rendered diagnoses of cataracts, posterior vitreous detachment, and refractive error.  In a March 2021 optometry note, the Veteran reported light sensitivity during the day.  The provider rendered diagnoses of age-related nuclear sclerotic cataracts, dry eye syndrome, posterior vitreous detachment, and refractive error.

The Board concludes that the evidence is persuasively against finding that the Veteran has any eye disability manifesting in pain and photophobia which is related to service.  The Veteran has diagnoses of age-related nuclear sclerotic cataracts, dry eye syndrome, posterior vitreous detachment, and refractive error current during the period on appeal.  However, refractive error of the eye is not a disease or injury for VA compensation purposes.  38 C.F.R. § 3.303(c).  There is no evidence indicating that the Veteran had a chronic eye disease or injury superimposed on it in service and causing additional disability, so as to permit service connection; indeed, the Board observes that the Veteran's left distant vision, noted to be 20/40 at entrance, was noted to be 20/30 at separation.  See VAOPGCPREC 82-90, 55 Fed. Reg. 4571 (1990). 

With respect to nuclear sclerotic cataracts, dry eye syndrome, and posterior vitreous detachment, there is no medical evidence indicating that they may be related to service.  During and following service only blurry vision and associated headaches were noted until September 1991, when the Veteran first reported intermittent black spots as well as blurry vision and the provider rendered diagnoses of anisometropia and floaters.  He reported in March 1992 seeing spots since sustaining a head injury 4 or 5 years earlier, which, at its earliest, would be after separation; the Board additionally observes that in the April 1986 report of medical history the Veteran denied having or having had a head injury.  Symptoms of dryness and itchiness, flashes of light, and sensitivity to light were not reported until February 2020 and the Veteran stated that dryness and itchiness and flashes of light had been ongoing only for a few months.  

The Veteran has not provided any lay evidence regarding the onset of his eye disability except to indicate that eye pain and photophobia began in 1986.  Given that, prior to February 2020, the Veteran had repeatedly reported blurred vision and, since September 1991, floaters in neurological and eye consultations and evaluations, the Board concludes that the Veteran would have sought treatment for other symptoms of floaters prior to September 1991 and dryness and itchiness, flashes of light, and sensitivity to light prior to February 2020 and that such treatment would have been noted in contemporaneous service and post-service treatment records.  Therefore, the Board additionally concludes that the absence of contemporaneous treatment records is probative and, to the extent that the Veteran
 not provided any lay evidence regarding the onset of his eye disability except to indicate that eye pain and photophobia began in 1986.  Given that, prior to February 2020, the Veteran had repeatedly reported blurred vision and, since September 1991, floaters in neurological and eye consultations and evaluations, the Board concludes that the Veteran would have sought treatment for other symptoms of floaters prior to September 1991 and dryness and itchiness, flashes of light, and sensitivity to light prior to February 2020 and that such treatment would have been noted in contemporaneous service and post-service treatment records.  Therefore, the Board additionally concludes that the absence of contemporaneous treatment records is probative and, to the extent that the Veteran intended to indicate that eye pain and photophobia had their onset during service, such statements, as they are inconsistent with the other evidence of record, are less than credible. The lack of contemporaneous treatment for such symptoms is more probative than the Veteran's reports over 30 years later.

The Board observes that the Veteran was not afforded an examination.  As there is no evidence indicating that the Veteran may have had a chronic eye disease or injury superimposed on his refractive disorder in service, causing additional disability, and no evidence indicating that the other current disabilities may be related to service, an examination is not necessary to satisfy VA's duty to assist.  McLendon at 86.  

Hence, after reviewing all the evidence of record, the Board finds that the evidence is persuasively against the claim for an eye disability manifesting in eye pain and photophobia.  As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and entitlement to service connection is not warranted.  See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

4. Entitlement to service connection for a cervical spine disability

5. Entitlement to service connection for a left shoulder disability

6. Entitlement to service connection for a right shoulder disability

7. Entitlement to service connection for a lumbar spine disability

The Veteran contends that his cervical and lumbar and left and right shoulder disabilities are related to training during service and had their onset in 1986: his cervical spine disability is related to lifting heavy objects during service and his bilateral shoulder and lumbar spine disabilities are related to running, jumping, and marching during service.

Certain chronic diseases, including arthritis, may be presumed to have been incurred during service if they become disabling to a compensable degree within one year of separation from active duty.  38 C.F.R. §§ 3.307, 3.309.

With chronic disease shown as such in service (or within the presumptive period under § 3.307) so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes.  For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word chronic.  Continuity of symptomatology after discharge is required where the condition noted during service is not, in fact, shown to be chronic, or where the diagnosis of chronicity may be legitimately questioned.  38 C.F.R. § 3.303(b).  

The AOJ rendered favorable findings that the Veteran had been diagnosed with degenerative disc disease of the neck and back and left and right shoulder degenerative arthritis.  The AOJ also favorably found that the Veteran had qualifying in-service events for his neck and back claims, noting an April 1986 complaint of neck pain and an April 1984 diagnosis of lumbar strain.

In the April 1984 service treatment note, the Veteran complained of lower back pain for two days, noting that he had injured his back while wrestling.  The provider rendered an assessment of bilateral muscle strain.  In an October 1985 service treatment record, the Veteran complained of back and neck pain lasting one month from uploading and downloading ammunition.  The provider rendered an assessment of back strain.  In an April 1986 service treatment record, the Veteran complained of stiffness and pain radiating from the right side of the neck into the right shoulder lasting one month.  He reported that it was relieved by "popping" his neck but worsened as the day went on.  The provider rendered an assessment of musculoskeletal pain secondary to tension.  In an April 1986 dental patient health questionnaire, the Veteran denied having or having had arthritis or rheumatism.  In the April 1986 separation report of medical history, clinical evaluations of the Veteran's upper extremities, spine, and other musculoskeletal
 and neck pain lasting one month from uploading and downloading ammunition.  The provider rendered an assessment of back strain.  In an April 1986 service treatment record, the Veteran complained of stiffness and pain radiating from the right side of the neck into the right shoulder lasting one month.  He reported that it was relieved by "popping" his neck but worsened as the day went on.  The provider rendered an assessment of musculoskeletal pain secondary to tension.  In an April 1986 dental patient health questionnaire, the Veteran denied having or having had arthritis or rheumatism.  In the April 1986 separation report of medical history, clinical evaluations of the Veteran's upper extremities, spine, and other musculoskeletal system were normal; no defects or diagnoses were noted; and the examiner rated the Veteran's physical capacity and upper and lower extremities as 1s in the PULHES profile and rated him as an A in the physical category.  In the April 1986 report of medical history, the Veteran endorsed swollen or painful joints and bone, joint, or other deformity but affirmatively denied having or having had arthritis, rheumatism, or bursitis; painful or "trick" shoulder; or recurrent back pain.  The examiner noted in the physician's summary the Veteran's bilateral knee pain.

In a June 1987 VA note, the Veteran complained of pressure on each side of the back lasting for one week.  The provider noted a history of bilateral costovertebral angle pain and indicated that it was probably a urinary tract infection.  In August 1987, the Veteran complained of frontal headaches and neck pain.  The provider rendered an assessment of persistent headaches.  In a July 1989 treatment record during a period of active service, the Veteran complained of a rash and knot on the neck, which the provider concluded was possible shingles.  In a February 1998 treatment note, following emergency treatment in December 1997 for a UTI, a provider noted that the UTI had been resolved and rendered an assessment of back and wrist pain.  

Chronic back pain was first noted in August 2000.

In a February 2001 treatment note, the Veteran complained of left shoulder pain, noting that he had been using his left hand and shoulder, including carrying his three children, since undergoing multiple [right] arm surgeries.  The provider rendered an assessment of shoulder bursitis, probably due to overuse.

In a November 2002 physical therapy note, the provider noted neck pain and upper extremity numbness which could be cervical stenosis but was very likely myofascial dysfunction.

In a February 2003 treatment note, the Veteran complained of right shoulder pain with a torn rotator cuff and cervical neck pain.  The provider noted that neck pain was likely to be muscular, noting negative cervical spine films.  

In a September 2004 orthopedic consultation, the Veteran reported a several year history of bilateral shoulder pain and neck pain.  A history of partial right supraspinatus tears on previous right shoulder MRIs was noted.  The provider rendered a diagnosis of partial supraspinatus tear of the right shoulder.

In a September 2004 physical therapy note, the Veteran reported pain in the right shoulder for the past two years, denying any injury or incident that caused the onset of symptoms.  He reported that shoulder symptoms steadily came on him.

In a May 2005 orthopedic clinic note, the provider noted cervical spine MRI results showing mild concentric bulge effacing cerebrospinal fluid without significant stenosis at C5-6 and left paracentral protrusion with bulge at C6-7 without evidence of neural foraminal narrowing or spinal canal stenosis.  The provider rendered a diagnosis of bilateral acromioclavicular joint arthritis.  

In a June 2006 orthopedic consultation, the Veteran reported neck pain and bilateral shoulder pain for the past couple of years.  The provider noted left MRI results showing no visualized nerve compression in the shoulder, rim rent tear of the supraspinatus tendon and mild degenerative changes of the acromioclavicular joint; right MRI results showing rim rent tear of supraspinatus tendon associated with tendinosis and Hill-Sach's lesion with normal looking anterior labrum; and negative EMG testing.  The provider noted bilateral rim rent supraspinatus tears which might be contributing to overall pain but stated that overall symptomatology seems more consistent with neck pathology.

In a February 2021 pain consultation, the Veteran reported widespread pain including his shoulders, neck, and back, for over 20 years which had gradually worsened and became really bad in the past 3 to 5 years.

In a June 2021 VA cervical spine examination report, the Veteran reported chronic neck pain for as long as he
 changes of the acromioclavicular joint; right MRI results showing rim rent tear of supraspinatus tendon associated with tendinosis and Hill-Sach's lesion with normal looking anterior labrum; and negative EMG testing.  The provider noted bilateral rim rent supraspinatus tears which might be contributing to overall pain but stated that overall symptomatology seems more consistent with neck pathology.

In a February 2021 pain consultation, the Veteran reported widespread pain including his shoulders, neck, and back, for over 20 years which had gradually worsened and became really bad in the past 3 to 5 years.

In a June 2021 VA cervical spine examination report, the Veteran reported chronic neck pain for as long as he could remember without any specific injury or event.  The examiner noted a May 2005 diagnosis of degenerative disc disease.  The examiner concluded that the Veteran's cervical spine disability is less likely than not related to service.  Noting the October 1985 complaint of neck pain, for which a diagnosis of back strain was rendered, and the complaint, at age 22, of neck pain radiating into the right shoulder and neck stiffness associated with occipital headaches, for which a diagnosis of musculoskeletal pain secondary to tension was rendered, the examiner stated that neck pain during service was acute only.  The examiner noted that there were no further complaints and that the Veteran's separation examination was silent for neck pain.  The examiner stated that it was not until 16 years later that records indicate the onset of chronic neck pain and concluded, given the 16-year timeframe from separation to the onset of neck pain, that the neck disability is less likely than not incurred during or caused by service.

In a June 2021 VA shoulder examination report, the Veteran also reported constant shoulder pain for as long as he could recall.  The examiner concluded that the Veteran's left and right shoulder disabilities are less likely than not related to service, noting that service treatment records and the separation examination are silent for bilateral shoulder complaints.  The examiner noted that the record is silent for complaints until 2001, when the Veteran was diagnosed with left shoulder bursitis, and that the Veteran was diagnosed with bilateral acromioclavicular joint degenerative arthritis in May 2005.  Noting the 19-year gap between separation and the 2005 diagnosis, the examiner concluded that the Veteran's bilateral shoulder disability is less likely than not incurred during or caused by service.

In a June 2021 VA thoracolumbar spine examination report, the Veteran reported lower back pain that started as achy pain for as long as he could remember which worsened over the years.  He could not recall any known event or injury.  The examiner concluded that the Veteran's back disability is less likely than not related to service.  The examiner stated that the Veteran had only an acute lumbar strain during service: noting the lumbar strain diagnosis, the examiner stated that the records are silent for further lower back complaints, including the April 1986 separation examination.  The examiner noted that the 1987 urinary tract infection with associated back pain was also an acute resolvable condition.

The Board affords these opinions probative value as they are based on review of the record and in-person examination.

The Board acknowledges the Veteran's report that he has experienced neck, shoulder, and back pain for as long as he can recall; the September 2004 notation of a "several-year history" of shoulder and neck pain; and February 2021 report of pain for over 20 years.  However, these are not specific and the Board concludes that it would be mere speculation to estimate how far back the Veteran can recall, how long a several-year history may last, or how much longer than 20 years the Veteran experienced pain.

With respect to the Veteran's claimed neck disability, the Board concludes that the evidence is persuasively against finding that the disability is related to service.  There is no credible lay or medical evidence indicating that the disability may be related to service: to the extent that the Veteran contends that cervicalgia had its onset in 1986 during service, the Board finds that this is inconsistent with the more contemporaneous report in 2006 of neck and shoulder pain for the past "couple of years." Therefore, due to the inconsistencies with the contemporaneous records, the Veteran's statements to the contrary lack credibility. While a couple of years technically refers to a two year period, the Board observes that the term may be colloquially used to refer to a period of a "few" years, which in common usage refers to a period much less than 20 years; thus this indicates, consistent with his treatment history, that his neck pain had its onset in the early 2000s and not in the 1980s.  Rather, the most probative medical evidence is against the
 the Board finds that this is inconsistent with the more contemporaneous report in 2006 of neck and shoulder pain for the past "couple of years." Therefore, due to the inconsistencies with the contemporaneous records, the Veteran's statements to the contrary lack credibility. While a couple of years technically refers to a two year period, the Board observes that the term may be colloquially used to refer to a period of a "few" years, which in common usage refers to a period much less than 20 years; thus this indicates, consistent with his treatment history, that his neck pain had its onset in the early 2000s and not in the 1980s.  Rather, the most probative medical evidence is against the claim.  As an initial matter, the Board observes that the neck complaints during service were not associated with a neck injury or disability, but with tension headaches and back strain.  Moreover, given the in-service history and separation examination, the examiner concluded that the neck complaints during service were acute only.  The examiner further concluded that, given the 16-year gap from separation to complaints of neck pain in the early 2000s, the disability is less likely than not related to service.

With respect to the left and right shoulder disabilities, the Board concludes, regarding the left shoulder, that the second factor for service connection is not met.  The Veteran's service treatment records are silent for any complaints, findings, treatment, or diagnosis of a left shoulder disability and the Veteran affirmatively denied painful or trick shoulder at separation.  Regarding the right shoulder, there is no credible lay or medical evidence indicating that the disability may be related to service: to the extent that the Veteran contends that his bilateral shoulder disability had its onset in 1986 during service, the Board finds that such a statement lacks credibility as it is inconsistent with the April 1986 denial of painful shoulder and arthritis and the more contemporaneous reports in 2004 of right shoulder pain for the past two years and in 2006 of shoulder pain for the past "couple of years."  Instead, the medical evidence is persuasively against the claim.  The Veteran had one complaint of neck pain radiating into the right shoulder, which was not attributed to a right shoulder injury or disease but to tension headaches.  The Veteran affirmatively denied painful or trick shoulder and arthritis and clinical evaluation of his upper extremities and musculoskeletal system was normal at separation.  Noting the absence of shoulder complaints during service and that the first shoulder complaint was in 2001, the examiner concluded that given the timeframe since discharge from service, the shoulder disability is less likely than not related to service.  

With respect to the lumbar spine disability, the Board concludes that the evidence is persuasively against service connection.  There is no credible lay evidence or medical evidence indicating that the disability may be related to service: to the extent that the Veteran contends that his shooting lumbar pain had its onset in 1986 during service, the Board finds that this statement lacks credibility as it is inconsistent with his denial in April 1986 of arthritis and recurrent back pain.  Rather, the most probative medical evidence is persuasively against the claim.  The Veteran had two complains of back pain during service, for which assessments of back strain and muscle strain were rendered, he denied recurrent back pain at separation, and the examiner noted normal clinical evaluation of the spine.  Noting the Veteran's in-service history, the examiner concluded that the lumbar strain was acute and concluded that the lumbar spine disability is less likely than not related to service.

The evidence is persuasively against finding that the Veteran's cervical or lumbar degenerative disc disease or left or right shoulder degenerative arthritis meets the criteria for chronic diseases.  38 C.F.R. §§ 3.303(b), 3.307, 3.309.  The Veteran's active duty service treatment records do not reflect any complaints, findings, treatment, or diagnosis of these degenerative disabilities.  Additionally, as explained above, there is no credible lay evidence that the Veteran had neck, shoulder, or back symptoms continuous since service; nor does the record reflect any continuity of symptomatology since service.  Finally, the evidence of record does not reflect manifestations of these degenerative disabilities within one year of separation from service.  With respect to the cervical spine, the most probative evidence shows that the August 1987 complaint of neck pain was associated with tension headaches, spine films in 2003 were negative, and the earliest diagnosis of cervical spine degeneration was in 2005.  With respect to the left and right shoulders, the most probative evidence shows that the Veteran's shoulder pain had its onset in the early 2000s.  With respect to the lumbar spine, the 1987 report of back pain was associated with urinary tract infection, which,
 nor does the record reflect any continuity of symptomatology since service.  Finally, the evidence of record does not reflect manifestations of these degenerative disabilities within one year of separation from service.  With respect to the cervical spine, the most probative evidence shows that the August 1987 complaint of neck pain was associated with tension headaches, spine films in 2003 were negative, and the earliest diagnosis of cervical spine degeneration was in 2005.  With respect to the left and right shoulders, the most probative evidence shows that the Veteran's shoulder pain had its onset in the early 2000s.  With respect to the lumbar spine, the 1987 report of back pain was associated with urinary tract infection, which, as noted by the examiner was an acute resolvable condition.  Chronic back pain was not noted until 2000.  

The Board acknowledges the Veteran's contentions that his neck disability is related to lifting heavy objects during service and that his bilateral shoulder and lumbar spine disabilities are related to running, jumping, and marching during service; however, as there is no competent evidence indicating that these disabilities may be related to these activities, additional medical opinions are not required to satisfy VA's duty to assist.  

Hence, after reviewing all the evidence of record, the Board finds that the evidence is persuasively against the claims for service connection for the cervical spine, left and right shoulder, and lumbar spine disabilities.  As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and entitlement to service connection is not warranted.  See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

8. Entitlement to service connection for a left pelvis disability manifesting in chronic pain 

The Veteran contends that a left pelvis disability manifesting in chronic pain had its onset in 1986 and is related to military training during service: specifically, running, jumping, and marching.  The Board concludes that service connection is not warranted.

The AOJ made no favorable findings for this issue.

However, the service treatment records do not reflect any complaints, findings, treatment, or diagnosis of a left groin or pelvis injury, disease, or disability.  

The Board observes that the Veteran was not afforded a medical examination.  However, as there is no evidence establishing that an event, injury, or disease occurred in service or an applicable presumptive period, an examination is not required to satisfy VA's duty to assist.  McLendon at 86.  

As the evidence does not reach relative equipoise that an in-service event, injury, or disease occurred, there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and entitlement to service connection for a left pelvis disability is not warranted.  See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

9. Entitlement to service connection for interstitial cystitis

10. Entitlement to service connection for a prostate disability

The Veteran makes no specific contentions regarding the claimed interstitial cystitis or prostate disabilities but generally contends that they had their onset in 1986.  The Board concludes that service connection is not warranted.

The AOJ favorably found that the Veteran has an enlarged prostate disability.  The AOJ made no favorable findings with respect to the cystitis claim.

The Veteran's service treatment records contain genitourinary complaints.  In a November 1982 treatment note, the Veteran complained of sharp pain in the inguinal region lasting for one week and the provider rendered an assessment of epididymitis.  In an August 1985 treatment note, a provider rendered an assessment of urinary tract infection versus urethritis.  There are multiple complaints related to an inguinal hernia for which the Veteran underwent surgery in February 1983; he again complained of inguinal pain in April 1984.

In the April 1986 separation examination report, on clinical evaluation, the examiner noted normal genitourinary system examination.  The examiner noted "none" in the summary of defects and diagnosis, rated the Veteran all 1s on the PULHES physical profile, and rated the Veteran an A in the physical category.  In an April 1986 report of medical history, the Veteran denied frequent or painful urination.

The record is silent for any assessments, impressions, or diagnoses of cystitis.  There is no lay or medical evidence of recurrent or persistent symptoms of cystitis.  

The record is silent for any complaints of a prostate disability prior to December 2019, when the Veteran reported weak stream, nocturia, and occasional dribbling.  In a March 2020 emergency department note, the provider noted that Flomax had resolved the issue
 examiner noted "none" in the summary of defects and diagnosis, rated the Veteran all 1s on the PULHES physical profile, and rated the Veteran an A in the physical category.  In an April 1986 report of medical history, the Veteran denied frequent or painful urination.

The record is silent for any assessments, impressions, or diagnoses of cystitis.  There is no lay or medical evidence of recurrent or persistent symptoms of cystitis.  

The record is silent for any complaints of a prostate disability prior to December 2019, when the Veteran reported weak stream, nocturia, and occasional dribbling.  In a March 2020 emergency department note, the provider noted that Flomax had resolved the issue of a weak urinary stream and the Veteran's active medications list subsequently included tamsulosin for prostate.

The Board concludes that the evidence does not reach relative equipoise that the Veteran has a current cystitis disability.  As noted above, there is no evidence of diagnoses or symptoms of cystitis.  While the Veteran appears to claim that he has interstitial cystitis, he is a layperson and does not profess to have the medical expertise required to render a diagnosis.  Further, he did not detail or explain how he became aware of his claimed disability; specifically, he provided no evidence that this is a disability diagnosed by a medical provider.  To the extent that an assessment may be rendered by a layperson with past experience with the disability, the record is silent for a history of cystitis.  The Board observes that the Veteran has not been afforded an examination and that the Veteran has a history of UTIs, including during service.  However, as there is no evidence of a current disability or persistent or recurrent symptoms of a disability, an examination is not required to satisfy VA's duty to assist.  McLendon at 86.  

The Board further concludes that the evidence is persuasively against finding that the Veteran has a prostate disability related to service.  There is no evidence indicating that the prostate disability may be related to an event, injury, or disease in service and no evidence that the disability had its onset during service.  Rather, at separation clinical genitourinary evaluation was normal and the Veteran denied frequent or painful urination.  The record is silent for complaints or treatment for a prostate disability until December 2019.  While the Veteran has not been afforded an examination for this issue, as there is no evidence indicating that the current disability may be related to service, an examination is not required to satisfy VA's duty to assist.  McLendon at 86.  

Hence, after reviewing all the evidence of record, the Board finds that the evidence does not reach relative equipoise that the Veteran has a current cystitis disability and that the evidence is persuasively against the claim for a prostate disability.  As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and entitlement to service connection is not warranted.  See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

11. Entitlement to service connection for bilateral plantar fasciitis

The Veteran contends that bilateral plantar fasciitis had its onset in 1986 and is related to military training during service: specifically, running, jumping, and marching.  The Board concludes that service connection is not warranted.

The AOJ made no favorable findings for this issue.

Service treatment records do not reflect any complaints, findings, treatment, or diagnosis of plantar fasciitis or any foot disability.  At separation, clinical evaluation of the feet was normal and the Veteran affirmatively denied having or having had foot trouble.  

The record is silent for any assessments, impressions, or diagnoses of plantar fasciitis.  There is no lay or medical evidence of recurrent or persistent symptoms of plantar fasciitis.  

The Board concludes that the evidence does not reach relative equipoise that the Veteran has plantar fasciitis current during the period on appeal.  As noted above, there is no evidence of diagnoses or symptoms of the disability.  While the Veteran appears to claim that he has plantar fasciitis, he did not detail or explain how he became aware of his claimed disability; specifically, he provided no evidence that this is a disability diagnosed by a medical provider.  To the extent that an assessment may be rendered by a layperson with past experience with the disability, the record is silent for a history of plantar fasciitis.  

Even assuming that the Veteran has plantar fasciitis current during the period on appeal, there is no evidence indicating that the disability is related to service, to include running, jumping, and marching during service.  

The Board observes that the Veteran has not been afforded an examination.  However, as there is no evidence of a
  While the Veteran appears to claim that he has plantar fasciitis, he did not detail or explain how he became aware of his claimed disability; specifically, he provided no evidence that this is a disability diagnosed by a medical provider.  To the extent that an assessment may be rendered by a layperson with past experience with the disability, the record is silent for a history of plantar fasciitis.  

Even assuming that the Veteran has plantar fasciitis current during the period on appeal, there is no evidence indicating that the disability is related to service, to include running, jumping, and marching during service.  

The Board observes that the Veteran has not been afforded an examination.  However, as there is no evidence of a current disability or persistent or recurrent symptoms of a disability and no evidence indicating that the claimed disability may be related to service, an examination is not required to satisfy VA's duty to assist.  McLendon at 86.  

Hence, after reviewing all the evidence of record, the Board finds that the evidence does not reach relative equipoise that the Veteran's claimed plantar fasciitis is related to service.  As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and entitlement to service connection is not warranted.  See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

REASONS FOR REMAND

1. Entitlement to service connection for a psychiatric disability is remanded.

In an April 2021 opinion, a VA examiner concluded that the Veteran's claims for anxiety, depression, and insomnia are understood under the DSM-5 as components of cyclothymic disorder with anxious distress.  The examiner also noted depressed mood, anxiety, and chronic sleep impairment as symptoms of the diagnosed disability.  Accordingly, the Board has combined the claims of service connection for anxiety, depression, and insomnia into a claim for service connection for a psychiatric disability.

A remand is warranted to correct a pre-decisional duty to assist error.

In a November 2002 VA physical therapy note, the Veteran reported drawing Social Security disability and in a March 2021 VA pain consultation, the Veteran reported that he had been on disability since the 1980s due to his hand and depression; however, there is no evidence of attempts to associate the Veteran's Social Security Administration records with the record. As there is no indication in the record that the Social Security disability records are relevant to any disabilities other than his hand and depression, the Board does not find that there any related predecisional error with respect to any of the claims decided above.   

Furthermore, there is evidence indicating that there may be outstanding VA treatment records.  February 1998 and January 1999 VA records note that the Veteran "is followed" by the mental health clinic for psychotic depression, indicating that he was contemporaneously receiving psychiatric treatment; however, there are no mental health clinic notes associated with the record from May 1992 to November 1999.  Additionally, a November 2019 mental health note identifies a November 2013 record stating that the Veteran will "continue with monthly visits" and a July 2016 note by K.J., the Veteran's mental health attending physician, indicating that he would continue with the current plan and treatment, as well as March 2018 and March 2019 notes by the same provider; however, these records are not associated with the record.

Finally, there are numerous treatment records in which K.J. noted under "Assessment/Diagnosis" recurrent, moderate major depressive disorder and generalized anxiety disorder.  A March 2021 note by a VA psychologist noted under "Assessment/Diagnosis" unspecified anxiety disorder, unspecified depressive disorder, and history of bipolar disorder.  In an April 2021 VA examination report, the examiner noted a diagnosis of cyclothymic disorder with anxious distress and indicated that the Veteran did not have more than one mental disorder diagnosed; however, while the examiner noted the diagnoses by the Veteran's treating VA providers, the examiner did not explain why these diagnoses were not included in the examination report.  Furthermore, the examiner noted in the opinion that the earliest treatment record for depression was in 1992 but did not address the Veteran's endorsement of frequent trouble sleeping, depression or excessive worry, and nervous trouble in the April 1986 report of medical history.

2. Entitlement to service connection for a disability manifesting in chronic pain is remanded.

A remand is warranted to correct a pre-decisional duty to assist error.

In a February 2021 VA pain consultation, the Veteran reported widespread "all over" pain for over 20 years which had gradually worsened and became very bad in the past 3 to 5 years.  He could not identify a precipitating event.  He reported that it
 examination report.  Furthermore, the examiner noted in the opinion that the earliest treatment record for depression was in 1992 but did not address the Veteran's endorsement of frequent trouble sleeping, depression or excessive worry, and nervous trouble in the April 1986 report of medical history.

2. Entitlement to service connection for a disability manifesting in chronic pain is remanded.

A remand is warranted to correct a pre-decisional duty to assist error.

In a February 2021 VA pain consultation, the Veteran reported widespread "all over" pain for over 20 years which had gradually worsened and became very bad in the past 3 to 5 years.  He could not identify a precipitating event.  He reported that it hurt "from the top of [his] head to his feet," endorsing headaches and pain in the shoulders, neck, back, hips, legs, knees, ankles, feet, arms, the right wrist and forearm, and "all [his] muscles."  He was noted to have allodynia all over at times.  The provider rendered an assessment of chronic pain syndrome with large myofascial overlay.

In a June 2021 VA examination report, however, the examiner concluded that the Veteran did not have a current diagnosis associated with any claimed chronic pain condition.  The examiner remarked that while the Veteran was noted to have widespread pain, there was no evidence to indicate an inflammatory or infectious arthritic condition and that the Veteran had a normal arthritis examination. The examiner stated that each complaint the Veteran experienced related to a specific joint or body area was unique to that location.  The examiner noted similar conclusions in a corresponding opinion.  However, the examiner did not explain whether the lack of evidence indicating an inflammatory or infectious arthritic condition precluded other disabilities manifesting in pain, to include disabilities manifesting in allodynia.  Further, while the examiner stated that the Veteran's complaints related to a specific joint or body area, the examiner did not address the Veteran's February 2021 statement that he had pain in all of his muscles or the provider's notation of large myofascial overlay.

3. Entitlement to service connection for a right pelvis disability manifesting in chronic pain is remanded.

A remand is warranted to correct a pre-decisional duty to assist error.

The Veteran claims that he has chronic right pelvic pain, suggesting persistent symptoms of a disability.  Service treatment records contain numerous complaints of right groin pain and notations of right inguinal hernia and right nerve entrapment.  As the Veteran has not been afforded an examination, a remand is warranted.

4. Entitlement to service connection for an intestinal disability is remanded.

A remand is warranted to correct a pre-decisional duty to assist error.

In a June 2021 VA examination report, the Veteran reported experiencing alternating constipation, diarrhea, and normal bowels.  The examiner concluded that no diagnosis of an intestinal condition was warranted, remarking that objective findings were normal and that the Veteran had a normal intestinal examination.  However, although the Veteran reported alternating constipation, diarrhea, and normal bowels, the examiner did not adequately explain whether the normal examination that day precluded a disability manifesting in alternating symptoms with periods of normal bowel function.

The matters are REMANDED for the following action:

1. Please attempt to associate with the record relevant Social Security Administration records concerning disability due to the depression.  Please document all requests as well as responses in the claims file. 

2. Please associate with the record outstanding VA psychiatric treatment records including:

(a.) Mental health clinic treatment for psychotic depression contemporaneous to February 1998 and January 1999;

(b.) Mental health treatment including monthly visits in the November 2013 timeframe through 2019.

3. After the actions requested in paragraphs 1 and 2 are complete, please refer the claim to an appropriate clinician for an addendum opinion as to the nature and etiology of the Veteran's psychiatric disability.  The clinician is requested to respond to the following:

(a.) Please identify all psychiatric disabilities current during the period on appeal, including an anxiety disorder and a depressive disorder.

(b.) For each disability identified, is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) related to service?    Please consider and address as appropriate Veteran's endorsement of frequent trouble sleeping, depression or excessive worry, and nervous trouble in the April 1986 separation report of medical history.

The clinician must explain the rationale for all opinions in detail, citing to supporting clinical data and/or medical literature, as appropriate.  The clinician should take into consideration that the Veteran is competent to report in service and post-service symptom experiences; other witnesses are competent to report observable symptoms.  If the clinician cannot provide an opinion without resorting to speculation, the clinician should
 a depressive disorder.

(b.) For each disability identified, is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) related to service?    Please consider and address as appropriate Veteran's endorsement of frequent trouble sleeping, depression or excessive worry, and nervous trouble in the April 1986 separation report of medical history.

The clinician must explain the rationale for all opinions in detail, citing to supporting clinical data and/or medical literature, as appropriate.  The clinician should take into consideration that the Veteran is competent to report in service and post-service symptom experiences; other witnesses are competent to report observable symptoms.  If the clinician cannot provide an opinion without resorting to speculation, the clinician should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made.

4. Please refer the claim to an appropriate clinician for an addendum opinion as to the nature and etiology of the claimed chronic pain disability.  The clinician is requested to respond to the following:

(a.) Please identify any chronic pain disabilities current during the period on appeal.  Please address the Veteran's February 2021 report that he had pain in all of his muscles and the VA provider's assessment of chronic pain syndrome with large myofascial overlay.  If it is concluded that there is no current disability as there is no evidence indicating an inflammatory or infectious arthritic condition, please explain whether this precludes other disabilities manifesting in pain.

(b.) For each disability identified, is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) related to service?

The clinician must explain the rationale for all opinions in detail, citing to supporting clinical data and/or medical literature, as appropriate.  The clinician should take into consideration that the Veteran is competent to report in service and post-service symptom experiences; other witnesses are competent to report observable symptoms.  If the clinician cannot provide an opinion without resorting to speculation, the clinician should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made.

5. Please schedule the Veteran for an examination as to the nature and etiology of any right pelvis chronic pain disability.  Any indicated tests or studies should be conducted.  The examiner is requested to respond to the following: 

(a.) Please identify any right pelvis chronic pain disability or functional impairment current during the period on appeal.

(b.) For each disability or functional impairment identified, is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) related to service?  Please consider and address as appropriate the Veteran's in-service history of right groin pain, February 1983 post-operative diagnosis of inguinal hernia, March1983 physical profile for right side nerve entrapment, September 1983 report of intermittent right groin pain and numbness for 3 months, and April 1984 report of continued inguinal and testicular pain since the February 1983 post-inguinal hernia repair.  

The examiner must explain the rationale for all opinions in detail, citing to supporting clinical data and/or medical literature, as appropriate.  The examiner should take into consideration that the Veteran is competent to report in service and post-service symptom experiences; other witnesses are competent to report observable symptoms.  If the examiner cannot provide an opinion without resorting to speculation, the examiner should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made.

6. Please refer the claim to an appropriate clinician for an addendum opinion as to the nature and etiology of the claimed intestinal disability.  The clinician is requested to respond to the following:

(a.) Please identify any intestinal disabilities or functional impairments current during the period on appeal.  Please note the Veteran's report of alternating diarrhea, constipation, and normal bowel function.  If it is concluded that the Veteran does not have a current disability or functional impairment, an adequate rationale must be provided.

(b.) For each disability or functional impairment identified, is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) related to service?    Please consider and address as appropriate a November 1983 service treatment record in which an assessment of gastroenteritis was rendered; a July 1984 STR in which the Veteran complained of diarrhea and sickness in the stomach; September 1984 STRs in which the Veteran complained of diarrhea lasting 2 weeks and the provider rendered an impression of punctate lesions in the rectum; and another September 1984 request for an air contrast barium enema in which the requesting provider noted pertinent clinical history of chronic diarrhea, occasionally with blood, and the radiographic
(b.) For each disability or functional impairment identified, is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) related to service?    Please consider and address as appropriate a November 1983 service treatment record in which an assessment of gastroenteritis was rendered; a July 1984 STR in which the Veteran complained of diarrhea and sickness in the stomach; September 1984 STRs in which the Veteran complained of diarrhea lasting 2 weeks and the provider rendered an impression of punctate lesions in the rectum; and another September 1984 request for an air contrast barium enema in which the requesting provider noted pertinent clinical history of chronic diarrhea, occasionally with blood, and the radiographic report showed unremarkable abdomen films and no evidence of polypoid, ulcerative, or neoplastic change.

The clinician must explain the rationale for all opinions in detail, citing to supporting clinical data and/or medical literature, as appropriate.  The clinician should take into consideration that the Veteran is competent to report in service and post-service symptom experiences; other witnesses are competent to report observable symptoms.  If the clinician cannot provide an opinion without resorting to speculation, the clinician should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made.

 

 

M. C. GRAHAM

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	M. Vashaw, Associate 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.