CORNEAL DISEASE INCLUDING SCARS OPACITIES

Summary

The Veteran served in the United States Marine Corps from January 1975 to January 1995. The Veteran appeals the denial of service connection for a right corneal abrasion and seeks service connection for diabetes, hypertension, a kidney condition, and sleep apnea. The Veteran contends these conditions are due to stress from his job as a recruiter and/or conceded water contamination at Camp Lejeune. His wife submitted a lay statement regarding his sleep apnea. The RO made favorable findings for current disabilities for diabetes, hypertension, kidney condition, and sleep apnea, and conceded exposure to contaminated water at Camp Lejeune. The Board found that the evidence warranted VA examinations for these conditions and remanded them for further development, including consideration under the PACT Act for a nexus opinion regarding TERA exposure. The Board denied service connection for the right corneal abrasion, finding no evidence of a current diagnosis during the appeal period, and that the criteria for service connection were not met. The case also lists multiple other conditions being remanded, including bilateral pes planus, degenerative arthritis of the right hip, right and left ankle conditions, and right and left hand/finger conditions.

Rationale

No evidence of current diagnosis; Criteria for service connection not met

Full Decision Text

Citation Nr: A26034819
Decision Date: 04/15/26	Archive Date: 04/15/26

DOCKET NO. 210427-155475
DATE: April 15, 2026

ORDER

Entitlement to service connection for a right corneal abrasion is denied.

REMANDED

Entitlement to service connection for diabetes is remanded.

Entitlement to service connection for hypertension is remanded.

Entitlement to service connection for a kidney condition is remanded.

Entitlement to service connection for sleep apnea is remanded.

Entitlement to service connection for bilateral pes planus is remanded.

Entitlement to service connection for degenerative arthritis, right hip, is remanded.

Entitlement to service connection for a right ankle condition is remanded.

Entitlement to service connection for a left ankle condition is remanded.

Entitlement to service connection for a right hand/finger condition, to include right hand strain, is remanded.

Entitlement to service connection for a left hand/finger condition, to include left hand strain, is remanded.

FINDING OF FACT

The evidence of record does not demonstrate that the Veteran has a diagnosis of right corneal abrasion at any time during the appeal period.

CONCLUSION OF LAW

The criteria for entitlement to service connection for a right corneal abrasion are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Marine Corps from January 1975 to January 1995.

This case comes to the Board of Veterans' Appeals (Board) on appeal from a February 2021 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO), and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA) applies.

In October 2020, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of a rating decision issued in December 2019. In February 2021, the agency of original jurisdiction (AOJ) issued the HLR decision on appeal, which considered the evidence of record at the time of the December 2019 rating decision.

Following the issuance of the February 2021 HLR decision on appeal, the Veteran filed a VA Form 10182, Notice of Disagreement, in April 2021, and selected the Hearing Docket. A Board hearing was held on March 25, 2025. A transcript is of record.

Therefore, the Board may only consider the evidence of record at the time of the December 2019 AOJ decision, which was subsequently subject to HLR, as well as any evidence submitted by the Veteran, or his representative, at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the December 2019 decision, which was subsequently subject to HLR, and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801.

The Board acknowledges the Veteran's June 20, 2025 request for an additional 90 days to submit documentation in support of his appeal; however, in AMA, there are strict rules regarding the submission of documentation, and the Veteran was explicitly advised of these limitations at the beginning of his hearing. See March 25, 2025 Hearing Transcript. There is no indication in this case that a waiver of the strict evidentiary window rules established by statute and regulation has occurred. See 38 C.F.R. §20.105; see also, 38 U.S.C. § 7113 (The statute uses the word "shall" throughout and does not include any provision allowing the Board to consider evidence outside of the strictly defined evidentiary records. Congress did not leave room for judicial discretion in defining the scope of the evidentiary record before the Board.). Therefore, anything submitted by the Veteran after June 25, 2025 was not considered by the Board.

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 303(a). It may also be granted for any disease diagnosed after discharge, when all evidence establishes that the disease was incurred in service. 38 C.F.R. § 303
 the word "shall" throughout and does not include any provision allowing the Board to consider evidence outside of the strictly defined evidentiary records. Congress did not leave room for judicial discretion in defining the scope of the evidentiary record before the Board.). Therefore, anything submitted by the Veteran after June 25, 2025 was not considered by the Board.

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 303(a). It may also be granted for any disease diagnosed after discharge, when all evidence establishes that the disease was incurred in service. 38 C.F.R. § 303(d).

Generally, to establish service connection, a claimant must demonstrate: (1) the existence of 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. 38 C.F.R. § 3.303; see Shedden v. Principi, 381 F.3d 1163, 1166-1167 (Fed. Cir. 2004).

1. Entitlement to service connection for a right corneal abrasion is denied. 

The Veteran seeks service connection for a right corneal abrasion and contends that it was caused by an in-service event. See August 2019 VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits.

In the absence of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 255 (1992). Since the evidence of record is insufficient to establish a current diagnosis of right corneal abrasion, the remaining two elements of service connection need not be addressed, and service connection for right corneal abrasion must be denied.

The Board acknowledges that the limited service treatment records (STRs) in the file contain a notation of a left corneal abrasion in May 1985; however, this is not relevant to the Veteran's claimed right eye condition and there is no current diagnosis of right eye corneal abrasion within the Veteran's medical treatment records. Furthermore, a January 2019 VA Medical Center (VAMC) treatment note indicates that there are no apparent abnormalities in the right eye. See January 31, 2019 VAMC Miami Diabetic Teleretinal Imaging Consult Note. Notably, in the Veteran's own hearing testimony, he admitted that he has not seen a doctor for his alleged eye condition for about four to five years, and at his last examination the doctor indicated that nothing abnormal was seen. See March 25, 2025 Hearing Transcript, pg. 26. 

Finally, there are additional statutory and regulatory provisions potentially applicable to the Veteran herein, considering he served at Camp Lejeune and it was conceded that he participated in a toxic exposure risk activity (TERA). Under the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxins Act of 2022 ("PACT Act"), examinations and opinions are mandated in certain situations. See 38 U.S.C. § 1168. However, that provision does not apply if the claimed condition is based on physical trauma, like the alleged corneal abrasion in this case, which the Veteran contends originated from sports related injuries in service. See 89 Federal Register 51224 (June 17, 2024); VBA Letter 20-24-06, at page 12 (June 12, 2024). Therefore, there is no basis upon which to order a remand for a medical examination/opinion under the PACT Act.

REASONS FOR REMAND

1. Entitlement to service connection for diabetes is remanded.

2. Entitlement to service connection for hypertension is remanded.

3. Entitlement to service connection for a kidney condition is remanded.

4. Entitlement to service connection for sleep apnea is remanded.

The Veteran contends that he should be service connected for diabetes, hypertension, and a kidney condition, because the constant stress from his job as a recruiter in the Marine Corps and/or the conceded water contamination at Camp Lejeune caused those conditions. See August 2019 VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits; see also, December 16, 2019 Correspondence from Veteran. The Veteran also seeks service connection for sleep apnea, contending that he only sleeps three to four hours per night. See August 2019 VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits; see also, August 2019 Personal Statement from Veteran. He also produced a statement from his wife, who indicated
 he should be service connected for diabetes, hypertension, and a kidney condition, because the constant stress from his job as a recruiter in the Marine Corps and/or the conceded water contamination at Camp Lejeune caused those conditions. See August 2019 VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits; see also, December 16, 2019 Correspondence from Veteran. The Veteran also seeks service connection for sleep apnea, contending that he only sleeps three to four hours per night. See August 2019 VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits; see also, August 2019 Personal Statement from Veteran. He also produced a statement from his wife, who indicated that she has known the Veteran to have sleep apnea for over thirty years. See October 31, 2019 Wife Lay Statement.

The RO made favorable findings that the Veteran has a current disability with respect to each of the above conditions, which are binding on the Board. See February 2021 Rating Decision. The RO also conceded that the Veteran was exposed to contaminated water while stationed on Marine Corps Base Camp Lejeune, as confirmed by service records for the period of October 1975 to June 1976. Id.

The Board finds that the threshold for providing a VA examination as to the claims for entitlement to service connection for diabetes, hypertension, a kidney condition, and sleep apnea has been met, and that the issues must be remanded so that such examinations may be provided. See 38 U.S.C. § 5103A (d) (2); 38 C.F.R. § 3.159 (c) (4) (i); McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006); see also, Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994) (Even if service connection cannot be established on a presumptive basis, the Board must still address service connection on a direct basis.) 

Additionally, remand is also required under the PACT Act for a VA examination and medical opinion to address whether the Veteran's diabetes, hypertension, kidney condition, and sleep apnea are etiologically related to his participation in the conceded TERA. Specifically, the PACT Act requires that, when a Veteran participated in a TERA during their active service and files a claim for service connection for a disability, and there is evidence of such disability, VA must provide the Veteran with a VA examination and obtain a medical opinion addressing the possibility of a nexus between the claimed disability and the TERA, with certain limited exceptions. See 38 U.S.C. § 1168. The Board acknowledges that the Pact Act was established in August 2022, after the rating decision on appeal in this case; therefore, the AOJ did not make a pre-decisional duty to assist error based on any provisions in the PACT Act, since it was not in effect at the time of the rating decision on appeal. Nevertheless, remand for PACT Act-compliant opinions has a reasonable possibility of aiding in substantiating the Veteran's above-referenced claims and the Board may remand to satisfy a regulatory and/or statutory duty. See 38 C.F.R. § 20.802. 

5. Entitlement to service connection for bilateral pes planus is remanded.

The Veteran contends that his pre-existing condition of flat feet was aggravated by service, specifically from daily physical training exercises with new recruits. See August 2019 VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits. At the Board hearing, the Veteran explained that for over seventeen years he was on recruiting duty and his lower extremities were affected due to running over 100 miles per week. See March 25, 2025 Hearing Transcript, pgs. 3-4.

When evaluating the Veteran's claims on a direct basis, there is no dispute that elements one and two of service connection have already been established. In this case, the RO made favorable findings pertaining to the first two elements of service connection, which are binding on the Board. With respect to the first element, the RO found that the Veteran has a current disability due to the Veteran's diagnosis of bilateral pes planus at the VA examination. The RO also found that the second element of service connection was satisfied, since the evidence demonstrates that a qualifying event had its onset during service, namely the Veteran's participation in daily physical training and exercises from January 1975 to January 1995. 

The only remaining question before the Board is whether the Veteran's current bilateral pes planus condition was aggravated by service, since the pes planus condition was noted at entry. See December 6, 1974 Report of Medical Examination. 

The Veteran was afforded a VA examination pertaining to his feet
 which are binding on the Board. With respect to the first element, the RO found that the Veteran has a current disability due to the Veteran's diagnosis of bilateral pes planus at the VA examination. The RO also found that the second element of service connection was satisfied, since the evidence demonstrates that a qualifying event had its onset during service, namely the Veteran's participation in daily physical training and exercises from January 1975 to January 1995. 

The only remaining question before the Board is whether the Veteran's current bilateral pes planus condition was aggravated by service, since the pes planus condition was noted at entry. See December 6, 1974 Report of Medical Examination. 

The Veteran was afforded a VA examination pertaining to his feet in December 2019, wherein the examiner indicated diagnoses of flat feet, hallux valgus, and degenerative arthritis bilaterally. See December 3, 2019 Foot Conditions, Including Flatfoot (Pes Planus) Disability Benefits Questionnaire (DBQ). The examiner concluded that the Veteran's claimed condition, which clearly and unmistakably existed prior to service, was clearly and unmistakably not aggravated beyond its natural progression by an in-service injury, event, or illness. As rationale, the examiner explained that "no evidence was found to indicate that the Veteran's bilateral flat foot (which clearly and unmistakably existed prior to service) was aggravated by PT and exercises with new recruits during service. A nexus has not been established." Id.

At the outset, the Board finds this opinion inadequate, as it did not consider the October 2019 lay statement submitted by a fellow service member, explaining that the recruiter school instructors, like the Veteran, ran even more than those on the drill field and that during service they did a lot of running and jumping in boots. Furthermore, the examiner cites to a lack of evidence; however, there is a specific finding in the record that the Veteran's STRs are unavailable, despite there being a few pages within the record. In situations where there are unavailable or illegible STRs or military personnel records, the Board has a heightened obligation to explain its findings and conclusions and to consider the benefit of the doubt rule carefully. See O'Hare v. Derwinski, 1 Vet. App. 365, 367 (1991). The Board finds that the examiner's citation to a lack of evidence in this situation, coupled with the fact that he failed to consider the lay statements of record, causes this opinion to be inadequate.

Where VA provides the Veteran with an examination, the examination and medical opinion must be adequate. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Here, the RO's failure to obtain an adequate medical opinion constitutes a pre-decisional duty to assist error, which requires remand to correct under the AMA.

The Board acknowledges the positive private medical opinion of record, related to the Veteran's foot conditions and submitted within the applicable evidentiary window following the Board hearing; however, it is insufficient to support an award of service connection for this condition since it used the incorrect standard for aggravation of a pre-existing condition. As such, there is no adequate opinion of record and remand is necessary to obtain an adequate opinion.

6. Entitlement to service connection for degenerative arthritis, right hip, is remanded.

The Veteran seeks service connection for a right hip condition, which he claims was caused by daily physical training and exercises with new recruits. See August 2019 VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits. During the Board hearing, the Veteran explained that he had no issues with his right hip prior to service, but that he began to experience constant pain from running in service. See March 25, 2025 Hearing Transcript, pgs. 8-9.

As with the prior condition, the RO made favorable findings with respect to the first two elements of service connection, which are binding on the Board. The RO found that the Veteran has been diagnosed with a disability, based on treatment records from the Orlando VAMC, dated December 16, 2019, which indicated a diagnosis and treatment for osteoarthritis of the right hip joint. The RO also conceded an in-service event, as records from January 1975 to January 1995 show that the Veteran participated in daily physical training and exercises. Therefore, the only remaining issue before the Board is whether the current condition was caused by the conceded in-service event.

The Veteran was afforded a VA examination pertaining to his right hip in December 2019, wherein the examiner diagnosed the Veteran with right hip degenerative arthritis. See December 3, 2019 Hip and Thigh Conditions DBQ. The examiner indicated an onset date of the 1980s and noted that the Veteran stated he has been suffering from hip pain since military service. The Veteran denied a specific
 and treatment for osteoarthritis of the right hip joint. The RO also conceded an in-service event, as records from January 1975 to January 1995 show that the Veteran participated in daily physical training and exercises. Therefore, the only remaining issue before the Board is whether the current condition was caused by the conceded in-service event.

The Veteran was afforded a VA examination pertaining to his right hip in December 2019, wherein the examiner diagnosed the Veteran with right hip degenerative arthritis. See December 3, 2019 Hip and Thigh Conditions DBQ. The examiner indicated an onset date of the 1980s and noted that the Veteran stated he has been suffering from hip pain since military service. The Veteran denied a specific injury, but stated that the damage to his hip occurred over time. Id. The examiner concluded that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. See December 3, 2019 Medical Opinion DBQ. As rationale, the examiner conceded a right hip diagnosis, but concluded that "no evidence was found in the medical record to indicate that the Veteran sustained a right hip injury while participating in PT and exercises with new recruits during service. Based on a review of the medical record, history of present illness, and today's examination, a nexus has not been established." Id.

At the outset, the Board finds this medical opinion inadequate for appellate review, as it is based on an inaccurate factual premise and it did not consider the relevant lay statements of record. Specifically, during the examination, the Veteran told the examiner that there was no specific injury in service, but that his hip condition occurred over time. Furthermore, the examiner did not consider the lay statement submitted by the Veteran's wife which indicated that he has had trouble with his hip for over thirty years. See October 31, 2019 Wife Statement. Again, the RO's failure to obtain an adequate medical opinion constitutes a pre-decisional duty to assist error, which requires remand to correct under the AMA. See Barr, supra.

7. Entitlement to service connection for a right ankle condition is remanded.

8. Entitlement to service connection for a left ankle condition is remanded.

The Veteran seeks service connection for his bilateral ankle conditions. See August 16, 2019 VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits. He contends that he has suffered from bilateral ankle pain since military service and denies any specific ankle injury, but instead contends that the injuries occurred over time. See December 2019 Ankle Conditions Disability Benefits Questionnaire (DBQ). At the Board hearing, the Veteran testified that he had no ankle problems prior to service and that his current bilateral ankle conditions are the result of constant running in boots during service, especially during the course of his recruitment duties. See March 25, 2025 Hearing Transcript, pgs. 15-16.

In this case, the RO made favorable findings pertaining to the first two elements of service connection, which are binding on the Board. With respect to the first element, the RO found that the Veteran has a current disability due to the Veteran's diagnosis of degenerative arthritis, right ankle, and lateral collateral ligament strain, left ankle, during the December 3, 2019 VA examination. The RO also found that the second element of service connection was satisfied for both ankles, since the evidence demonstrates that a qualifying event had its onset during service, namely the Veteran's participation in daily physical training and exercises from January 1975 to January 1995. 

The only remaining question before the Board is whether the Veteran's current bilateral ankle conditions had their onset in service or are otherwise related to an in-service event, injury, or disease.

The Veteran was afforded a VA examination in December 2019, wherein the examiner diagnosed the Veteran with lateral collateral ligament sprain, left, and degenerative arthritis, right. See December 3, 2019 Ankle Conditions DBQ. The DBQ indicates that the Veteran told the examiner that he has been suffering from bilateral ankle pain since military service and that he denied any specific ankle injury, instead explaining that the bilateral ankle conditions occurred over time during service. The examiner concluded that the claimed ankle conditions were less likely than not incurred in or caused by the claimed in-service injury, event, or illness. See December 3, 2019 Medical Opinion DBQ. As rationale, the examiner indicated that while the Veteran has a bilateral ankle diagnosis, no evidence was found in the medical record to indicate that the bilateral ankle injuries were caused by the conceded physical training and exercises with new recruits during service. 

At the outset, the Board finds this opinion inadequate, as it again did not consider the October 2019 lay statement by a fellow service member, which explains that the recruiter school instructors ran even more than those on the drill field
 injury, instead explaining that the bilateral ankle conditions occurred over time during service. The examiner concluded that the claimed ankle conditions were less likely than not incurred in or caused by the claimed in-service injury, event, or illness. See December 3, 2019 Medical Opinion DBQ. As rationale, the examiner indicated that while the Veteran has a bilateral ankle diagnosis, no evidence was found in the medical record to indicate that the bilateral ankle injuries were caused by the conceded physical training and exercises with new recruits during service. 

At the outset, the Board finds this opinion inadequate, as it again did not consider the October 2019 lay statement by a fellow service member, which explains that the recruiter school instructors ran even more than those on the drill field and that during service they did a lot of running and jumping in boots. It also cites to negative evidence, despite the finding that the Veteran's STRs are unavailable.

Here, the RO's failure to obtain an adequate medical opinion constitutes a pre-decisional duty to assist error, which requires remand to correct under the AMA. See Barr, supra.

The Board acknowledges the positive private medical opinion of record, related to the Veteran's ankle conditions and submitted within the applicable evidentiary window following the Board hearing; however, it is insufficient to support awarding service connection for this condition. The opinion seems to be based entirely on the history provided by the Veteran, as the examiner indicated that no records were reviewed prior to providing the medical opinion. Additionally, the examiner's opinion lacks rationale and merely states the "patient's activity while in service, including walking 750 mi weekly, greatly impacted the condition of his feet and ankles." Consequently, the Board finds that it is entitled to little probative weight. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-05 (2008).

Although the Board regrets the delay, it finds that a remand is necessary to obtain an adequate medical opinion that specifically addresses all relevant lay statements.

9. Entitlement to service connection for a right hand/finger condition, to include right hand strain, is remanded.

10. Entitlement to service connection for a left hand/finger condition, to include left hand strain, is remanded.

The Veteran contends that he developed bilateral hand/finger arthritis due to daily physical training and exercises with new recruits during service. See August 2019 VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits. At the Board hearing, the Veteran explained that training with the recruits included pull-ups of approximately 20-30 three times per day and that sometimes in the morning he can't close his hands. He also explained that his position as recruiter included preparing a lot of paperwork. See March 25, 2025 Hearing Transcript, pgs. 15-18. 

As with the prior conditions, the RO made favorable findings with regard to the first two elements of service connection, which are binding on the Board. With respect to the first element, the RO found that the Veteran has been diagnosed with a disability as the December 3, 2019 VA examination indicated bilateral hand strain. With respect to the second element, the RO conceded an in-service event due to service records showing that the Veteran participated in daily physical training and exercises during his entire active-duty service period. Therefore, the only issue before the Board is whether the Veteran's diagnosed condition was caused by service.

The Veteran was afforded a VA examination related to hand and finger conditions in December 2019, wherein the examiner diagnosed the Veteran with bilateral hand strain. See December 3, 2019 Hand and Finger Conditions DBQ. The examiner noted the Veteran's statements that he has been suffering from bilateral hand and finger pain since military service and that he denied any specific trauma. The examiner also indicated that the Veteran had left third and fourth finger trigger release surgery in 2004, but that he continues to complain of bilateral hand and finger pain. Id. The examiner concluded that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. As rationale, the examiner explained that a review of the medical records shows no evidence to support a diagnosis of bilateral hand and finger arthritis. While this is technically correct, the Board will broadly construe the issue of service connection for bilateral hand/finger arthritis as a claim for service connection for a hand/finger condition, to include hand strain, since the Board must consider any disability that "may reasonably be encompassed by" the symptoms. See Clemons v. Shinseki, 23?Vet. App.?1, 6 (2009). The RO's failure to obtain opinions based on the diagnoses indicated in the DBQ constitutes a duty to assist error, which requires remand to remedy.

The matters are REMANDED for the following actions:

1. In remanding this matter, the
 records shows no evidence to support a diagnosis of bilateral hand and finger arthritis. While this is technically correct, the Board will broadly construe the issue of service connection for bilateral hand/finger arthritis as a claim for service connection for a hand/finger condition, to include hand strain, since the Board must consider any disability that "may reasonably be encompassed by" the symptoms. See Clemons v. Shinseki, 23?Vet. App.?1, 6 (2009). The RO's failure to obtain opinions based on the diagnoses indicated in the DBQ constitutes a duty to assist error, which requires remand to remedy.

The matters are REMANDED for the following actions:

1. In remanding this matter, the Board makes no finding, implicit or otherwise, as to the credibility of the Veteran's assertions. Neither the Veteran's credibility nor lack thereof should be presumed in this remand.

2. Schedule the Veteran for VA examinations pertaining to the following conditions: (1) diabetes; (2) hypertension; (3) kidney condition, and (4) sleep apnea. 

After a review of the record, for each above-referenced conditions, the examiner should express an opinion as to the following: 

Whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's condition is caused by or otherwise etiologically related to his active service. Rationale must be provided for the opinion proffered.

The examiner must also opine whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's diagnosed condition was due to the synergistic, combined effect of all of his TERAs.

3. Obtain a medical opinion from an appropriate clinician addressing the nature and etiology of the Veteran's bilateral pes planus disorder. The entire claims file must be made available to and be reviewed by the examiner, including a copy of this remand order. If the examiner decides an examination is necessary, then one shall be provided.

The examiner is asked to provide an opinion addressing the following:

Is there clear and unmistakable evidence that the Veteran's bilateral pes planus disorder was NOT aggravated (permanently worsened) during military service. 

The term "aggravated" in this context refers to a permanent worsening of the underlying condition beyond the natural progress of the disease, as contrasted to temporary or intermittent flare-ups of symptomatology that resolve with a return to the baseline level of disability.

The examiner should address the entrance examination that documented pre-existing pes planus. The examiner should also address all relevant lay statements, in particular those noting the Veteran's increase in symptoms following his 17 years of recruitment duties, which included running and jumping in boots. 

A full and complete rationale for all opinions expressed must be provided.

4. Obtain a medical opinion from an appropriate clinician addressing the nature and etiology of the following conditions: (1) degenerative arthritis, right hip; (2) right ankle condition; (3) left ankle condition; (4) right hand/finger condition, to include right hand strain; (5) left hand/finger condition, to include left hand strain. The entire claims file must be made available to and be reviewed by the examiner, including a copy of this remand order. If the examiner decides an examination is necessary, then one shall be provided.

The examiner is asked to provide an opinion addressing the following:

Whether it is at least as likely as not that the Veteran's above-referenced conditions are etiologically related to the Veteran's military service. 

In rendering his/her opinion, the examiner should elicit a full history from the Veteran and consider all lay statements of record. The Board notes that the Veteran is competent to attest to factual matters of which he has first-hand knowledge, and if there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation.

Any resort to speculation must be explained.

 

 

G. A. WASIK

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Riccio, C., Associate Attorney

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.