Citation Nr: 18139811 Decision Date: 10/01/18 Archive Date: 10/01/18 DOCKET NO. 15-30 554 DATE: October 1, 2018 REMANDED Entitlement to service connection for bilateral foot disability, to include pes planus and plantar fasciitis, as secondary to service-connected anterior tibialis tendonitis of the lower extremities is remanded. REASONS FOR REMAND The Veteran had active service from September 2004 to May 2005. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In November 2015, the Veteran testified before the undersigned Veterans Law Judge (VLJ) at a video conference hearing. A transcript of his testimony is of record. This case was last before the Board in March 2017, when it was remanded for additional development. The prior remand included the issue of entitlement to service connection for a psychiatric disorder. Service connection for schizophrenia was granted in a March 2018 rating decision. Accordingly, that issue has been resolved and is not presently on appeal before the Board. 1. Entitlement to service connection for bilateral foot disability, to include pes planus and plantar fasciitis, as secondary to service-connected anterior tibialis tendonitis of the lower extremities is remanded. In accordance with the remand directives an addendum opinion was obtained in March 2017. Nevertheless, that opinion is not fully responsive to the remand directives. While the clinician opined that the Veteran’s plantar fasciitis and pes planus were less likely than not caused or aggravated by her service-connected anterior tibialis, the rationale did not address the Veteran’s plantar fasciitis. Additionally, the clinician incorrectly stated that the record did not reveal treatment or complaints related to pes planus. VA treatment records from July 25, 2013, April 11, 2008, March 14, 2007, and October 27, 2006 note the Veteran’s reports of ongoing foot pain and need for orthotics. Accordingly, an addendum opinion is warranted. Moreover, as clinical records from the Portsmouth Naval Medical Center, obtained during the last remand, document the Veteran’s April 20, 2005 report of foot pain, the addendum opinion should also address direct service connection. The Board has not overlooked the nexus statement from a VA podiatrist indicating that pes planus “may result” from a leg muscle injury “if this affects her lower leg muscles.” While the Board acknowledges the opinion, it is speculative in nature and therefore inadequate for adjudicating the claim. The evidence also indicates there may be outstanding relevant VA treatment records. A February 6, 2008 VA treatment record, which was associated with the claims file during the last remand, indicates that a fee basis physical therapy record was scanned into VistA Imaging. It does not appear that this record has been associated with the claims file. As the Veteran received fee basis physical therapy for her service-connected anterior tibialis tendonitis of the lower extremities this record is potentially relevant. Therefore, on remand the record should be obtained. The matter is REMANDED for the following actions: 1. Ask the Veteran to provide the names and addresses of all medical care providers who have recently treated her for her claimed disability. After securing any necessary releases, request any relevant records identified. In addition, obtain any updated VA treatment records dated since September 18, 2018 and the fee basis physical therapy record that was referenced in the February 6, 2008 VA treatment record. If any requested records are unavailable, the Veteran should be notified of such. 2. After the above is completed to the extent possible, forward the claims file to a VA podiatrist to obtain an addendum opinion regarding the Veteran's pes planus and plantar fasciitis. If an examination is deemed necessary to respond to the questions presented, one should be scheduled. Following review of the claims file, the clinician should opine: (a.) Whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s plantar fasciitis arose during service or is otherwise related to service, to include the Veteran’s April 7, 2005 report of right foot bone pain. Please explain why or why not. (b.) Whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s pre-existing pes planus underwent (c.) a permanent worsening during service? Please explain why or why not, to include addressing the Veteran’s April 7, 2005 report of right foot bone pain. (d.) If the pre-existing pes planus underwent a permanent worsening during service, was that worsening clearly the result of the normal progression of the pes planus, versus being the results of events during service? Please explain why or why not. (e.) Whether it is at least as likely as not (50 percent probability or greater) that the plantar fasciitis was caused by her service-connected anterior tibialis tendonitis of the lower extremities. Please explain why or why not. (f.) If not caused by the service-connected anterior tibialis tendonitis of the lower extremities, is it at least as likely as not that the Veteran's the bilateral pes planus and/or plantar fasciitis is worsened beyond natural progression (aggravated) by his service-connected anterior tibialis tendonitis of the lower extremities? If the clinician finds that the Veteran's bilateral pes planus or plantar fasciitis was aggravated by his service-connected anterior tibialis tendonitis of the lower extremities, the clinician should attempt to quantify the level of aggravation beyond the baseline level of pes planus and plantar fasciitis. In so opining, the podiatrist should address the VA treatment records from July 25, 2013, April 11, 2008, March 14, 2007, and October 27, 2006 documenting complaints of and treatment for foot pain, the October 12, 2006 treatment record noting 4/5 muscle strength in the bilateral tibialis posterior and extensor hallucis longus, and tibialis anterior, and the March 21, 2017 nexus statement from VA podiatrist J. L. H. A complete rationale should be provided for all opinions and conclusions expressed. K. A. BANFIELD Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Anderson