Citation Nr: 18141508 Decision Date: 10/10/18 Archive Date: 10/10/18 DOCKET NO. 16-05 011 DATE: October 10, 2018 REMANDED Entitlement to service connection for a bilateral foot disorder, to include pes planus degenerative joint disease, and metatarsalgia, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from July 1984 to May 1988. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Atlanta, Georgia. Entitlement to service connection for a bilateral foot disorder, to include pes planus, degenerative joint disease, and metatarsalgia is remanded. The Veteran contends that she has bilateral pes planus, degenerative joint disease, and metatarsalgia, due to her service connected bilateral hallux valgus, status post bunionectomy and hammer toes disabilities. A January 2014 DBQ examination reflects that the Veteran was diagnosed with each of these disabilities; however no etiological opinion was provided at that time. With this claim, the Veteran was afforded a VA examination in December 2015. The VA examiner opined that the Veteran’s pes planus, degenerative joint disease and metatarsalgia, was less likely than not (less than 50 percent) incurred in or caused by the claimed in-service injury, event, or illness. His rationale was that hammertoes, hallux valgus and callouses involve a distinct and separate part of the foot from pes planus, and metatarsalgia and do not cause the conditions as secondary conditions. The VA examiner opined that the Veteran’s degenerative joint disease is not secondary to hammertoes, hallux valgus or callouses. The Board finds that the December 2015 VA examination is incomplete as it did not address whether the Veteran's bilateral pes planus, degenerative joint disease and metatarsalgia, was aggravated by her service connected bilateral status post bunionectomy and hammer toes. See El-Amin v. Shinseki, 26 Vet. App. 136, 140 (2013) (indicating that findings of "not due to," "not caused by," and "not related to" a service connected disability are insufficient to address the question of aggravation under § 3.310(b)). Accordingly, a remand is warranted to afford the Veteran a new VA examination and opinion. The matter is REMANDED for the following action: 1. Schedule the Veteran for a VA examination, by a VA examiner who has not previously examined her to determine the nature and etiology of her bilateral pes planus, degenerative joint disease and metatarsalgia. The VA examiner must review the claims file in its entirety, including this REMAND, and must note that review in the report. All appropriate finding should be reported in detail. The examiner should provide an opinion on the following: (a) Opine whether it is at least likely as not (50 percent or greater possibility) that the Veteran’s bilateral pes planus, degenerative joint disease, and metatarsalgia had its onset during active duty service or is otherwise related to any in-service disease, event, or injury, to include being aggravated by her service connected bilateral status post bunionectomy and hammer toes. The VA examiner is reminded that the lack of a documented bilateral flatfoot disorder, to include pes planus and degenerative joint disease with metatarsalgia, on separation cannot serve as the sole basis for a negative finding. The Veteran’s lay contentions must be considered and weighed in making the determination as to whether a nexus exists between the claimed diseases and military service. (b) Opine whether it is at least likely as not (50 percent or greater possibility) that the Veteran’s bilateral pes planus, degenerative joint disease, and metatarsalgia are caused by the Veteran’s service-connected bilateral hallux valgus, status post bunionectomy, hammer toes, and callous disabilities? (c) Opine whether it is at least likely as not (50 percent or greater possibility) that the Veteran’s bilateral pes planus, degenerative joint disease, and metatarsalgia are aggravated (permanently increased in severity beyond the natural progress of the disorder) by the Veteran’s service-connected bilateral hallux valgus, status post bunionectomy, hammer toes, and callous disabilities? The VA examiner should provide a complete rationale for the conclusions reached. If an opinion cannot be reached without resorting to speculation, the examiner must explain why. 2. After completing the above action, and any other indicated development, the Veteran’s claim must be re-adjudicated. If the benefit sought on appeal remains denied, a supplemental statement of the case must be provided to the Veteran and his representative. LESLEY A. REIN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Mahaffey, Associate Counsel