Citation Nr: 18141616 Decision Date: 10/11/18 Archive Date: 10/11/18 DOCKET NO. 10-04 806 DATE: October 11, 2018 REMANDED Entitlement to service connection for bilateral shin splints is remanded. Entitlement to service connection for bilateral plantar fasciitis is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from March 2004 to January 2007, to include service in the Southwest Asia Theater of Operations. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2007 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran’s appeal initially included claims of service connection for cold injuries to the hands and feet, a bilateral ankle disorder, and a left wrist disorder. In January 2015, the Board granted the Veteran’s claims of service connection for cold injuries to her hands and feet and remanded the claims of bilateral ankle disorder, left wrist disorder, and the claims currently on appeal for additional development. In December 2016, the Board again remanded the claims of bilateral ankle disorder, left wrist disorder, and the claims currently on appeal for additional development. The RO subsequently granted the claims of service connection for a bilateral ankle disorder and left wrist disorder in a June 2017 rating decision. As this award represented a full grant of the benefits sought on appeal, the claims are no longer before the Board. The issue of entitlement to a total disability rating based on individual unemployability has been raised by the record, but has not adjudicated by the Agency of Original Jurisdiction (AOJ). See September 2018 Informal Hearing Presentation. The Veteran and her representative are advised that effective March 24, 2015, VA requires claims to be submitted on a standard application form prescribed by the Secretary. See 38 C.F.R. §§ 3.1(p), 3.155, 3.160. This matter is referred to the AOJ as an intent to file a claim. See 38 C.F.R. § 3.155(b). 1. Entitlement to service connection for bilateral shin splints is remanded. The Veteran contends that she has bilateral shin splints that are related to her military service. The Board remanded this claim in December 2016 for a VA examination. The Board’s directives requested the examiner to note the presence or absence of identified pathology, and if there was no identified pathology, to determine if the Veteran has signs or symptoms of an undiagnosed illness. On examination in March 2017, the examiner noted that the Veteran had a history of shin splints, but did not have any current symptoms. A nexus opinion was not provided. While the Veteran may not have been experiencing pain or other signs or symptoms during the examination, she has reported pain in her lower leg during the appeal period. See VA Problem List and May 2007 VA Examination. As such, per the Board’s directives, the examiner should have addressed whether the Veteran’s previous reports of pain in her lower leg were signs or symptoms of an undiagnosed illness. Given this deficiency, there has not been substantial compliance with the Board’s remand directives and an addendum opinion is required. Stegall v. West, 11 Vet. App. 268 (1998); see 38 C.F.R. § 4.2. 2. Entitlement to service connection for bilateral plantar fasciitis is remanded. The Veteran contends that she has a current diagnosis of plantar fasciitis that is related to her military service, to include her in-service complaints of bilateral foot pain, diagnosis of plantar fasciitis, and/or an injury to her feet caused by climbing over rocks. The Board previously remanded this claim for further development in January 2015 and December 2016. The Board’s remand directives have been substantially complied with. Stegall, 11 Vet. App. at 268. The Veteran was afforded a VA examination for her feet in March 2017; however, the examiner opined that the Veteran’s claimed condition was less likely than not related to service because the Veteran did not have any signs of, or a current diagnosis of, bilateral plantar fasciitis. However, a review of the Veteran’s VA treatment records show that the Veteran has been diagnosed with bilateral plantar fasciitis. See January, February, and March 2016 VA treatment records. As the examiner’s opinion did not consider all relevant evidence of record, the opinion is inadequate and a new opinion to determine the etiology of the Veteran’s plantar fasciitis is required. Dalton v. Nicholson, 21 Vet. App. 23 (2007). The matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from September 2017 to the present. 2. Obtain an addendum opinion from the March 2017 examiner, or another appropriate clinician if the examiner is unavailable, regarding the Veteran’s claimed lower leg conditions. The claims file, and a copy of this Remand, must be reviewed by the examiner. The examiner must opine whether the Veteran’s previous reports of lower leg pain were attributable to a known clinical diagnosis, and if so, whether it is at least as likely as not that the diagnosis is related to service. If the Veteran’s previous reports of lower leg pain were not attributable to a known clinical diagnosis, the examiner must opine whether it is at least as likely as not that the reported symptoms were manifestations of an undiagnosed illness or part of a medically unexplained multi-symptom illness under 38 C.F.R. § 3.317. A complete rationale for all opinions must be provided. The examiner is advised that the Veteran is competent to report observable symptomatology, and that the Veteran’s lay statements should be presumed to be credible for the purposes of this examination. 3. Obtain a VA medical opinion regarding the etiology of the Veteran’s plantar fasciitis from a qualified medical professional. The need for a physical examination is left to the discretion of the VA examiner. The examiner must review the entire claims file and a copy of this Remand. The examiner must opine whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s plantar fasciitis had its onset in, or is otherwise related to active service, to include her in-service diagnosis of plantar fasciitis, complaints of bilateral foot pain, and her lay assertion that she injured her feet when climbing over rocks. If the examiner finds that the Veteran’s plantar fasciitis is less likely than not related to her active service, the examiner is asked to opine whether it is at least as likely as not that it was caused or aggravated by her service-connected bilateral pes planus with painful bunions. The term “aggravation” means a chronic worsening of a disability beyond its natural progression. If aggravation is found, then, to the extent possible, the examiner should establish a baseline level of severity of the plantar fasciitis prior to aggravation by the service-connected disability. A complete rationale must be provided for all opinions expressed. The rationale must consider and discuss the pertinent evidence of record, to include the Veteran’s lay statements. If the examiner is not able to provide an opinion without resorting to speculation, he or she must provide an explanation for why that is so. The examiner is further advised that the inability to provide an opinion without resorting to speculation must be based on the limitation of knowledge in the medical community at large and not a limitation - whether based on lack of expertise, insufficient information, or unprocured testing - of the individual examiner. D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD E. Mortimer, Associate Counsel