Citation Nr: 18142196 Decision Date: 10/16/18 Archive Date: 10/12/18 DOCKET NO. 09-14 431 DATE: October 16, 2018 REMANDED Entitlement to a disability rating in excess of 10 percent for stress fracture of the left foot is remanded. Entitlement to a disability rating in excess of 10 percent for stress fracture of the right foot is remanded. REASONS FOR REMAND The Veteran had active duty military service from August 1994 to January 1996. Entitlement to a disability rating in excess of 10 percent for stress fracture of the left foot is remanded. Entitlement to a disability rating in excess of 10 percent for stress fracture of the right foot is remanded. This matter was previously before the Board in February 2017, when the Board granted entitlement to a 10 percent disability rating for each foot but denied a still higher disability rating. That decision was appealed to the United States Court of Appeals for Veterans Claims (Court) which, in March 2018, issued a Joint Motion for Remand (JMR) on the issue of entitlement to a disability rating greater than 10 percent for each foot disability. The Vetearn’s stress fracture residuals in the left and right foot are each rated as 10 percent disabling using the criteria set forth in Diagnostic Code 5284. Under these criteria, moderate residuals of foot injuries are rated 10 percent disabling; moderately severe residuals of foot injuries are rated 20 percent disabling; and severe residuals of foot injuries are rated 30 percent disabling. A Note to Diagnostic Code 5284 provides that foot injuries with actual loss of use of the foot are to be rated 40 percent disabling. 38 C.F.R. § 4.71a. During the period that the Veteran’s appeal was pending before the Court, she was treated at VA for additional symptoms of foot pain and tests revealed additional foot diagnoses. It is unclear how or whether the diagnoses are related to the Veteran’s service-connected disabilities, to include whether they would provide a basis for higher disability ratings. For that reason, the Board finds that this matter should be remanded for an additional VA examination. The Board notes that the JMR was focused on the significance of the Veteran’s use of assistive devices, including braces and a cane. Specifically, it is important to determine if the use of and need for these devices indicates that the Veteran’s right and left foot stress fractures more closely approximate a moderately severe disability picture than a moderate disability picture. This question should be addressed by the examiner on remand. The matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from February 2017 to the present. 2. Then, schedule the Veteran for an examination by an appropriate clinician to determine the current severity of her service-connected residuals of stress fractures of the right and left feet. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. The examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. The examiner should specifically address the treatment records from July and August 2017, including the MRI and other imaging, showing additional diagnoses, and should state whether these diagnoses are related to the service-connected stress fractures. This should include an opinion as to whether it is at least as likely as not (probability 50 percent or greater) that these diagnoses were caused or aggravated (made permanently worse by) the service-connected stress fractures. The examiner should also address the Veteran’s need for and use of assistive devices including braces and a cane and offer an opinion as to whether the Veteran’s disability picture more nearly approximates a moderately severe disability than a moderate disability as a result. The examiner should identify any symptoms and functional impairments due to stress fractures and any residuals alone and discuss the effect of the Veteran’s stress fractures on any occupational functioning and activities of daily living. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). JAMES L. MARCH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Cheryl E. Handy, Counsel