Citation Nr: 18143224 Decision Date: 10/18/18 Archive Date: 10/18/18 DOCKET NO. 16-12 543 DATE: October 18, 2018 REMANDED Entitlement to service connection for a left foot disability is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1989 to June 1990. This matter comes before the Board of Veteran’s Appeals (Board) on appeal from an October 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran had a hearing before the undersigned in March 2018. 1. Entitlement to service connection for a left foot disability is remanded. The Veteran is seeking service connection for his left foot disability. Before a decision can be reached on this claim, a remand is necessary to ensure that there is a complete record upon which to afford the Veteran every possible consideration. See 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. The Veteran contends that he has a left foot disability prior to his service and that such was aggravated by his service. An examination is necessary in a service connection claim where the information and evidence of record does not contain sufficient competent medical evidence to decide the claim. McLendon v. Nicholson, 20 Vet. App. 79, 83-86 (2006). The Veteran has been diagnosed with hallux valgus and pes planus of the left foot. See May 2018 Urban Health Systems Evaluation. The Veteran reported that his rigorous military training aggravated his pre-existing left foot disability. See March 2018 Board Hearing transcript. The Veteran’s service treatment records show that upon his enlistment examination in August 1988 and then again in July 1989, he had mild, asymptomatic hallux valgus and pes planus of the feet. A May 1990 medical board report reflected that the Veteran was separated from service with diagnoses of symptomatic pes planus equinus syndrome and hallux valgus left foot. See August 2014 STR-Medical pg. 5, 10-12. If a pre-existing disorder is noted upon entry into service, service connection may still be granted based on aggravation during service of that disorder. 38 U.S.C. § 1153; 38 C.F.R. § 3.306(b). A pre-existing injury or disease will be considered to have been aggravated by active service where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. 38 U.S.C.§ 1153; 38 C.F.R. § 3.306(a). Clear and unmistakable evidence (obvious or manifest) is required to rebut the presumption of aggravation where the pre-service disability underwent an increase in severity during service. 38 C.F.R. § 3.306(b). The Veteran has submitted a May 2018 private opinion by Dr. R.S. opining that the Veteran’s left foot condition was directly related to his service. However, the opinion did not sufficiently address whether the Veteran’s pre-existing disability of the left foot was aggravated by his service, specifically by his contended rigorous military training during service, and why such was aggravated. Therefore, an opinion should be obtained to address the issue of whether the Veteran’s pre-existing left foot condition was aggravated by service. The matter is REMANDED for the following action: Schedule the Veteran for a VA examination and opinion regarding whether the Veteran’s left foot disability which existed prior to his service was aggravated beyond its natural progression by service. The evidentiary record, including a copy of this remand, must be made available to and reviewed by the examiner. The examination report must include a notation that this record review took place. The examiner is to answer the following questions: a) Was the Veteran’s preexisting left foot disability aggravated by his active service? That is, was there any increase in the Veteran’s preexisting left foot disability during his active service? b) If you find that the Veteran’s preexisting disability was aggravated (increased in severity) during his active service, then is it obvious or manifest that this increase in disability was due to the natural progress of his preexisting injury and not due to his service? c) Is it at least as likely as not that any current left foot disability was incurred, or was caused by an event, during his military service? (Continued on the next page)   The examiner should review the service treatment records, to include the May 1990 medical board report. The examination report must include a complete rationale for all opinions expressed. If the examiner feels that a requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e. no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e. additional facts are required, or the examiner does not have the needed knowledge or training). S. HENEKS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD N. Kamal, Associate Counsel