Citation Nr: 18147778 Decision Date: 11/06/18 Archive Date: 11/06/18 DOCKET NO. 09-13 203 DATE: November 6, 2018 REMANDED Entitlement to service connection for a bilateral foot disability, to include as secondary to service-connected knee disability is remanded. Entitlement to service connection for a bilateral ankle disability, to include as secondary to service-connected knee disability is remanded. REASONS FOR REMAND The Veteran had active duty service from June 1962 to May 1964. In September 2012, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge. A transcript of that hearing is of record. In October 2013, the Veteran’s appeal was remanded for additional evidentiary development. In October 2016, the Board denied the Veteran’s claims of entitlement to service connection for allergic rhinitis, a skin disability of the hands and forearms, a bilateral foot disability, to include as secondary to service-connected knee disability, and a bilateral ankle disability, to include as secondary to service-connected knee disability. The Veteran appealed the Board’s October 2016 decision to the United States Court of Appeals for Veterans Claims (Court). A March 2018 Court Order vacated, in part, the Board’s decision, and issued a Memorandum Decision for readjudication of the Veteran’s claims of entitlement to service connection for a bilateral foot disability and bilateral ankle disability, each to include as secondary to service-connected knee disability. A remand was ordered with respect to these issues; the remainder of the Board’s October 2016 decision concerning service connection for allergic rhinitis and a skin disability of the hands and forearms remains intact. Thus, the Veteran’s claims of entitlement to service connection for a bilateral foot disability and bilateral ankle disability, each claimed to include as secondary to service-connected knee disability are again before the Board. It is noted that in May 2018, the Board remanded the issue of entitlement to service connection for a right ear disability. A review of the record reveals that evidentiary development is still ongoing. As such, that matter is not currently before the Board and it will be the subject of a subsequent Board decision, if necessary. Entitlement to service connection for a bilateral foot disability and/or a bilateral ankle disability, to include as secondary to service-connected knee disability are remanded. As discussed above, in March 2018, the Court issued a Memorandum Decision and Order vacating and remanding these issues to the Board for additional action. The Veteran contends that the prior VA examination reports, of which there are many and which the Board relied on, were inadequate for rating purposes because the VA examiners should have provided a more specific discussion of any gait problems and whether any such gait problem caused or aggravated the Veteran’s conditions in his feet. In other words, the Veteran has argued that his service-connected knee disability altered his gait and that the disabilities for which he sought secondary service connection, including the ankle and foot conditions, resulted from unusual stress or loading of his limbs and back. The Board observes that there is both lay and medical evidence that the altered gait also may have caused the ankle and foot disabilities. In two separate letters, the Veteran’s osteopath attributed left foot pain to an altered gait resulting from instability in the service-connected knee disability. In his testimony before the Board, the Veteran stated that he believed his ankle problem resulted from favoring his right knee over the years. The medical question to be illuminated by a VA medical examination was whether the altered gait, was also the cause of the maladies of his bilateral foot and ankle disabilities. Notably, the September 2015 VA medical examination report failed to acknowledge the possible effect of the Veteran’s altered gait. Invoking uncited medical literature, the examiner stated that “the development of arthritis is most commonly due to age, weight, normal wear/tear of repetitive joints. Additionally, the acquired flat foot deformity of the left foot is most likely than not an external contributing factor of the Veteran’s left ankle and foot conditions.” As such, pursuant to the March 2018 Court Order, the appeal is remanded for an additional VA examination correcting the inadequacies described in the Memorandum Decision. Specifically, it must be determined whether the Veteran’s bilateral foot and ankle disabilities are related to either his military service or service-connected knee disability, to include due to any gait disturbance. The matters are REMANDED for the following action: 1. Schedule the Veteran for VA orthopedic-type examination(s) with examiner(s) of appropriate expertise in order to determine the nature and etiology of the Veteran’s bilateral foot and bilateral ankle disabilities. The examiner(s) is/are to be provided access to the Veteran’s electronic claims file. He/she is requested to review all pertinent records associated with the claims file, the Veteran’s service treatment records, post-service medical records, and the Veteran’s own assertions. Any indicated diagnostic tests and studies should also be accomplished. It should be noted that the Veteran is competent to attest to factual matters of which he had first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiners should provide a fully reasoned explanation. (a) The VA examiner(s) must opine whether it is at least as likely as not (50 percent or higher degree of probability) that any bilateral foot and bilateral ankle disabilities identified manifested in service or are otherwise causally or etiologically related to his military service. (b) If not directly related to service, the appropriate examiner should offer an opinion as to whether it is at least as likely as not (50 percent or higher degree of probability) that any identified bilateral foot and ankle disabilities are caused by his service-connected knee disability. (c) That examiner should then opine whether the bilateral foot and ankle disabilities are aggravated (i.e., permanently worsened beyond the normal progression of that disease) by his service-connected knee disability. A specific discussion of any gait problems and whether any such gait problem caused or aggravated the Veteran’s bilateral foot and ankle disabilities should also be set out. All examination findings/testing results, along with complete, clearly-stated rationale for the conclusions reached, must be provided. All prior reports should be addressed and/or reconciled, as necessary. 2. After the development requested has been completed, the Agency of Original Jurisdiction (AOJ) should review any report to ensure that it is in complete compliance with the directives of this remand. If the report is deficient in any manner, the AOJ must implement corrective procedures at once. MICHAEL D. LYON Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Miller, Associate Counsel