Citation Nr: 18148884 Decision Date: 11/08/18 Archive Date: 11/08/18 DOCKET NO. 18-44 329 DATE: November 8, 2018 REMANDED Entitlement to service connection for left ankle disorder, to include as secondary to service-connected disability, is remanded. Entitlement to service connection for left heel/foot disorder, separate and distinct from service-connected left foot metatarsalgia status post bunionectomy, to include as secondary to service-connected disability, is remanded. REASONS FOR REMAND The Veteran had active duty from September 2002 to September 2005. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued in October 2017 by a Department of Veterans Affairs (VA) Regional Office. In June 2018, the RO issued a rating decision granting service connection for degenerative disc disease L5-S1, left trochanteric pain syndrome, and right trochanteric pain syndrome, which had been on appeal from the October 2017 rating decision. As such are considered full grants of the benefits on appeal, and the Veteran has not appealed either the evaluation or effective date assigned to these disabilities, these matters are not before the Board. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997). Additionally, in her August 2018 substantive appeal, the Veteran expressly limited her appeal to the issues of entitlement to service connection for disorders of the left ankle and left heel. This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900(c) (2017). 38 U.S.C. § 7107(a)(2) (2012). Entitlement to service connection for disorders of the left ankle and left heel/foot The Veteran seeks service connection for disorders of the left ankle and left heel/foot, which she contends are separate and distinct from, and secondary to, her service-connected left foot metatarsalgia status post bunionectomy (bunionectomy residuals) and/or patellofemoral pain syndrome of the right and left knees (knee disabilities). In support of her claims, the Veteran cites private podiatry records dated in June 2016 and June 2017, which she submitted to VA in August 2018. These records indicate the Veteran’s current service-connected bunionectomy residuals cause hallux limitus (stiff big toe) and gait changes that result in pain throughout the foot, heel, and ankle. A July 2017 VA treatment record also states the bunionectomy residuals resulted in essential fusion of the great toe, which left the Veteran with very limited flexion and extension. Such record also shows diagnoses of bilateral heel spurs and pes planus. Prior to the submission of the private podiatry records, a January 2015 VA foot condition examination did not provide an etiological opinion pertinent to the issues on appeal. A September 2017 VA examiner diagnosed bilateral ankle sprain and opined that such are not secondary to service-connected bunionectomy residuals. The examiner reasoned there was no medical evidence to support that bunionectomy predisposes individuals to ankle sprain. Notably, the examiner did not address the nature or etiology of the bilateral heel spurs or pes planus documented in the July 2017 VA treatment record. In May 2018, a VA clinician opined the Veteran’s current bilateral ankle sprain is less likely than not due to her service-connected knee disabilities. The examiner reasoned that the Veteran’s current ankle sprains are due to specific injuries, as opposed to overuse. The examiner noted that the Veteran’s knee disabilities are commonly due to over use. The clinician also opined that the Veteran’s current bilateral foot/heel conditions are not related to her service-connected bilateral knee disabilities. The examiner found the March 2018 VA examination focused on the development and treatment of bunion and that there was no documentation of bilateral foot or heel pain. The examiner did not provide an opinion with respect to whether any current disorder was secondary to service-connected bunionectomy residuals. In light of the conflicting and incomplete evidence of record, the Board finds an addendum opinion and, if necessary, examination is needed to clarify the nature and etiology of any current left ankle disorder and/or left heel/foot disorder that are separate and distinct from the Veteran’s service-connected disabilities. Initially, the Board notes the Veteran submitted the private podiatry records after the May 2018 VA examination and, as such, the VA examiner did not have the opportunity to address such evidence. Additionally, the Board finds the medical opinions of record, to include the private podiatry records, do not address the etiology of the specific diagnoses of record and all possible theories of entitlement to service connection. Further, the Federal Circuit recently held that “disability” as used in 38 U.S.C. § 1110 (2012) “refers to the functional impairment of earning capacity, not the underlying cause of said disability,” and “pain alone can serve as a functional impairment and therefore qualify as a disability”. Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). As a result, a diagnosis of “left heel pain" or “left foot pain” may be considered a current disability for service connection purpose. Therefore, remand is warranted to determine whether any left ankle and/or left heel/foot disorder, separate and distinct from the Veteran’s service-connected disabilities, is proximately due to and/or aggravated by such disabilities. Additionally, given the potential probative value of the Veteran’s private podiatry treatment records, any outstanding treatment records must be obtained upon remand. The matters are REMANDED for the following actions: 1. The Veteran should be given an opportunity to identify any outstanding VA and private treatment records relevant to her claims. After obtaining any necessary authorization from the Veteran, obtain all outstanding records. For private treatment records, make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and afford her an opportunity to submit any copies in her possession. For federal records, all reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the file. The Veteran must be notified of the attempts made and why further attempts would be futile and allowed the opportunity to submit such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 2. Then, schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any current left ankle, left heel, and left foot disorder, even if such has resolved. (a.) The clinician should identify all current disorders that are separate and distinct from the Veteran’s service-connected disabilities. The examiner specifically should state whether the Veteran’s left ankle, heel, and foot complaints are attributed to a known clinical diagnosis. In this regard, the examiner is directed to assume that the Veteran has a current disability if there is functional impairment associated with any complaints of pain of the left ankle, heel, and/or foot. (b.) For each disorder, the examiner should provide an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that such disorder is proximately due to and/or aggravated by a service-connected disability. For any aggravation found, the examiner should state, to the best of his or her ability, the baseline of symptomatology and the amount, quantified if possible, of aggravation beyond the baseline symptomatology. (c.) If arthritis of any disorder is diagnosed, the examiner should offer an opinion as to whether it manifested within one year of the Veteran’s separation from service in September 2005, and, if so, describe the manifestations.   A rationale for all opinions offered should be provided. M. M. Celli Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Joshua Castillo, Counsel