Citation Nr: 18151108 Decision Date: 11/20/18 Archive Date: 11/16/18 DOCKET NO. 16-44 133 DATE: November 20, 2018 REMANDED Entitlement to service connection for a low back disorder, to include as secondary to service-connected pes planus is remanded. Entitlement to service connection for peripheral neuropathy of the left lower extremity, to include as secondary to service-connected pes planus is remanded. Entitlement to service connection for peripheral neuropathy of right lower extremity, also claimed as secondary to service-connected pes planus is remanded. Entitlement to service connection for a psychiatric disorder, to include as secondary to service-connected pes planus is remanded. REASONS FOR REMAND The Veteran, who is the appellant, had active service from April 1971 to August 1971. As it relates to the claim of service connection for a low back disorder, the Board notes that the Veteran was afforded a VA examination in June 2012. At that time an opinion was rendered that the claimed low back disorder was less likely than not proximately due to or the result of the Veteran’s service-connected condition (pes planus). Unfortunately, the examiner did not address the question of aggravation. Given the foregoing, an additional VA examination is warranted. As to the claim of service connection for a psychiatric disorder, to include as secondary to service-connected pes planus, the Veteran was afforded a VA examination in July 2013. At that time, the examiner checked the box that the claimed condition was less likely than not incurred in or caused by a claimed inservice injury, event or illness. As rationale for the opinion, the examiner stated that the Veteran’s unspecified mental disorder was at least as likely as not related to his financial stress and anger and frustration with the Regional Office for not increasing his service-connected benefits to 100 percent and giving him aid and attendance. The examiner noted that the Veteran had a long history of pes planus and he could not locate any medical documentation of seeking any psychiatric treatment directly related to mental stress caused by flat feet. He stated that the Veteran’s psychiatric disorder was less likely than not related to his bilateral pes planus. The examiner then indicated that medical opinions for secondary service connection, to include an opinion with regard to aggravation, were not applicable. The Board notes that treatment records added to the record following the examination now contain diagnoses of PTSD, anxiety disorder, and a mood disorder. Moreover, while an opinion was rendered, the boxes checked by the examiner and the rationale provided do not properly address the claim in order to adequately decide the issue. Given the foregoing, an additional examination is warranted. As it relates to the claims of service connection for peripheral neuropathy of the right and left lower extremities, the Board notes that the Veteran was afforded a VA examination in September 2012. As part of the examination, several opinions were rendered. The first opinion indicated that the claimed condition was at least as likely as not caused by the claimed inservice injury, event or illness; however, the rationale provided did not provide an adequate basis to grant service connection. While it appears that this may have been written in error, with a handwritten note to that effect on the side of the opinion, the author of the handwritten note does not appear to be the author of the opinion. Given the foregoing, the Veteran should be afforded an additional VA examination to address the issue of peripheral neuropathy of the lower extremities and its relationship, if any, to the Veteran’s period of service and/or his service-connected pes planus. The matters are REMANDED for the following action: 1. Undertake appropriate development to obtain all outstanding VA and/or private treatment records related to the Veteran's outstanding claims. If any requested records are not available, the record should be annotated to reflect such and the Veteran notified. 2. Schedule the Veteran for a VA examination to determine the etiology of any low back disorder. The examiner must review the claims file in conjunction with the examination. The examiner is to note all current low back disorders. The examiner is requested to offer the following opinions: Is it as likely as not (50 percent probability or greater) that any current low back disorder is etiologically related to the Veteran's period of service? If not, is it as likely as not (50 percent probability or greater) that any current low back disorder is caused by the service-connected pes planus? If not, is it at least as likely as not (50 percent probability or greater) that any current low back disorder is aggravated by the service-connected pes planus? If aggravation is found, to the extent that is possible, the examiner is requested to provide an opinion as to approximate baseline level of severity of the nonservice-connected disorder before the onset of aggravation. Complete detailed rationale is requested for each rendered opinion. 3. Schedule the Veteran for a VA examination to determine the etiology of any current psychiatric disorder. The examiner must review the claims file in conjunction with the examination. The examiner is to note all current psychiatric disorders. The examiner is requested to offer the following opinions: Is it as likely as not (50 percent probability or greater) that any current psychiatric disorder is etiologically related to the Veteran's period of service? If not, is it as likely as not (50 percent probability or greater) that any current psychiatric disorder is caused by the service-connected pes planus? If not, is it at least as likely as not (50 percent probability or greater) that any current psychiatric disorder is aggravated by the service-connected pes planus? If aggravation is found, to the extent that is possible, the examiner is requested to provide an opinion as to approximate baseline level of severity of the nonservice-connected disorder before the onset of aggravation. Complete detailed rationale is requested for each rendered opinion. 4. Schedule the Veteran for a VA examination to determine the etiology of any peripheral neuropathy of the right and/or left lower extremity. The examiner must review the claims file in conjunction with the examination. The examiner is to note all current neuropathy of the lower extremities. The examiner is requested to offer the following opinions: Is it as likely as not (50 percent probability or greater) that any current neuropathy of the lower extremities is etiologically related to the Veteran's period of service? If not, is it as likely as not (50 percent probability or greater) that any current neuropathy of the lower extremities is caused by the service-connected pes planus? If not, is it at least as likely as not (50 percent probability or greater) that any current neuropathy of the lower extremities is aggravated by the service-connected pes planus? If aggravation is found, to the extent that is possible, the examiner is requested to provide an opinion as to approximate baseline level of severity of the nonservice-connected disorder before the onset of aggravation. Complete detailed rationale is requested for each rendered opinion. (Continued on the next page)   5. Review the claims file. If any development is incomplete, including if the examination report does not contain sufficient information to respond to the questions posed, take corrective action before readjudication. See Stegall v. West, 11 Vet. App. 268 (1998). K. Parakkal Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T.S.Kelly, Counsel