Citation Nr: 18153352
Decision Date: 11/27/18	Archive Date: 11/27/18

DOCKET NO. 16-48 908
DATE:	November 27, 2018
REMANDED
Entitlement to service connection for bilateral metatarsalgia is remanded.
REASONS FOR REMAND
The Veteran had active service from March 1971 to March 1974.
This matter comes before the Board of Veterans’ Appeals (Board) on appeal of a July 2014 decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri.
The issue on appeal must be remanded for additional medical inquiry.
The Veteran underwent medical examination in January 1971, just prior to entering active service.  In the report of medical history, the Veteran indicated a history of foot trouble.  But the report of medical examination noted the feet as normal.  During active service, the Veteran underwent surgery on his feet.  
A medical opinion addressing whether the Veteran had a foot disorder prior to service, and if so, whether service (to include surgery) aggravated a pre-service foot disability, is necessary.  See 38 U.S.C. § 1111 (2012).  
The matter is REMANDED for the following action:
1. Include in the claims file any VA medical evidence that is not now of record.  
2. Schedule an examination to determine the nature and etiology of current foot disability.  After examining and interviewing the Veteran, and reviewing the claims file, the examiner should answer the following questions.
(a). What foot disorders has the Veteran been diagnosed with since September 2008? 
(b). Is it clear and unmistakable (i.e., undebatable) that the Veteran had foot disability prior to commencement of active service in March 1971?
(c). If it is clear and unmistakable that foot disability pre-existed active service, is it also clear and unmistakable that the disorder WAS NOT aggravated (i.e., permanently worsened) during service? In other words, is it clear and unmistakable that any increase in disability during service was due to the natural progress of the disorder?
(d). If you find by clear and unmistakable evidence that a pre-service foot disorder was not aggravated by service – is it at least as likely as not (i.e., probability of 50 percent or greater) that any current foot disability is related to service? 
In answering this question, discuss the evidence in STRs indicating that the Veteran injured his foot during service, and underwent foot surgery during service.    
Also discuss whether the Veteran has a current foot disorder that amounts to a superimposed disability (in addition to any congenital foot disorder the Veteran may have had at service entrance) which, at least as likely as not, relates to service. 
Please explain in detail any opinion provided.

 
CHRISTOPHER MCENTEE
Acting Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	B. J. Komins, Associate Counsel