Citation Nr: 18156445
Decision Date: 12/11/18	Archive Date: 12/10/18

DOCKET NO. 16-60 727
DATE:	December 11, 2018
REMANDED
Entitlement to a rating in excess of 10 percent for residuals of a left foot fracture of the 4th proximal phalanx.
Entitlement to a rating in excess of 10 percent for residuals of right foot fractures of the 2nd and 3rd metatarsals.
REASONS FOR REMAND
The Veteran had active military service from September 1997 to September 2001.
The Veteran is currently service connected disabilities for residuals of a left foot fracture of the 4th proximal phalanx, and residuals of right foot fractures of the 2nd and 3rd metatarsals.  Each foot is rated at 10 percent.
In March 2016, the Veteran filed a claim seeking compensation for his foot disabilities.  He was afforded a VA examination to assess the severity of his service-connected foot symptoms in June 2016.  The examiner also noted the Veteran had bilateral pes planus, and the RO obtained addendum opinions from the examiner to ascertain the etiology of the pes planus.  However, the opinions obtained were not complete, as the examiner did not opine as to whether the Veteran’s pes planus in either foot had been aggravated by the Veteran’s service-connected foot fracture residuals.  The Board notes that the Veteran’s mild pes planus was clearly noted on his January 1997 entrance examination, but his arches were noted as being normal at his July 2001 separation examination, and only mild in a December 2001 VA examination shortly after separation, so there is no evidence of a worsening to any degree, much less beyond the natural progression of the condition, during active service.  Proper medical nexus opinions must be obtained regarding the Veteran’s bilateral pes planus before the Board can decide these claims.
Further, the June 2016 VA examiner did not provide responses for all of the rating criteria needed to assess the Veteran’s service-connected foot conditions.  Specifically, he did not provide a response for the section of the examination addressing malunion or nonunion of tarsal or metatarsal bone, which directly pertains to the Diagnostic Code under which the Veteran’s foot disabilities are evaluated.  Further, he did not respond to the question asking about the effects of the use of arch supports, built-up shoes or orthotics on the Veteran’s pes planus symptoms.  A new VA examination is needed in order for the Board to obtain a complete assessment of the Veteran’s service-connected foot symptomatology. 
The matters are REMANDED for the following action:
1. Schedule the Veteran for a VA foot conditions examination to determine the current severity of his service-connected residuals of a left foot fracture of the 4th proximal phalanx and residuals of right foot fractures of the 2nd and 3rd metatarsals.  The examiner should respond to all sections of the VA examination report (especially addressing the relevance, if any, of the question of whether there is malunion or nonunion of tarsal or metatarsal bones), or provide an explanation as to why any response cannot be given.  The examiner should also provide the following opinion for the Veteran’s bilateral pes planus:
(a.) Is it at least as likely as not (50 percent or greater) that the pes planus of either foot was aggravated (made worse) by the Veteran’s service-connected residuals of a left foot fracture of the 4th proximal phalanx and/or by his service-connected residuals of right foot fractures of the 2nd and 3rd metatarsals?  Why or why not?    
If aggravation is found, the examiner should identify a baseline level of severity of the pes planus by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the pes planus.  If such cannot be done, it should be explained why.
 
 MATTHEW W. BLACKWELDER
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	C. Davidoski, Associate Counsel