Citation Nr: 18129017 Decision Date: 08/23/18 Archive Date: 08/23/18 DOCKET NO. 14-34 920A DATE: August 23, 2018 REMANDED Entitlement to service connection for right foot plantar fasciitis, to include as due to a right knee disability, is remanded. Entitlement to a rating in excess of 10 percent from June 1, 2013, to prior to March 5, 2014, in excess of 20 percent from August 1, 2014, to prior to August 21, 2015, and in excess of 20 percent from October 1, 2015, onwards, is remanded. Entitlement to a compensable rating for scarring as a result of back surgery is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1987 to October 1991. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a December 2012 rating decision by the Department of Veterans Affairs (VA). The Veteran attended a hearing before the undersigned in May 2018. During the course of the appeal, the Veteran has been assigned a series of temporary total ratings for his back and his back disability rating was raised to 20 percent, effective August 1, 2014. Since the RO did not assign the maximum disability rating possible, the appeal for a higher disability rating remains before the Board. AB v. Brown, 6 Vet. App. 35 (1993) (noting that where a claimant has filed a notice of disagreement as to an RO decision assigning a particular rating, a subsequent RO decision assigning a higher rating, but less than the maximum available benefit, does not abrogate the pending appeal). 1. Entitlement to service connection for right foot plantar fasciitis, to include as due to a right knee disability, is remanded. The Veteran is seeking service connection for right foot plantar fasciitis, which he asserts is due to his right knee disability. In December 2012, he underwent a VA examination. At that time, he reported to the examiner that he was previously informed that his foot condition is the result of an abnormal gait caused by his right knee disability. The examiner concluded that the Veteran’s right foot disorder is less likely as not related to service. In their opinion, the examiner cited the absence of a previous medical opinion linking the Veteran’s right foot disorder and his right knee disability. The examiner further stated that he cannot make such a medical nexus without resorting to mere speculation. The Board notes that when a medical examiner concludes that they are unable to provide a nexus opinion without speculation, the examiner must sufficiently explain the reasons for this inability. Jones v. Shinseki, 23 Vet. App. 382, 389-90 (2010). As the examiner did not explain why a more definitive response is not possible or feasible, the Veteran’s claim must be remanded for an addendum opinion regarding secondary service connection. 2. Entitlement to a rating in excess of 10 percent from June 1, 2013, to prior to March 5, 2014, in excess of 20 percent from August 1, 2014, to prior to August 21, 2015, and in excess of 20 percent from October 1, 2015, onwards, is remanded. The Veteran is seeking a higher rating for his back disability, which also consists of multiple temporary total ratings. He currently receives a 100 percent rating from November 14, 2012, to prior to June 1, 2013; a 10 percent rating from June 1, 2013, to prior to March 5, 2014; a 100 percent rating from March 5, 2014, to prior to August 1, 2014; a 20 percent rating from August 1, 2014, to prior to August 21, 2015; a 100 percent rating from August 21, 2015, to prior to October 1, 2015; and a 20 percent rating from October 1, 2015, onwards. The Veteran has undergone multiple VA examinations during the appeal period. However, as noted by the Veteran during his hearing, a December 2012 examination was conducted immediately after surgery. Additionally, during the February 2015 examination, the examiner failed to note that the Veteran suffers from intervertebral disc syndrome. Importantly, it also appears that the Veteran received a spinal cord stimulation for his severe pain after the February 2015 VA examination, which could indicate a worsening of his condition. The Board finds that another VA examination is necessary to determine the current status of the Veteran’s back disability. See Snuffer v. Gober, 10 Vet. App. 400 (1997) (holding that when a claimant asserts that the severity of a disability has increased since the most recent VA examination, an additional examination should be conducted). 3. Entitlement to a compensable rating for scarring as a result of back surgery is remanded. The Veteran is seeking service connection for scarring, which is the result of his multiple back surgeries. While a December 2012 VA examiner noted scarring, the scarring was not painful, unstable, or exceeding an area greater than 39 square centimeters. The February 2014 VA examiner noted no scar. During his May 2018 Board hearing, the Veteran complained that the scar was painful and tender. As a result, the examiner who is conducting the VA examination for the Veteran’s back disability will be asked to also evaluate the Veteran’s scar. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s right foot plantar fasciitis is at least as likely as not (1) proximately due to his right knee disability or (2) aggravated beyond its natural progression by his right knee disability. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected back disability. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. The examiner should also evaluate the Veteran’s scarring from his multiple back surgeries. The examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. To the extent possible, the examiner should identify any symptoms and functional impairments due to a back disability alone and discuss the effect of the Veteran’s disability on any occupational functioning and activities of daily living.   If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). B.T. KNOPE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Borman, Associate Counsel