Citation Nr: 19190823 Decision Date: 12/03/19 Archive Date: 12/03/19 DOCKET NO. 10-46 511 DATE: December 3, 2019 REMANDED Entitlement to service connection for a right foot disability is remanded. Entitlement to service connection for a left foot disability is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Navy from December 1972 to January 1975. His decorations include the National Defense Service Medal. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a March 2009 rating decision issued by the Department of Veterans’ Affairs (VA) Regional Office (RO) in Muskogee, Oklahoma. In his October 2010 VA Form 9 the Veteran requested a hearing by video teleconference, but he later withdrew his request in a July 2014 document. This matter was previously before the Board in October 2014, February 2017, and February 2018, when it was remanded to the RO for additional development. While the Board sincerely regrets the additional delay, another remand is necessary to ensure compliance with the prior remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). 1. Entitlement to service connection for a right foot disability is remanded. 2. Entitlement to service connection for a left foot disability is remanded. The Veteran contends that he was given improper footwear in service, and that as a result he has current problems with his bilateral feet. In its October 2014 remand, the Board directed the RO to obtain VA treatment records from Fort Sill, Oklahoma and from Knoxville, Tennessee, and to afford the Veteran a VA examination to consider the nature and etiology of any right and left foot disabilities. The RO obtained VA treatment records from Fort Sill and Knoxville, and in February 2016 the Veteran was afforded a VA examination in connection with his claim. The February 2016 VA examiner noted current diagnoses of hallux valgus bilaterally, status-post bunionectomy bilaterally, a calcaneal spur on the left foot, and an old fracture of the fifth metatarsal and a small calcaneal spur on the right foot. He also explicitly considered but excluded diagnoses of bilateral pes planus and bilateral foot degenerative changes of the first metatarsal joints because there was no pathology to render those diagnoses. The examiner then offered negative nexus opinions as to the diagnosed conditions, reasoning that the only foot condition noted in service was a partial avulsion of the right great toenail in October 1972, and that this resolved without sequelae. The examiner opined that the in-service condition was not related to any current foot condition, as a nail avulsion does not cause any of the Veteran’s current foot conditions. The Board again considered the Veteran’s claims regarding his bilateral feet in February 2017, when it remanded the claims with instructions for the RO to obtain updated VA treatment records, service treatment records (STRs) from Roosevelt Roads Naval Hospital in Puerto Rico and from the Naval Hospital in Newport, Rhode Island, and to afford the Veteran an examination in connection with any skin conditions of the bilateral feet. Upon remand, the RO obtained records from Roosevelt Roads Naval Hospital, and while it received a negative response in April 2017 regarding its attempt to obtain records from the Naval Hospital in Newport, Rhode Island, the Board notes that these records are present in the claims file. The Veteran was also afforded a VA examination in order to assess the nature and etiology of any skin condition of his feet in June 2017, after which the RO granted entitlement to service connection for stasis dermatitis of the bilateral feet. In a September 2017 Supplemental Statement of the Case, however, the RO continued to deny the Veteran’s more general claims for a right foot disability and a left foot disability. In its February 2018 remand, the Board found the February 2016 VA examination inadequate because the examiner failed to adequately address the Veteran’s statements regarding the cause of onset and continuity of his foot symptoms. It instructed the RO to obtain updated VA treatment records and to afford the Veteran a new VA examination to address the nature and etiology of any currently present disability in either foot. It instructed the examiner to consider specifically the Veteran’s contention that his foot problems are the result of wearing footwear that was too small in service. The RO obtained updated VA treatment records and afforded the Veteran a new VA examination in July 2019. The examiner noted that current diagnoses included bilateral hallux valgus, bilateral calcaneal spurs, bilateral degenerative arthritis, and status-post bilateral bunionectomies. The VA examiner offered a negative nexus opinion regarding the Veteran’s bilateral hallux valgus. She reasoned that the only treatment for any foot condition in service was the partial nail avulsion of the right great toe and opined that the Veteran’s hallux valgus was as likely as not due to an inherited genetic defect which can be and is known to be the cause of hallux valgus. She also stated that if any improper footwear was used in service it would require many more than two years to be considered a factor in the development of hallux valgus. The Board finds that the July 2019 VA examination is inadequate because it does not comply with the February 2018 remand directive to consider the nature and etiology of any currently present disability in either foot. While the examiner considered and offered a nexus opinion on the Veteran’s bilateral hallux valgus, she did not consider the Veteran’s bilateral calcaneal spurs, bilateral degenerative arthritis, or status-post bilateral bunionectomies, even though she noted each of these as currently present diagnoses. Under the circumstances, an addendum opinion is warranted. See Stegall, supra. The matters are REMANDED for the following action: Obtain an addendum opinion from an appropriate clinician regarding whether it is at least as likely as not that any currently diagnosed foot disability had its onset during the Veteran’s active service or is otherwise etiologically related to such service. The Board emphasizes that the examiner should be asked to provide an opinion as to each currently diagnosed foot disability, including the Veteran’s bilateral calcaneal spurs, bilateral degenerative arthritis, and status-post bilateral bunionectomies. In so doing, the examiner should specifically address the Veteran’s contention that his current foot disabilities were caused by improper footwear during service. A complete rationale for all opinions expressed must be provided. Joshua R. Castillo Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Oldroyd, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.