Citation Nr: 19124237 Decision Date: 04/01/19 Archive Date: 04/01/19 DOCKET NO. 13-28 357 DATE: April 1, 2019 REMANDED Service connection for flat feet is remanded.   REASONS FOR REMAND The appellant served on active duty for training (ACDUTRA) from October 1973 to December 1973. The case is on appeal from a November 2009 rating decision. In August 2017, the appellant testified at a Board hearing. The claim came before the Board in October 2017 and was remanded for further development. In the decision, the Board noted the appellant raised a claim for service connection for a back disorder in his September 2013 substantive appeal that had not been adjudicated by the RO. To date, this issue has not been adjudicated by the RO. Therefore, the issue of service connection for a back disorder is referred to the RO again for appropriate action. 38 C.F.R. § 19.9(b). In September 2018, the appellant filed an informal motion to advance his case on the on the docket (AOD) due to his health. The appellant requested expedited treatment due to a terminal illness; however, no further evidence was submitted related to this request. The Board finds that good or sufficient cause for AOD due to serious illness is not supported. Thus, the motion for AOD is denied. 38 C.F.R. § 20.900(c). Service connection for flat feet. The appellant contends that his current bilateral flat feet condition was not a pre-existing disorder and was incurred during his period of ACDUTRA. Alternatively, he asserts if the disorder is found to be pre-existing, then it was aggravated during his period of ACDUTRA. As noted, the claim came before the Board in October 2017. The Board determined the appellant is not entitled to the presumption of soundness in adjudicating his current claim as he has two months of ACDUTRA service, with no full-time active duty service. See Donnellan v. Shinseki, 24 Vet. App. 167, 172 (2010); Paulson v. Brown, 7 Vet. App. 466, 470 (1995). Thus, the appellant must establish that a disease or injury was incurred or aggravated during his period of ACDUTRA. The Board in October 2017 remanded the claim for a VA opinion to determine whether the appellant’s flat feet disorder preexisted service; if so, whether his flat feet disorder was aggravated by ACDUTRA; and if not, whether his flat feet disorder was caused by ACDUTRA. The Board directed the examiner to address the lay evidence of record, including the appellant’s and his longtime friend’s hearing testimony, that the appellant had no problems with his feet prior to service and that any notations that problems pre-existed service are incorrect. The appellant was afforded a January 2018 VA examination in which the examiner indicated it is at least as likely as not the appellant’s flat feet did pre-exist ACDUTRA. She opined there is clear evidence in the appellant’s service treatment records that his pes planus pre-existed service, as his service treatment records reported “the Veteran had pain in the arches of both feet all his life.” The examiner indicated there is no medical evidence to support that the appellant’s flat feet were caused by an injury incurred during ACDUTRA. Further, she opined the pre-existing disorder was not aggravated by his period of ACDUTRA. She noted a service treatment record form November 1973 reported the appellant was separated from service due to his painful feet. However, she stated, no other medical reports were found to support continuing bilateral foot pain or aggravation for the time immediately after service, until approximately 35 years later in 2008. Despite the January 2018 VA examination report, the Board finds an addendum opinion from the VA examiner is required. While she accurately addressed the appellant’s service treatment and personnel records, she did not adequately discuss the lay evidence of record as to the etiology of his flat feet. Specifically, the appellant has consistently asserted he had no problems with his feet prior to service and that any notations that problems pre-existed service are incorrect. He has indicated he experienced pain and swelling in his feet in his third week of ACDUTRA, after a 17-mile hike in his boots with a pack on his back and weapon in his hand. He stated that he was treated again in his sixth week of ACDUTRA after his feet were so swollen that he could not get his boots off. Moreover, his childhood friend similarly testified that he has known the appellant for 60 years and that the appellant did not have feet problems prior to service. Therefore, the Board requires medical clarification of the questions presented in the October 2017 Board remand to achieve substantial compliance with the remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The matter is REMANDED for the following action: Forward the claims file to the VA examiner who conducted the January 2018 VA foot examination to obtain an addendum opinion to address the nature and etiology of the appellant’s flat feet disorder. If this examiner is no longer available, forward the claims file to an appropriate medical profession for an addendum opinion. It is left to the examiner’s discretion whether to schedule the appellant for an examination. After a review of the entire claims file, the examiner should answer the following: (A) Whether it is at least as likely as not (a 50 percent or greater probability) that the appellant’s flat feet did not pre-exist ACDUTRA? (B) If thought to pre-exist, whether it is at least as likely as not (a 50 percent or greater probability) that the appellant’s flat feet were aggravated by an injury (or disease) during ACDUTRA, including activities related to training? Aggravation is an increase in disability beyond the natural progress of the disease or temporary flare-up. (C) If the flat feet disorder does not pre-exist ACDUTRA, whether it is at least as likely as not (50 percent or greater probability) that the appellant’s flat feet disorder was caused by an injury or disease during ACDUTRA? The lay evidence of record should be thoroughly discussed, including the August 2017 Board hearing testimony from the appellant and his friend. The examiner should provide a complete rationale for all opinions provided. RYAN T. KESSEL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. Isaacs, Associate Counsel