Citation Nr: 19127167 Decision Date: 04/09/19 Archive Date: 04/08/19 DOCKET NO. 13-27 355 DATE: April 9, 2019 REMANDED Entitlement to service connection for bilateral shin splints is remanded. Entitlement to service connection for a bilateral foot disability is remanded. REASONS FOR REMAND The Veteran, who is the appellant, had active service from May 2003 to June 2008. This matter was previously before the Board in November 2017. At that time, the Board noted that regarding the Veteran’s bilateral foot disability, the service treatment records reflected that the Veteran reported complaints of bilateral foot pain in March 2004 and was diagnosed with plantar fasciitis. The Board observed that the Veteran reported bilateral foot pain again in December 2006 and imaging studies reflected mild bilateral pes planus, right greater than left. The Board also noted that the Veteran reported complaints of bilateral foot pain lasting two months in November 2007 and stated that his feet had hurt his entire career. At that time, the Veteran was diagnosed with bilateral foot pain, probable arthritis. The Board currently observes that on his May 2008 report of medical history, the Veteran reported having foot pain. The Veteran reported that his feet hurt all the time, especially in the morning when he woke up. In the comments section of the report, the examiner indicated that the Veteran had plantar pain, especially early in the morning. In a May 2008 Report of Medical Assessment, the Veteran was diagnosed as having plantar fasciitis. At the time of his June 2008 service separation examination, the Veteran was again diagnosed as having plantar fasciitis. The Veteran was scheduled for a VA examination to determine the etiology of any current foot disorder and its relationship, if any, to his period of service. A VA examination was performed in March 2018. At that time, the examiner rendered a diagnosis of plantar fasciitis. An opinion was prepared in conjunction with the examination. In the opinion, the examiner indicated that the Veteran’s claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. As rationale, the examiner stated that a review of the Veteran’s STRs revealed that he was seen and evaluated for bilateral foot pain in November 2007, diagnosed with bilateral foot pain/probably arthritis and treated with Naprosyn and stretching. He noted that a review of the Veteran’s VAMC records revealed that he was seen and examined for foot pain from 2010 through 2017, diagnosed with foot pain and acute gouty arthritis, and treated with activity mods, NSAIDs, and colchicine. He further observed that the Veteran was noted to have bilateral ankle pain, foot pain, knee pain and shin splints at the time of a November 2010 VA examination. He stated that there was evidence of a foot condition in 2007 and 2010, however documentation from 2011 through 2017 noted that the Veteran’s foot pain was secondary to gouty flairs, which responded to colchicine and NSAIDs. Thus, it was more likely that the Veteran’s current bilateral foot condition was secondary to his gout and less likely secondary to injuries or events sustained during his military service. Although the Board notes that the required actions were performed with regard to the remand requests, the Board observes that the examiner, in his rationale, did not address the complaints and findings made at the time of the Veteran’s May 2008 and June 2008 examinations. As noted above, on his May 2008 report of medical history, the Veteran reported having foot pain and that his feet hurt all the time, especially in the morning when he woke up. Moreover, in the comments section of the report, the examiner indicated that the Veteran had plantar pain, especially early in the morning. Furthermore, in the May 2008 Report of Medical Assessment and at the time of his June 2008 service separation examination, the Veteran was diagnosed as having plantar fasciitis, which he has been currently diagnosed as having. In addition, the Veteran reported having foot pain on his initial application for compensation. Given the foregoing, a supplemental opinion addressing the additional inservice findings, the Veteran’s reports of continuity of symptoms, and the relationship, if any, between the current diagnosis of plantar fasciitis and service, is warranted. As to the claim of service connection for shin splints, the Board notes that in the prior remand, it was indicated that the Veteran’s service treatment records reflected that he reported complaints of shin splints or shin pain in August 2003, January 2004, and July 2004. On his initial application for compensation, the Veteran again noted having shin splints. The Veteran also reported having shin splints at the time of his November 2010 VA examination, with a history of shin splints being noted. In conjunction with the November 2017 remand, the Veteran was afforded a VA examination in March 2018, with an opinion being rendered at that time. At the time of the examination, the examiner rendered a diagnosis of bilateral shin splints, date of diagnosis of 2018. In the examination portion, the examiner checked the “yes” box when asked if the Veteran had shin splints. In the March 2018 opinion report, the examiner indicated that the claimed condition was less likely than not incurred in or caused by the claimed inservice injury, event, or illness. As rationale, the examiner indicated that there was insufficient evidence to support that the Veteran developed bilateral shin splints during his military service that became an ongoing concern requiring evaluation and treatment by medical providers. Specifically, he noted that the Veteran’s medical records were silent for evaluation and treatment for shin splints from 2010 to the present time. Further, he stated that the Veteran was not able to engage in high impact activities due to his many medical conditions and thus did not currently experience symptoms secondary to shin splints. Thus, it was less likely than not that the Veteran had bilateral shin splints which were incurred or caused by in service injuries or events. While the Board notes that the remand directives were complied with in that an examination was performed and an opinion was obtained, the rationale supplied is inconsistent with the examination findings. In the opinion, the examiner specifically indicated that the Veteran does not have shin splints, however, in the examination report, the examiner specifically stated that the Veteran currently has shin splints. Such reports are inconsistent and warrant further clarification. The matters are REMANDED for the following actions: 1. Undertake appropriate development to obtain all outstanding VA and/or private treatment records related to the Veteran's outstanding claims. If any requested records are not available, the record should be annotated to reflect such and the Veteran notified. 2. Return the claims file to the VA examiner who performed the Veteran's March 2018 foot and shin splint examinations for a supplemental opinion. The examiner is requested to provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that any current foot or shin splint disability is related to active service, to include any duties which the Veteran performed in service. The examiner must provide a comprehensive report including complete rationales for all conclusions reached. As to the foot disability, the examiner must also discuss the findings of plantar fasciitis during service, the Veteran’s reports of continuity since service, including on the initial application for benefits, and the current findings of plantar fasciitis. As to any shin splint disability, the examiner must discuss the findings of shin splints during service; the Veteran’s reports of continuity since service, including on his initial application; and reconcile the difference between the diagnoses of shin splints at the time of the March 2018 examination and the examiner’s notation in the rationale section of the medical opinion that the Veteran does not currently have shin splints. Complete detailed rationale is requested for each opinion that is rendered. K. PARAKKAL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. S. Kelly, Counsel