Citation Nr: 20002887 Decision Date: 01/13/20 Archive Date: 01/13/20 DOCKET NO. 15-18 532 DATE: January 13, 2020 REMANDED The claim for service connection for a left foot disorder is remanded. The claim for service connection for a right foot disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1959 to September 1968 and from August 1969 to February 1970. The Veteran testified before the undersigned Veterans Law Judge during an April 2018 Travel Board hearing. The transcript is of record. This appeal was remanded by the Board in July 2018 but for the reasons explained below, the Board finds the appeal must be remanded once again. Entitlement to service connection for right and left foot disorders. The Board remanded this appeal in July 2018, in pertinent part, for a VA examination and opinion. The Veteran was afforded a VA foot examination in September 2019. Unfortunately, the VA examiner did not address all of the Veteran’s foot diagnoses, nor did the opinion include adequate discussion of pes planus, which was noted on the Veteran’s 1959 entrance examination. Thus, another remand is required. Specifically, the September 2019 VA examiner did not address the Veteran’s degenerative joint disease in the first metatarsal joint and whether it might be related to service. The VA examiner recorded the Veteran’s report regarding participation in foot locker races in service and resulting foot injuries including stress fractures but did not address the medical journal article regarding the possibility that stress fractures may lead to chronic pain if they do not heal properly. This was significant as the service treatment records are positive for a diagnosis of stress fractures in both heels in September 1966. Although the Veteran’s service separation examination report noted normal feet in September 1968, the corresponding report of medical history, signed by a service clinician, noted the Veteran’s stress fracture on the right side. Additionally, the VA examiner based the negative opinion on the fact that the Veteran had not had continuity of care for the feet following service, but did not explain why such continuity of care was significant or necessary in order to demonstrate a nexus between the events in service and the current disabilities. Further, the examiner’s rationale did not appear to consider the Veteran’s sworn testimony that he had chronic foot problems since service with symptoms that varied in terms of severity, regardless of whether he sought medical treatment. See Transcript page 14. Further, the Board notes that outstanding service treatment records were obtained as a result of the July 2018 remand and those records raised additional questions regarding the current diagnosis of bilateral pes planus. Specifically, the August 1959 entrance examination contains the notation “pes planus, marked” which changes the nature of the question regarding service connection for pes planus. On remand, the examiner is asked to address whether pes planus, as a preexisting disability, worsened in disability during service, and if so, whether such was the result of the natural progression of the disease. For all of these reasons, a remand for another foot examination is required. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA foot examination to address whether the Veteran’s foot disorders are related to service. Following review of the entire electronic file, interview and examination of the Veteran, the examiner is asked to address the following. (a.) Identify all right and left foot disorders current at any time pertinent to the claim for service connection, including bunions, osteoarthritis, degenerative joint disease of the first metatarsal joints, hammertoes and soft tissue calcifications, and pes planus, all bilaterally. (See September 2012 VA X-ray, May 2018 private treatment record, and September 2019 VA examination report.) (b.) For each disorder identified, the examiner is asked to address whether it is at least as likely as not (i.e., 50 percent or greater probability) that the disability had its onset during active service, or is related to any in-service disease, event, or injury, to include the Veteran’s participation in foot locker races described above. Consider the medical journal article that the Veteran provided that indicates that stress fractures may cause chronic pain if they do not heal properly. Consider also the Veteran’s testimony that he experienced chronic foot problems that varied in terms of severity over time, depending on the types of activities he was doing and/or the weather. (c.) Notwithstanding the answers to the question above, with respect to pes planus, the examiner is asked to review the August 1959 entrance examination, and address the notation “pes planus, marked”. The examiner should opine as to whether it is at least as likely as not that a preexisting pes planus disability increased in disability during the Veteran’s period of active duty service from 1959 to 1968. If so, the examiner should also indicate whether it is clear and unmistakable (i.e., undebatable), that such increase was due to the natural progression of the disease. (d.) Complete rationale should be provided for all opinions rendered. 2. Then, readjudicate the issues on appeal. If any benefit sought on appeal remains denied, issue a supplemental statement of the case and allow the Veteran and his representative an appropriate period to respond. V. Chiappetta Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Donna D. Ebaugh, 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.