Citation Nr: 20006071 Decision Date: 01/28/20 Archive Date: 01/24/20 DOCKET NO. 18-29 546 DATE: January 28, 2020 REMANDED Service connection for right foot hammertoes is remanded. Service connection for left foot hammertoes is remanded. Service connection for right foot hallux rigidus and hallux valgus is remanded. Service connection for left foot hallux rigidus and hallux valgus is remanded. Service connection for a right lower extremity, tarsal tunnel syndrome is remanded. Service connection for a left lower extremity, tarsal tunnel syndrome is remanded Service connection for right foot metatarsalgia is remanded. Service connection for left foot metatarsalgia is remanded REASONS FOR REMAND The Veteran served on active duty from September 1987 to September 1995. He is seeking service connection for hammertoes of the left and right foot, great toe hallux rigidus and hallux valgus of the right and left foot, tarsal tunnel syndrome of the left and right lower extremity, metatarsalgia of the left and right foot, asserting in 2016 that they were secondary to his service-connected pes planus (rated at 30 percent). The Veteran’s service treatment records are silent for complaints or diagnosis relating to hammertoes, hallux rigidus or hallux valgus, tarsal tunnel syndrome, or metatarsalgia. However, the Veteran stated in a May 2018 statement that he began experiencing an array of bilateral foot and toe problems, including chronic pain, numbness, tingling, while he was in service. He was treated with orthotics and other medication to ease his symptoms of metatarsal issues and hallux valgus. He asserted that the pain started in 1991 and had continued ever since. It is his contention that his diagnosed conditions of bilateral hallux valgus, hallux rigidus, metatarsalgia, tarsal tunnel syndrome, and hammer toes were either caused and/or aggravated by his service-connected pes planus. Post service, the Veteran was diagnosed with inducted tarsal tunnel syndrome bilaterally in 2012. He was later found to have developed hammertoes, hallux valgus, hallux rigidus, and metatarsalgia in January 2014. When the Veteran was afforded a VA examination to determine the etiology of his conditions, the December 2016 VA examiner found that the conditions were less likely than not to be related to his military service. The examiner also found that the Veteran’s bilateral hammer toes, metatarsalgia, hallux vulgus/hallux rigidus, and tarsal tunnel syndrome were all less likely than not to be related to his service-connected bilateral pes planus. The examiner explained that upon reviewing the Veteran’s claims file, he found no documentation of metatarsalgia, hammer toes, tarsal tunnel syndrome, or hallux valgus during service and that the conditions did not develop until approximately 20 years after service. The Board now finds that December 2016 VA examination report is inadequate as it failed to provide sufficient rationale to explain the negative nexus between the Veteran’s current disabilities and his service-connected pes planus. The examiner also did not address aggravation. Therefore, the claims must be remanded to obtain an addendum opinion. The matters are REMANDED for the following action: 1. Obtain an addendum medical opinion to determine the etiology of the Veteran’s bilateral hammer toes, metatarsalgia, hallux vulgus/hallux rigidus, and tarsal tunnel syndrome. For each of the conditions, the examiner is asked to address the following: a) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s bilateral hammer toes, metatarsalgia, hallux vulgus/hallux rigidus, and/or tarsal tunnel syndrome had onset in or was otherwise related to his military service? Why or why not? (The examiner should consider the Veteran’s March 2018 letter in which the he discusses in-service symptoms.) b) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s bilateral hammer toes, metatarsalgia, hallux vulgus/hallux rigidus, and/or tarsal tunnel syndrome was caused by his service-connected bilateral pes planus? Why or why not? c) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s bilateral hammer toes, metatarsalgia, hallux vulgus/hallux rigidus, and or tarsal tunnel syndrome were aggravated (made worse) by his service-connected bilateral pes planus? Why or why not? MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. Yeh, 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.