Citation Nr: 20007445 Decision Date: 01/29/20 Archive Date: 01/29/20 DOCKET NO. 19-06 142A DATE: January 29, 2020 REMANDED Entitlement to service connection for a low back disability, to include as secondary to service-connected bilateral plantar fasciitis, is remanded. REASONS FOR REMAND The Veteran had active military service from September 1977 to May 1983. This matter came before the Board of Veterans’ Appeals (Board) on appeal from a February 2018 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The issues of entitlement to service connection for bilateral pes planus, talonavicular joint collapse, and bilateral knee disability; and entitlement to an initial increased rating for service-connected bilateral plantar fasciitis were addressed in a separate January 2010 Board decision. 1. Entitlement to service connection for a low back disability, to include as secondary to service-connected bilateral plantar fasciitis, is remanded. The Board’s review of the claims file reveals that further action on the claim of entitlement to service connection for a low back disability is needed. At the outset, the Board notes that the Veteran has a current diagnosis of a low back pain, degenerative arthritis of the spine, and lumbar radiculopathy. See November 2018 C&P Exam and April 2019 CAPRI. A review of the service treatment records shows that in February 1978 the Veteran complained of back pain after falling on a trampoline. See September 2011 STR – Medical. The Veteran was noted to have spasms, but an x-ray scan of the low back revealed no acute disease, no fracture, and normal alignment. The Veteran was afforded a VA examination in November 2018. The Veteran reported that his condition began when he fell off a ladder ten feet high in 2016. The Veteran stated that his condition worsened over time. The examiner diagnosed the Veteran with degenerative arthritis of the spine and opined that the Veteran’s low back disability is less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner explained that the May 2013 and October 2011 radiology records show that there is no talonavicular collapse and only small congenital arches which may aggravate plantar fasciitis. However, there is nothing found in a thorough literature search that suggests that this condition causes arthritis of the spine or degenerative disc disease of the spine. As such, the examiner concluded that the Veteran’s low back disability is most likely due to the wear and tear condition of heavy work over a long period of time as a construction worker. In contrast, the Veteran submitted various articles about the impact that feet disability has on back pain. See March 2019 Medical Treatment Record – Non-Government Facility. Additionally, the Veteran submitted an article that found that soft tissue injury is a connective tissue disorder that has permanent negative sequela and is the cause of future arthritis. See November 2019 Correspondence. The Board finds that the November 2019 examiner did not address. Additionally, the examiner did not explain the impact, if any, that the February 1978 fall had on the Veteran’s low back disability. Furthermore, the Board notes that the Veteran submitted various articles that have not been considered by the examiner. As such, a remand is warranted. The matter is REMANDED for the following action: Obtain an addendum to the November 2018 VA examination from an appropriately qualified examiner to determine the nature and etiology of any low back disability. The claims file, including a copy of this remand, must be made available to be reviewed by the examiner. The examiner must provide an opinion as to whether it is at least as likely as not (50 percent probability or more) that the low back disability had its onset in service or is otherwise etiologically related to service. The examiner should address the February 1978 ladder/trampoline incident. The examiner should also discuss the medical literature associated with the file regarding soft tissue injury. See November 2019 Correspondence. Then, the examiner must state whether it is at least as likely as not (a fifty percent probability or greater) that the Veteran’s low back disability was (a) caused by or has been (b) aggravated (worsened beyond the natural progress of the disorder) by his service-connected bilateral plantar fasciitis. The examiner should address the medical literature associated with the file regarding deformities in the lower extremity and/or feet and its impact on back pain. See March 2019 Medical Treatment Record – Non-Government Facility. If aggravation is found, identify to the extent possible the baseline level of disability prior to the aggravation and determine what degree of additional impairment is attributable to the service-connected disability. (Continued on the next page)   A detailed rationale for the opinion must be provided. S. HENEKS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board P. Noh, 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.