Citation Nr: 20025762 Decision Date: 04/15/20 Archive Date: 04/15/20 DOCKET NO. 11-32 483 DATE: April 15, 2020 REMANDED Entitlement to service connection for a cervical spine disability is remanded. Entitlement to service connection for a left ankle disability is remanded. Entitlement to service connection for a right ankle disability is remanded. Entitlement to service connection for a right heel disability is remanded. REASONS FOR REMAND The Veteran served in the United States Army from July 1982 to November 1982. Additionally, the Veteran served in the United States Air Force from February 1984 to June 1992, February 2003 to November 2003, and from May 2006 to November 2006. These matters come before the Board of Veterans’ Appeals (Board) on appeal from an August 2010 rating decision from the Roanoke, Virginia Regional Office (RO) for the Department of Veterans Affairs (VA). In April 2016, the Veteran testified at a Central Office hearing in Washington, DC before the undersigned Veterans Law Judge. A copy of the hearing transcript has been associated with the electronic claims filed. In September 2016, the Board remanded the Veteran’s claims for further development. Following the initial remand for examinations and opinions, the Board found that the opinions offered were inadequate and remanded the claims again in December 2017. After compliance with the associated remand directives, the case is back in front of the Board for further consideration. Although the Board regrets the delay, an additional remand is required in this case. 1. Cervical Spine The Veteran contends his recurrent neck pain and muscle spasms are related to service. He does not have a specific cause of his neck condition, but initially reported the neck pain in a March 1993 periodic examination. October 2013 treatment records provided by Kaiser Permanente show an X-ray reading interpreted as straightening of the cervical spine with mild spurring at C4, C5, and C6, moderate right-sided neural foramina narrowing at C3-C4 and C4-C5, as well as mild neural foraminal narrowing at C5-C6. The final impression was mild degenerative changes of the cervical spine. The July 2019 VA examination for Neck (Cervical Spine) Conditions and correlating opinion again did not address the October 2013 medical evidence. The Board finds the July 2019 medical opinion inadequate regarding the issue of service connection for a neck disability. Once VA undertakes to provide a VA examination, it must ensure that the examination is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Without further clarification, the Board is without medical expertise to determine the nature and etiology of the claimed disabilities. Colvin v. Derwinski, 1 Vet. App. at 171 (1991). In light of the above, the Board finds that an addendum opinion must be obtained for the claim of service connection for the neck. 2. Left Ankle 3. Right Ankle 4. Right Heel The Veteran contends he hurt his ankle and right heel while in in service. Specifically, from instances of playing softball and basketball. The Veteran’s service treatment records show a right heel contusion in April 1988 while playing softball. He was additionally treated for a right ankle sprain and found to have mild swelling and bruising posterior to the lateral malleolus. The Veteran again twisted his ankle in August 1991 while playing basketball. June 2016 treatment records from his private orthopedic and sports medicine provider indicate diagnoses for primary osteoarthritis of both ankles and feet. He was prescribed bilateral custom foot orthotics with metatarsal pads. Imaging of the ankle from November 2016 additionally shows subtle irregularity and small spur at the left medial malleolus, likely sequela of a prior injury. The July 2019 VA examinations for Foot Conditions, including Flatfoot (Pes Planus) and for Ankle Conditions, with their correlating opinions, once again did not address the June 2016 medical evidence. The Board finds the July 2019 medical opinions inadequate regarding the issues of service connection for a bilateral ankle disability and right heel disability. Once VA undertakes to provide a VA examination, it must ensure that the examination is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Without further clarification, the Board is without medical expertise to determine the nature and etiology of the claimed disabilities. Colvin v. Derwinski, 1 Vet. App. at 171 (1991). In light of the above, the Board finds that addendum opinions must be obtained for the claims of service connection for the ankles and right heel. The matters are REMANDED for the following action: 1. Arrange to obtain an addendum medical opinion by the VA examiner who examined the Veteran in July 2019 in connection with his claim for service connection for his neck disability. If that individual is not available, document that fact in the record, and arrange to obtain an addendum opinion from an appropriate physician based on claims file review (if possible). Only arrange for the Veteran to undergo examination if one is deemed necessary in the judgment of the physician designated to provide the addendum opinion. The contents of the entire election claims file, to include a complete copy of this remand, must be made available to the designated individual, and the addendum opinion/examination report should reflect consideration of the Veteran’s documented medical history and assertations. The appropriate examiner must offer an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the current condition of neck pain and mild degenerative changes is related to the Veteran’s time in service. Even if there is no current pathology or diagnosis, the examiner must express an opinion as to whether the prior October 2013 diagnosis of mild degenerative changes of the cervical spine was related to service. In offering the opinion, the examiner is asked to specifically comment on the Veteran’s March 1993 complaint of neck pain in his service treatment records. A rationale for all opinions offered is requested as the Board is precluded from making any medical findings. The examiner is reminded that merely stating that it is his or her opinion that the neck disability is or is not connected to service is not sufficient. 2. Arrange to obtain an addendum medical opinion by the VA examiner who examined the Veteran in July 2019 in connection with his claim for service connection for bilateral ankle disability. If that individual is not available, document that fact in the record, and arrange to obtain an addendum opinion from an appropriate physician based on claims file review (if possible). Only arrange for the Veteran to undergo examination if one is deemed necessary in the judgment of the physician designated to provide the addendum opinion. The contents of the entire election claims file, to include a complete copy of this remand, must be made available to the designated individual, and the addendum opinion/examination report should reflect consideration of the Veteran’s documented medical history and assertations. The appropriate examiner must offer an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the current condition of bilateral ankle disability is related to the Veteran’s time in service. Even if there is no current pathology, the examiner must discuss whether the prior diagnosis in June 2016 private treatment records indicating a diagnosis of primary osteoarthritis of both ankles and feet was at least as likely as not related to service. In offering the opinion, the examiner is asked to specifically comment on the Veteran’s August 1991 treatment for a sprained ankle. A rationale for all opinions offered is requested as the Board is precluded from making any medical findings. The examiner is reminded that merely stating that it is his or her opinion that the bilateral ankle disability is or is not connected to service is not sufficient. 3. Arrange to obtain an addendum medical opinion by the VA examiner who examined the Veteran in July 2019 in connection with his claim for service connection for right heel disability. If that individual is not available, document that fact in the record, and arrange to obtain an addendum opinion from an appropriate physician based on claims file review (if possible). Only arrange for the Veteran to undergo examination if one is deemed necessary in the judgment of the physician designated to provide the addendum opinion. The contents of the entire election claims file, to include a complete copy of this remand, must be made available to the designated individual, and the addendum opinion/examination report should reflect consideration of the Veteran’s documented medical history and assertations. The appropriate examiner must offer an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the current condition of right heel disability is related to the Veteran’s time in service. Even if there is no current pathology or diagnosis the examiner must specifically comment on the Veteran’s April 1988 right heel contusion and the June 2016 private treatment records indicating primary osteoarthritis of both feet, specially addressing whether those prior diagnoses are related to service. A rationale for all opinions offered is requested as the Board is precluded from making any medical findings. The examiner is reminded that merely stating that it is his or her opinion that the right heel disability is or is not connected to service is not sufficient. H. SEESEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Department of Veterans Affairs 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.