Citation Nr: 20043729 Decision Date: 06/29/20 Archive Date: 06/29/20 DOCKET NO. 15-32 170 DATE: June 29, 2020 REMANDED Entitlement to service connection for pes planus, plantar fasciitis, hallux limitus right, plantar spurs bilateral, degenerative joint disease (DJD) first metatarsophalangeal (MTP) right, and metatarsal cuneiform exostosis is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) to include extraschedular consideration is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1960 to February 1963. In his August 2015 Substantive Appeal, the Veteran requested a Board hearing. In October 2015, the Veteran confirmed his desire to have a Board hearing. However, in November 2015, he withdrew his request for a hearing. 38 C.F.R. § 20.704(e). In February 2017, the Board remanded the claim for entitlement to service connection for bilateral foot disability for further development. In December 2017, the Board remanded the claim for entitlement to service connection for bilateral foot disability and TDIU for further development. The Veteran has been diagnosed with pes planus, plantar fasciitis, hallux limitus right, plantar spurs bilateral, DJD first MTP right, and metatarsal cuneiform exostosis. The Veteran contends that his bilateral foot disabilities had their onset in service or, in the case of pes planus, was aggravated by service. The record reflects that the Veteran’s bilateral pes planus was noted on his entrance exam. Thus, a claim of service connection for bilateral pes planus will be considered on the basis of aggravation of a pre-existing disability. 38 U.S.C. § 1153; 38 C.F.R. § 3.306. Regarding his pes planus, in his September 2017 Correspondence, the Veteran stated in the spring of 1960, he was involved in an exercise in full combat uniform. He stated that he jumped over obstacles and tripped on a big object. He experienced excruciating pain. At the time of the accident, he was wearing World War II brown combat boots that did not contain metal sole plates nor arch supports. He stated if his condition pre-existed service, his training and/or military wear aggravated his condition. In April 2014, the Veteran was afforded a VA examination to determine the nature and etiology of his bilateral foot disability. The examiner diagnosed the Veteran with pes planus. The examiner provided an opinion and rationale; however, in a February 2017 Board decision, the Board determined that the examination was inadequate because the examiner failed to take into account the Veteran’s lay statements about his symptoms and injuries. The Board also stated that the examiner failed to consider the Veteran’s post-service treatment records, which include foot-related diagnoses other than pes planus. The Board remanded the claim for a new VA examination. In May 2017, the Veteran was afforded another VA examination to determine the nature and etiology of his bilateral foot disabilities. The examiner confirmed the Veteran’s pes planus diagnosis and diagnosed the Veteran with plantar fasciitis. The examiner provided an opinion and rationale; however, in January 2019, the agency of original jurisdiction (AOJ) obtained an addendum opinion from the examiner. The examiner was asked to identify all current foot disorder(s) other than pes planus and plantar fasciitis that had been present since service, including consideration of the diagnoses of paresthesias, calcaneal valgus, hallux rigidus, and degenerative joint disease and cuneiform joints. In her 2019 opinion, the examiner stated that the Veteran’s diagnoses of hallux limitus right, plantar spurs bilateral, DJD first MTP right, and metatarsal cuneiform exostosis were all progression of the Veteran’s service-connected pes planus. However, in January 7, 2020, the AOJ determined that the January 2019 opinion was not complete or adequate because the examiner’s rationale indicated that the bilateral foot disabilities, other than pes planus and plantar fasciitis, were secondary or aggravated by pes planus; however, the AOJ noted that the Veteran was not service connected for pes planus. On January 21, 2020, the AOJ obtained another opinion. The VA examiner noted that in 2004, the Veteran was only diagnosed with flatfeet and onychomycosis, and it was not until the 2006 x-rays revealed bilateral calcaneal spurs and DJD of the first metatarsals. However, the Board notes that by November 2004, the Veteran had already been diagnosed with hallux rigidus, calcaneal spurs, degenerative arthritis of the first MP joint, metatarsal cuneiform exostosis b/1 and onychomycosis, and hallux rigidus. As it appears that the VA examiner failed to consider all of the Veteran’s post-service treatment records, the Board finds the examination is inadequate. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Consideration of entitlement to TDIU is dependent upon the impact of the Veteran’s service-connected disabilities on his ability to obtain or retain substantially gainful employment. Accordingly, the matter of a TDIU is inextricably intertwined with the Veteran’s claim for service-connection for bilateral foot disabilities. Harris v. Derwinski, 1 Vet. App. 180 (1991). Remand of the inextricably intertwined TDIU claim is therefore required. The matters are REMANDED for the following action: 1. Obtain and associate with the claims file any updated VA and private treatment records not already of record. 2. Schedule the Veteran a new VA examination with an appropriate examiner, if possible, other than the examiners who conducted the May 2017/January 2019 and 2020 VA examinations, to determine the etiology of the Veteran’s bilateral foot disabilities, to include pes planus, plantar fasciitis, paresthesias, hallux limitus right, plantar spurs bilateral, DJD first MTP right, and metatarsal cuneiform exostosis. The entire claims file must be made available to and be reviewed by the examiner. Any indicated tests and studies must be conducted. Based on a review of the entire record, the examiner should respond to the following: i. Identify any foot disorder that has been present during the period on appeal. The examiner should specifically account for the presence or absence of each of the foot disabilities identified above. ii. Determine if it is at least as likely as not (a 50 percent or greater probability) that any diagnosed foot disorder had its onset during active service or is otherwise related to the Veteran’s military service. iii. With respect to any diagnosed bilateral pes planus, the examiner is asked to opine whether the Veteran’s pes planus, which was noted on entry, underwent an increase in severity beyond the natural progression of the disability in service. If the physician determines that there was an increase in the severity of any pre-existing disorder during service, the physician should offer an opinion as to whether such increase was clearly and unmistakably due to the natural progression of the disease. In rendering an opinion, the examiner must specifically comment on the Veteran’s statements that his military gear and/or military training aggravated his condition. The supporting rationale for all opinions expressed must be provided. If the examiner is unable to provide the required opinion, he or she should explain why the required opinion cannot be provided. Additionally, the examiner must address any conflicting medical evidence of record. 3. After completing the above development, and any other development deemed necessary, readjudicate the issues on appeal. If the benefits sought on appeal remain denied, furnish the Veteran and his representative a Supplemental Statement of the Case and afford them the opportunity to respond. MICHAEL LANE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Moore 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.