Citation Nr: 21000207 Decision Date: 01/04/21 Archive Date: 01/04/21 DOCKET NO. 16-55 831 DATE: January 4, 2021 REMANDED Entitlement to service connection for bilateral hallux valgus, as secondary to service-connected bilateral plantar fasciitis and left retro patellar pain syndrome (left knee condition), is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from July 1982 to September 1988. In June 2020, the Board of Veterans’ Appeals (Board) remanded the issue of entitlement to service connection for bilateral hallux valgus for further development. Specifically, the Board instructed the regional office (RO) to schedule the Veteran for a VA examination pertaining to his claims. Upon review of the record, the Board finds that the claim must be remanded. The Board sincerely regrets the additional delay caused by this remand, particularly as this matter has been the subject of a prior remand, but wishes to assure the Veteran that it is necessary for a full and fair adjudication of his claim. Bilateral hallux valgus The Board finds that a new examination and etiological opinion are warranted for the Veteran’s claim. The Veteran contends that his bilateral hallux valgus is secondary to his service-connected bilateral plantar fasciitis and his left knee condition. The Veteran underwent a VA examination in August 2020, in which the examiner opined that the Veteran’s bilateral hallus valgus was less likely than not proximately due to or the result of the Veteran’s bilateral plantar fasciitis and left knee condition. In support of her opinion, she explained that the conditions are not medically related as the bilateral hallus valgus is an entirely separate entity from the service-connected conditions and that a thorough review of medical literature failed to demonstrate a causal relationship. The Board finds the August 2020 examination and opinion to be inadequate. In particular, in determining that, because they are separate entities, the Veteran’s hallux valgus was unrelated to the Veteran’s service-connected plantar fasciitis or knee condition, the examiner did not address the Veteran’s contention that an altered gait starting in the 1980s from his service-connected conditions led to his hallux valgus. See Aug. 2020 VA Examination at 4. Instead, the examiner relied only on the absence of medical literature without discussing the facts of the case. See Bailey v. O’Rourke, 30 Vet. App. 54, 60 (2018) (a medical opinion that relies on the absence of general medical literature supporting nexus without discussing the specific facts of the case is inadequate); Barr v. Nicholson, 21 Vet. App. 303, 311 (2007); Stefl v. Nicholson, 21 Vet. App. 120, 123-24 (2007). Accordingly, remand for a new examination to address the etiology of the Veteran’s bilateral hallus valgus is warranted. The matters are REMANDED for the following action: 1. Assist the Veteran in associating with the claims file updated treatment records. 2. Schedule the Veteran for a VA examination with an appropriate examiner to determine the nature and etiology of the Veteran’s bilateral hallux valgus. The claims file should be made available to the examiner for review in connection with the examination. Based on review of the record and conducting an examination of the Veteran, the examiner should respond to the following: (a.) The examiner should state whether it is at least as likely as not (i.e., at least a 50 percent probability) that the Veteran’s bilateral hallus valgus was caused or aggravated by the Veteran’s service-connected bilateral plantar fasciitis and left knee condition. AN OPINION AS TO BOTH CAUSATION AND AGGRAVATION IS REQUESTED. The examiner must discuss the Veteran’s theory that he began to alter his gait in the 1980’s due to his service-connected plantar fasciitis and left knee condition which led to his hallux valgus. (b.) If the examiner finds that the Veteran’s bilateral hallus valgus was aggravated by his service-connected plantar fasciitis and/or left knee condition, then he/she should specify the baseline level of disability of the bilateral hallus valgus prior to aggravation due to the service-connected plantar fasciitis and left knee condition.  Note that aggravation means any incremental increase in disability in the non-service-connected connection (i.e., any additional impairment of earning capacity) resulting from the service-connected condition. The Board recognizes the practical difficulties of scheduling an examination in view of the COVID-19 epidemic and requests flexibility and understanding in affording the Veteran an opportunity for an examination. If an in-person examination cannot be provided, consider other appropriate alternatives, such as a telehealth examination. The examiner must provide the rationale for all proffered opinions. If the examiner is unable to provide any required opinion, he or she should explain why. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation as to why this is so. If the inability to provide a more definitive opinion is the result of a need for additional information, the examiner should identify the additional information that is needed. A. S. CARACCIOLO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. L. Park, 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.