Citation Nr: 21001438 Decision Date: 01/08/21 Archive Date: 01/08/21 DOCKET NO. 12-33 493A DATE: January 8, 2021 REMANDED Service connection for a left foot condition, to include traumatic arthritis.   REASONS FOR REMAND The Veteran had active service from July 1972 to June 1976 and from October 1990 to March 1991. He served in Southwest Asia from October 1990 to March 1991. He also had service in the Reserve. This matter is on appeal from a May 2010 rating decision. The Veteran testified before the undersigned Veterans Law Judge in a videoconference hearing from the RO in June 2017. Most recently, in an August 2020 decision, the Board granted service connection for kidney cancer. The Board also denied six other issues. At that time, the Board remanded the left foot claim for additional development. Service connection for a left foot condition, to include traumatic arthritis. This issue is remanded as there was not substantial compliance with the Board’s prior remand in August 2020. The Board remanded for a VA opinion addressing whether a current diagnosis, particularly gout and left heel spur, was related to service. The Board directed the examiner to address whether “any diagnosed disorder—or functional impairment associated with the left foot—had its onset directly during the Veteran’s service or is otherwise causally related to any event or circumstance of his service.” (Emphasis added.) Upon remand, a VA examiner in September 2020 reviewed the Veteran’s case and concluded that the Veteran’s condition was less likely than not related to service. The examiner spent the majority of the opinion explaining why the evidence did not support a diagnosis of traumatic arthritis. With regard to etiology, the VA examiner opined that “there is NO current ARTHRITIC foot condition that is due to or had onset during military service.” (All CAPS in original.) With regard to the other diagnoses, the VA examiner also explained why the heel spur or gout were not consistent with an undiagnosed illness or medically unexplained chronic multisymptom illnesses (MUCMI). However, the examiner did not address whether either diagnosis may have had its direct onset during service or otherwise be related to service, as asked by the Board. Rather, the VA examiner explained that heel spurs occur when calcium deposits build up on the underside of the heel bone, but can also be caused by strains on foot muscles and ligaments, stretching of the plantar fascia. Regarding gout, the examiner explained that the etiology is hyperuricemia or when uric acid deposits build up in the body/joints. To this end, the examiner’s explanation tends to include some supporting evidence. The examiner stated that heel spurs can be caused by strain on the foot muscles and ligaments. On this point, the Veteran maintains that he injured the left foot when he hit the side of his ankle, causing an inverted sprain, while parachuting. Board Hr’g Tr. 24. The Veteran’s service records confirm the he was awarded the Parachutist Badge. According to a June 1992 certificate, the Veteran completed the Airborne Course. He submitted jump records showing jumps throughout 2002. The service treatment records (STRs) do not confirm a left foot injury. The STRs show, however, that he was put on profile in August 2003 for left leg inverted sprain. No details were provider, and there are no other STRs reflecting treatment for this injury. The Air Force Base at which this injury occurred informed the RO in February 2009 that it had no records on file for the Veteran. However, the medical records show that a private x-ray of the left ankle, tibia and fibula was taken in March 2003. The x-ray report does not state why the x-ray was taken other than to note “trauma.” The results showed no acute osseous abnormalities found. He had follow-up treatment with a private provider approximately 14 days later, which noted he had fallen on the left lower leg and had a left ankle sprain. This evidence does not confirm the claimed parachute injury. However, the Board has already found the Veteran’s testimony to be competent and credible evidence of the injury, especially as it is consistent with the official service department evidence, including the August 2003 profile. Taken together, the September 2020 VA examiner’s opinion identified strain on the foot muscles and ligaments as a potentially etiology of heel spurs. The Veteran’s service was consistent with strains on the foot due to parachute jumping, including an injury in August 2003. The VA examiner did not specifically address whether there was a connection between the two. The Board, in its lay capacity, cannot infer that the examiner intended to imply a positive nexus. Rather, the examiner was silent on this question. The examiner’s opinion otherwise answers the questions posed by the Board. But, without an opinion as to heel spurs and gout, the opinion is not compliant with the Board’s remand. Because there has not been substantial compliance with the Board’s previous remand directives, another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). The matters are REMANDED for the following action: Obtain an opinion from an appropriate clinician regarding the Veteran’s left foot. An in-person examination of the Veteran should be arranged if determined necessary by the appointed examiner. The examiner is asked to address whether gout and/or heel spurs at least as likely as not had its onset directly during the Veteran’s service or is otherwise causally related to any event or circumstance of his service. In answering this question, the examiner should refer to the prior VA opinion in September 2020 indicating that heel spurs can be caused by strains on foot muscles and ligaments. The examiner should address whether the Veteran’s heel spurs are related to strain placed on the foot from parachute jumps, including an injury while parachuting. The examiner is asked to consider the statements from the Veteran indicating symptoms starting from service. The examiner is asked to explain why his statements make it more or less likely that a current condition started during service. If indicated, it should be explained whether there is a **medical** reason to believe that the Veteran’s recollection of his symptoms during and after service may be inaccurate or not medically supported as the onset or cause of his current diagnosis. The examiner should not rely on silence in the medical records unless it can be explained: (a) why the silence in the available records can be taken as proof that the symptom(s) did not occur, including why the fact would have normally been recorded if present, or (b) why the absence of medical records is medically significant. RYAN T. KESSEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Bosely, 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.