Citation Nr: 21002627 Decision Date: 01/14/21 Archive Date: 01/14/21 DOCKET NO. 11-06 514 DATE: January 14, 2021 REMANDED Entitlement to service connection for a right foot disorder is remanded. Entitlement to service connection for a left foot disorder is remanded. Entitlement to service connection for a right ankle disorder is remanded. Entitlement to service connection for a left ankle disorder is remanded. Entitlement to service connection for a right knee disorder is remanded. REASONS FOR REMAND The Veteran had active service from February 1978 to April 1980. These matters are on appeal from a March 2010 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. In October 2014, the Veteran testified at a Travel Board hearing held before the undersigned. A transcript of the proceeding is associated with the record. In January 2015 and May 2017, the Board remanded the appeal to the Agency of Original Jurisdiction (AOJ) for additional evidentiary development. In May 2017, the Board found the May 2016 VA medical opinion to be inadequate and remanded the appeal to obtain adequate medical opinions to address whether the Veteran’s disabilities clearly and unmistakably preexisted his active service and clearly and unmistakably were not aggravated beyond the natural progress of the disease by such service. In July 2018, the AOJ issued a supplemental statement of the case (SSOC) and included the issue of entitlement to service connection for a left knee injury. However, service connection for a left knee injury is not on appeal. In the October 2012 VA Form 9, the Veteran limited his appeal to the right knee. In January 2015 and May 2017, the Board limited its decisions to the right knee. In response to the July 2018 SSOC, the Veteran has not provided argument in support of a left knee injury. Thus, the Board finds that the inclusion of the left knee in the July 2018 supplemental statement of the case was an error and this issue is not currently before the Board on appeal. 1. Entitlement to service connection for a right foot disorder is remanded. 2. Entitlement to service connection for a left foot disorder is remanded. The Veteran testified that his doctor told him that his bilateral foot disabilities were caused by his in-service motor vehicle accident. The Veteran also argued that his preexisting bilateral pes planus was aggravated beyond its natural progression by being on his feet for prolonged periods of time during active service. In December 2017, VA obtained an addendum opinion to address the etiology of the Veteran’s disorders of the bilateral feet. The VA examiner diagnosed gout of the bilateral feet and pes planus of the bilateral feet. He opined that there was clear and unmistakable evidence that the Veteran’s bilateral pes planus preexisted service and provided adequate rationale for this portion of the opinion. However, the VA examiner did not provide adequate rationale regarding whether the Veteran’s bilateral pes planus was clearly and unmistakably not aggravated beyond its natural progress during his active service. The opinion does not address the Veteran’s in-service motor vehicle accident or his contention that his bilateral pes planus was aggravated by being on his feet for prolonged periods of time during active service. The VA examiner did not provide an etiological opinion regarding the Veteran’s gout. A remand is required to obtain adequate opinions regarding the etiology of the Veteran’s disorders of the bilateral feet. For the purposes of the opinion, the Board finds that the Veteran’s gout did not preexist the Veteran’s period of active service. Upon remand, another VA medical opinion must be obtained. 3. Entitlement to service connection for a right ankle disorder is remanded. 4. Entitlement to service connection for a left ankle disorder is remanded. The Veteran testified that he was told by a doctor that his bilateral ankle disabilities were caused by his in-service motor vehicle accident. In December 2017, the VA examiner stated that the Veteran entered service with traumatic arthropathy of the left ankle status post motor vehicle accident. This is factually incorrect. The Veteran was involved in a motor vehicle accident in January 1978 during his period of active service. The VA examiner also indicated that the Veteran had gout of the bilateral ankles. Based upon the forgoing, the Board finds that the presumption of soundness has not been rebutted regarding any of the Veteran’s bilateral ankle disabilities. The VA examiner did not provide an etiological opinion regarding the Veteran’s gout. A remand is required to obtain adequate VA medical opinions regarding the etiology of the Veteran’s disorders of the bilateral ankles. 5. Entitlement to service connection for a right knee disorder is remanded. The Veteran testified that his right knee disability began during active service as a result of his motor vehicle accident. The March 1980 separation examination includes a report of recurrent right knee pain attributed to the 1978 motor vehicle accident. In December 2017, the VA examiner indicated that the Veteran entered service with posttraumatic knee arthropathy as a result of a prior motor vehicle accident. This is factually incorrect. The Veteran’s motor vehicle accident occurred during active service. The presumption of soundness regarding the Veteran’s right knee disorders has not been rebutted. A remand is required to obtain adequate VA medical opinions regarding the etiology of the Veteran’s right knee disorders. The matters are REMANDED for the following actions: 1. Obtain an addendum opinion from an appropriate clinician, other than the December 2017 VA examiner, regarding the etiology of the Veteran’s disorders of the bilateral feet. The VA examiner must address the following: a. Is there clear and unmistakable evidence that the Veteran’s bilateral pes planus DID NOT undergo an increase in severity during service? In rendering the opinion, the VA examiner must address the Veteran’s contention that he experienced increased foot pain due to prolonged periods of being on his feet during service and the effect of his January 1978 motor vehicle accident on his feet. b. If the Veteran’s bilateral pes planus increased in severity during service, was the bilateral pes planus clearly and unmistakably not aggravated beyond the natural progress of the disease by such service? In rendering the opinion, the VA examiner must address the Veteran’s contention that he experienced increased foot pain due to prolonged periods of being on his feet during service and the effect of his January 1978 motor vehicle accident on his feet. c. Is it at least as likely as not that the Veteran’s gout of the bilateral feet was at least as likely as not related to his active service, including the 1978 motor vehicle accident and/or prolonged periods of being on his feet during service? A rationale must be provided for all opinions and the examiner may not rely solely on a lack of medical documentation as his or her rationale. The Veteran should be presumed sound with regard to gout of the bilateral feet (gout did not exist prior to service). 2. Obtain an addendum opinion from an appropriate clinician, other than the December 2017 VA examiner, regarding whether the Veteran’s left ankle arthropathy and gout of the bilateral ankles are at least as likely as not related to his active service, including the 1978 motor vehicle accident. A rationale must be provided for all opinions and the examiner may not rely solely on a lack of medical documentation as his or her rationale. The Veteran should be presumed sound with regard to disabilities related to his bilateral ankle (the disabilities did not exist prior to service). 3. Obtain an addendum opinion from an appropriate clinician, other than the December 2017 VA examiner, regarding whether the Veteran’s right knee arthropathy and gout of the right knee are at least as likely as not related to his active service, including the January 1978 motor vehicle accident. In rendering the opinion, the VA examiner is asked to address the Veteran’s separation examination that includes a report of recurrent right knee pain attributed to the 1978 motor vehicle accident. A rationale must be provided for all opinions and the examiner may not rely solely on a lack of medical documentation as his or her rationale. The Veteran should be presumed sound with regard to disabilities related to his right knee (the disabilities did not exist prior to service). 4. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal. If the benefits sought are not granted to the Veteran’s satisfaction, send the Veteran a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. DAVID L. WIGHT Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R.R. Watkins, 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.