Citation Nr: 21003098 Decision Date: 01/19/21 Archive Date: 01/19/21 DOCKET NO. 11-13 792 DATE: January 19, 2021 REMANDED Entitlement to service connection for a lumbar spine disability, to include degenerative disc disease, as secondary to service-connected bilateral pes planus, is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1966 to November 1968, with additional reserve service. This matter comes before the Board of Veterans’ Appeals (Board) from an August 2008 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In May 2015, the Veteran and his wife testified at a hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. This matter was previously before the Board in February 2019, when it was remanded for additional development. 1. Entitlement to service connection for a lumbar spine disability, to include degenerative disc disease, as secondary to service-connected bilateral pes planus Regrettably, the Board finds an additional VA opinion is needed prior to adjudicating the claim. The Board previously remanded the claim in February 2019 to obtain an addendum VA opinion addressing whether the Veteran’s current lumbar spine disability was caused or aggravated by his bilateral pes planus, to include addressing the contention that the Veteran’s pes planus caused a 22-mm leg length discrepancy noted by his chiropractor, which the chiropractor noted puts stress on the back. While a negative VA opinion was rendered in December 2019, the examiner did not provide an adequate rationale for the conclusion reached. As there has not been substantial compliance with the Board’s prior remand instructions, a remand is required. See Stegall v. West, 11 Vet. App. 268 (1998). Additionally, subsequent to the Board’s remand, additional evidence was added to the record, including July 2020 and October 2020 correspondence from the Veteran asserting that there is a positive correlation between foot deviations, like pes planus, and chronic back problems and medical articles, which the Veteran asserts support his contentions. Finally, in statements on appeal, including at his Board hearing, the Veteran asserted that his current back disability is related to an injury sustained while lifting heavy weapons and due to the wear and tear of activities during active duty. As the Board is herein remanding this matter, a VA opinion that specifically addresses this contention would be helpful to the Board. Thus, in light of the record, the Board finds an addendum opinion is warranted. The matters are REMANDED for the following actions: 1. Ask the Veteran to provide the names and addresses of all medical care providers who have recently treated him for his claimed lumbar spine disability. After securing any necessary releases, request any relevant records identified that are not duplicates of those associated with the claims file. In addition, obtain updated VA treatment records since August 2020. If any requested records are unavailable, the Veteran should be notified of such. 2. After records development is completed, forward the claims file to a VA specialist in the field of podiatry or orthopedics, if possible, to obtain an addendum opinion on whether the claimed lumbar spine disability is related to service or secondary to the service-connected bilateral pes planus. If an examination is deemed necessary to respond to the questions presented, one should be scheduled. After reviewing the claims file, the examiner should respond to the following: (a.) Is it at least as likely as not (50 percent probability or greater) that any currently diagnosed lumbar spine disability, to include degenerative disc disease, is directly related to service? The examiner should explain why or why not. In rendering the opinion, the examiner should address whether the disability is a maturation of the Veteran’s complaints of back pain and assessment of mild muscular sprain documented in his service treatment records; whether the current lumbar spine disability is a post-traumatic reaction to the wear and tear of activities performed during active duty; and the contention that the Veteran’s low back pain has continued since active duty. (b.) If not related to service, is it at least as likely as not (50 percent probability or greater) that a current lumber spine disability, to include degenerative disc disease, was caused by his service-connected bilateral pes planus? The examiner must explain why or why not. In rendering the opinion, the examiner must address the mechanical effect, if any, of the bilateral pes planus on the lumbar spine; the Veteran’s contention that his pes planus caused the 22-mm leg length discrepancy noted by his chiropractor, which the chiropractor noted puts stress on the back; and the Veteran’s contentions that medical research reflects a positive correlation between foot deviations (such as pes planus) and chronic back problems (see appellant correspondence and medical article submissions, received July 2020 and October 2020). (c.) If not caused by the service-connected pes planus, is it at least as likely as not that the Veteran’s current lumbar spine disability was worsened (aggravated) beyond natural progression by his service-connected bilateral pes planus? The examiner must explain why or why not. In rendering the opinion, the examiner must address the mechanical effect, if any, of the bilateral pes planus on the lumbar spine; the Veteran’s contention that his pes planus caused the 22-mm leg length discrepancy noted by his chiropractor, which the chiropractor noted puts stress on the back; and the Veteran’s contentions that medical research reflects a positive correlation between foot deviations (such as pes planus) and chronic back problems (see appellant correspondence and medical article submissions, received July 2020 and October 2020). If so, the examiner should attempt to qualify the degree of worsening beyond the baseline level of the lumbar spine disability.   The examiner must provide a complete rationale for the opinions and conclusions expressed. K. A. BANFIELD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. C. Birder 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.