Citation Nr: 21003194 Decision Date: 01/19/21 Archive Date: 01/19/21 DOCKET NO. 18-12 321 DATE: January 19, 2021 REMANDED Entitlement to service connection for a right foot disorder, to include as secondary to service-connected lumbar spine and bilateral knee conditions, is remanded. Entitlement to service connection for a left foot disorder, to include as secondary to service-connected lumbar spine and bilateral knee conditions, is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1979 to December 2000. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2017 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously before the Board in November 2018 and September 2020, when it was remanded for additional development. The Veteran contends that his bilateral foot disorders, diagnosed as pes planus and plantar fasciitis, are either directly related to his active service or secondary to his service-connected lumbar spine and bilateral knee disorders. As directed in the prior Board remand, a VA examination was provided in October 2020. The examiner was directed to provide an opinion regarding the etiology of the Veteran’s bilateral foot conditions, which have been diagnosed as pes planus and plantar fasciitis. In providing this opinion, the examiner was to address the potential connection to service on both a direct and secondary basis, considering whether the Veteran’s foot disabilities are proximately due to or aggravated beyond their natural progression by his service-connected bilateral knee and spine disabilities. In the provided report, the examiner opines the Veteran’s claimed foot disabilities are not at least as likely as not due to or aggravated by his service-connected bilateral knee and spine conditions. As rationale, the examiner states that pes planus may possibly cause knee arthritis or spinal problems, but the reverse is not possible as there is no known pathophysiologic causative connection between back or knee problems and the development of pes planus or plantar fasciitis. The examiner provides no support for this finding or any explanation for the basis of this conclusion. The examiner also does not specifically address contentions the Veteran and his representative have raised regarding the effects of altered gait due to his knee and back problems and whether they have had an effect on the progression of his bilateral foot problems. VA has a duty to ensure any medical examination or opinion it provides is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (overruled on other grounds, Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013)). A medical opinion is adequate where it is based upon consideration of the full medical history and describes a disability in sufficient detail so that the Board’s evaluation will be fully informed. Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). The Board finds the October 2020 examiner’s rationale in support of his opinion is inadequate, and a remand is required to obtain a new opinion. The matters are REMANDED for the following action: Obtain a new medical opinion regarding the nature and etiology of any bilateral foot disability, to include pes planus and plantar fasciitis. The Veteran should only be scheduled for a new examination if deemed necessary by the selected examiner. For each diagnosed foot disability, the examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease. If not, then the examiner must opine as to whether it is at least as likely as not either proximately due to, or aggravated by, his service-connected spine and/or bilateral knee disabilities, to include any altered gait attributable to either the spine or knee disabilities or both. The opinion must address both causation and aggravation in the context of secondary service connection to be deemed adequate. The examiner is advised aggravation means an increase in the severity of the underlying disability beyond its natural progression. If aggravation is found, the examiner should attempt to quantify the degree of additional disability resulting from the aggravation. (Continued on the next page)   The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be specifically acknowledged and considered in formulating any opinion. If the examiner rejects the Veteran’s reports, he or she must provide a reason for doing so. The fact that his report of symptoms is not corroborated by contemporaneous medical treatment records is not, by itself, a sufficient reason to reject the Veteran’s report of symptoms capable of lay observation. The examiner’s report must include a complete rationale for the opinion. M. HYLAND Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Pitman, 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.