Citation Nr: 21063814 Decision Date: 10/18/21 Archive Date: 10/18/21 DOCKET NO. 17-43 787 DATE: October 18, 2021 REMANDED Entitlement to service connection for a right foot disability is remanded. Entitlement to service connection for a left foot disability is remanded. REASONS FOR REMAND The Veteran served in the Army National Guard with verified periods of active duty for training (ACDUTRA) from February 1982 to May 1982 and from June 1982 to August 1982. She separated from the National Guard in May 1983. This appeal stems from an August 2013 rating decision which, in pertinent part, denied service connection for a right foot disability and a left foot disability. In December 2019, the Board of Veterans' Appeals (Board) remanded this matter. . Foot Disabilities VA afforded the Veteran a December 2020 compensation examination and after review of the record and examination, the examiner determined that the Veteran's current right and left foot disabilities were less likely than not related to service. The examiner determined that service treatment records and medical records did not sufficiently demonstrate that the current diagnoses of bilateral pes planus and bilateral plantar fascitis were incurred in or caused by service. The Board notes that the December 2020 VA examiner's opinion is inadequate for a number of reasons. First, the examiner relied on the absence of evidence in the Veteran's service treatment records to provide a negative opinion. Dalton v. Nicholson, 21 Vet. App. 23, 39-40 (2007). In general, an adequate medical opinion must support its conclusion with an analysis that can be weighed against contrary opinions and be based upon prior medical history and examinations. See Bowling v. Principi, 15 Vet. App. 1, 12 (2001) (emphasizing the Board's duty to return an inadequate examination report "if further evidence or clarification of the evidence . . . is essential for a proper appellate decision"). Here, the examiner made no attempt to explain why the Veteran's marching and training in service did not cause or contribute to the bilateral pes planus or plantar fascitis. It is also noted that a medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record. Stefl v. Nicholson, 21 Vet. App. 102, 124-25. A "medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two." Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). Additionally, a review of the record includes an independent medical evaluation from T. Guthrie., a practicing family physician, who opined that having the Veteran do extended marches on flat feet as likely as not resulted in damage to her feet and that it was fairly certain that her flat feet did not develop suddenly while on active duty. See February 7, 2017, VBMS entry Medical Treatment Record Non-Government Facility. The clinician did not address or consider the post-service medical evidence of record cited in the December 2019 Board remand and the opinion from T. Guthrie (see below) in the opinion or rationale. Given the above deficiencies, the Board finds remand is necessary to obtain an adequate addendum medical opinion. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The matters are REMANDED for the following actions: 1. Obtain an addendum opinion from an appropriate VA examiner with regard to the likely etiology of any current right and left foot disabilities (aside from the already service-connected fibromyalgia) the Veteran has presented during the claim period (from September 2012 to the present) even if resolved. The claims file and a copy of this remand will be made available to the examiner, who will acknowledge receipt and review of these materials. The need for another examination is left to the discretion of the medical professional offering the addendum opinion. For each foot disability, the examiner should opine whether it is at least as likely as not (a 50 percent or greater probability) that the disability: (a) had an onset in service; or (b) is otherwise related to an in-service injury, event or disease. The examiner should consider all medical and lay evidence of record, including the Veteran's May 2011 report of joint aches in her feet (See VBMS entry Medical Treatment Record Non-Government Facility, receipt date 6/7/2004, page 56 of 76); the Veteran's March and August 1982 STRs noting foot issues (See VBMS entry STR - Medical-Photocopy, receipt date 6/4/2014, pages 16, 24, 42, and 44 of 82); the Veteran's September 1985 testimony that she experienced pain down to her foot after her in-service injury (See VBMS entry Hearing Testimony, receipt date 9/16/1985, page 10 of 12); and the June 2015 private opinion that prolonged marching, running, and other weightbearing activities during service would have created difficulties with the Veteran's feet (See VBMS entry Medical Treatment Record Non-Government Facility, receipt date 2/7/2017, pages 3 and 5 of 6). The examiner should note that the Veteran is competent to attest to factual matters of which she has first-hand knowledge. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should state this with a fully reasoned explanation. The examiner should not rely on the absence of evidence in the Veteran's service treatment records to provide a negative opinion. A complete rationale should be provided for all opinions and a discussion of the fact and medical principles involved would be of considerable assistance to the Board. 2. Thereafter, readjudicate the remanded claims. L. Chu Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Beach, 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.