Citation Nr: 21064088 Decision Date: 10/19/21 Archive Date: 10/19/21 DOCKET NO. 17-25 839 DATE: October 19, 2021 REMANDED Entitlement to a rating in excess of 10 percent for residuals status post repair, left Achilles tendon laceration is remanded. Entitlement to a compensable rating for left sural nerve neuropathy associated with left Achilles tendon laceration is remanded. REASONS FOR REMAND The Veteran had active duty service from August 1965 to January 1966. This matter comes before the Department of Veterans Affairs (VA) Board of Veterans' Appeals (Board) on appeal from an Agency of Original Jurisdiction (AOJ) rating decision dated in July 2016. The Veteran appeared at a Board video conference hearing in February 2020 before the undersigned Veterans Law Judge. A transcript of the hearing is of record. The Board remanded this case to the AOJ in August 2020 and March 2021 for additional development. The Board sincerely apologizes for additional delay in rendering a decision for these claims on appeal; however, to ensure the Veteran is afforded every opportunity to substantiate his claims, another remand is required. 1. Entitlement to a rating in excess of 10 percent for residuals status post repair, left Achilles tendon laceration is remanded. 2. Entitlement to a compensable rating for left sural nerve neuropathy associated with left Achilles tendon laceration is remanded. The focus of the remands in this case has been to identify and properly rate all the residuals of the Veteran's left Achilles tendon laceration. After the most recent remand, the AOJ assigned the Veteran a separate noncompensable (0 percent) rating for nerve damage associated with the Veteran's left ankle. However, the medical evidence suggests that there are other potential residuals and side effects that have not been addressed by a VA examiner, and that might warrant additional separate ratings. First, there is evidence that the Veteran has pes planus, plantar fasciitis, hindfoot valgus, and arthritis and osteophytes in his foot that may be associated with his left ankle disability. The Veteran had a VA examination in June 2021 which diagnosed the Veteran with plantar fasciitis and indicated his plantar foot pain was directly related to his left ankle, but no examination of the foot was completed. A November 2020 VA examination indicated that the Veteran had pes planus, arthritis, osteophytes, and hindfoot valgus. The examiner indicated that "the diagnosis" is a progression of the Veteran's ankle disability due to stress and deterioration of "the joint;" however, the examiner did not specify which diagnosis is associated with the ankle condition, nor was a foot examination performed to determine the severity of symptoms. Furthermore, the Veteran submitted private opinions in February 2015 and October 2015 indicating that his foot collapsed because of his history with his lacerated tendon. Second, there is evidence that the Veteran has limitation in his toes separate and apart from the limitation in his ankle that is linked to his original injury. See February 2020 private treatment record and opinion. However, as noted, the Veteran was not provided an examination of his feet and toes. Third, the May 2021 VA examiner diagnosed the Veteran with atherosclerotic changes of the distal posterior artery. There is no opinion regarding if the Veteran's atherosclerotic changes cause any functional loss or the severity. Therefore, a remand is required to determine if any of these diagnoses constitute residuals of the left Achilles laceration, and their severity. The matters are REMANDED for the following action: 1. Forward the record including a copy of this remand to a qualified examiner for completion of an addendum opinion. Following review of the record, the examiner should respond to the inquiry below. If the examiner determines that he or she cannot respond to the Board's inquiry as set forth in detail below without examination of the Veteran, the Veteran should be afforded such an in-person examination, or by other means if an in-person examination is not feasible. (a.) The examiner must opine if the Veteran has any foot diagnosis that is a residual of his left Achilles laceration, including pes planus, plantar fasciitis, hindfoot valgus, arthritis and osteophytes, limited range of motion of any toes, and atherosclerotic changes of the distal posterior artery. (b.) If it is determined that the Veteran has additional residuals of a left ankle injury, including pes planus, plantar fasciitis, hindfoot valgus, arthritis and osteophytes, limited range of motion of any toes, and atherosclerotic changes of the distal posterior artery, an examination must be completed to determine the severity and functional impairment caused by the residual, and if it is possible to differentiate the symptoms and impairments attributable to one residual or diagnosis from another. (c.) In addressing the Veteran's residuals of the left Achilles laceration, the examiner must discuss the following evidence: (1) the June 2021 VA examination that diagnosed the Veteran with plantar fasciitis and indicated his plantar foot pain was directly related to his left ankle; (2) the November 2020 VA examination which indicated that the Veteran had pes planus, arthritis, osteophytes, and hindfoot valgus, and that "the diagnosis" is a progression of the Veteran's ankle disability due to stress and deterioration of "the joint"; (3) the February 2015 and October 2015 private opinions indicating that the Veteran's foot collapsed because of his history with his lacerated tendon; (4) a February 2020 private treatment record and opinion indicating that the Veteran had an inability to flex and extend his left great toe, which is directly linked to his original injury; and (5) the May 2021 VA examination that diagnosed the Veteran with atherosclerotic changes of the distal posterior artery. (Continued on the next page) A complete explanation for all opinions expressed must be provided. A clearly stated rationale must not be based solely on lack of documentation or records. The reasons for any opinion must include a discussion of the relevant evidence. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why. S. L. Kennedy Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Smith, 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.