Citation Nr: 21065048 Decision Date: 10/22/21 Archive Date: 10/22/21 DOCKET NO. 17-61 688 DATE: October 22, 2021 REMANDED Entitlement to service connection for low back disability is remanded. Entitlement to service connection for left foot disability is remanded. Entitlement to service connection for right foot disability is remanded. REASONS FOR REMAND The Veteran in this case served on active duty from December 1971 to December 1973. In March 2020, the Veteran testified at a Board hearing at the local Regional Office before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the record. 1. Entitlement to service connection for low back disability is remanded. The Board finds that remand is required for another addendum VA opinion. The Veteran was provided with a VA examination in January 2021. The examiner determined that the Veteran' lumbosacral condition was less likely than not related to service as records did not indicate that he had back pain in service. In a January 2021 addendum opinion, the examiner reiterated that the records were silent for back complaints and that the Veteran did not complain of back pain until 2016, 40 years after discharge. The examiner stated that there was little objective evidence in this case and that she must rely on speculation. She stated that the timeline and lack of treatment were not compatible for an injury that would result in the current condition. The Board finds this opinion to be insufficient for adjudication purposes. Confusingly, the examiner stated that she had to rely on speculation in formulating her opinion, but then provided a negative nexus. If the examiner was unable to provide an opinion without resorting to speculation, she was directed to report which facts were unknown or testing that would be required to provide a proper opinion. The examiner did not adhere to these directives. Finally, the Board also notes that the examiner stated that the Veteran did not complain of back pain until 2016; however, private treatment records from 2013 indicated that the Veteran sought treatment for low back pain earlier than the examiner determined. A medical opinion based upon an inaccurate factual premise has no probative value. Reonal v. Brown, 5 Vet. App. 458, 461 (1993). As such, remand is required for an adequate opinion. 2. Entitlement to service connection for left foot disability is remanded. 3. Entitlement to service connection for right foot disability is remanded. The Veteran underwent a VA examination for his bilateral foot condition in January 2021. The examiner denied nexus for the Veteran's diagnosed bilateral plantar fasciitis. The examiner stated that if the Veteran's service boots aggravated his plantar fasciitis, his condition would have improved after he stopped wearing the shoes. The examiner then stated that there was lack of evidence of continuity of care to state that the condition was related to prior foot pain. The Board finds this opinion to be insufficient for adjudication purposes. The opinion is largely conclusory and relied largely on the absence of evidence as support. The examiner also discounted the Veteran's report of symptoms because it was not supported by medical evidence. In the March 2020 hearing, the Veteran stated that he self-treated his bilateral foot condition with soaks and baths following service but these statements regarding continuity of symptomatology were not addressed by the examiner. Dalton v. Nicholson, 21 Vet. App. 23 (2007). The examiner also utilized the wrong standard in providing her opinion. She provided an aggravation opinion rather than a causation opinion. It is noted that the Veteran's enlistment examination is absent for diagnosis or evidence of a foot condition. As such, the Veteran's claim is to be evaluated for causation and not aggravation. Therefore, remand is required for an adequate opinion. The matters are REMANDED for the following action: 1. Obtain an addendum opinion regarding the etiology of the Veteran's low back disability. The entire claims file must be made available to and be reviewed by the examiner. The need for an in-person examination is left to the discretion of the examiner. An explanation for all opinions expressed must be provided. The examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the low back disability had onset in, or is otherwise related to, active military service, to include an in-service fall from a ladder. 2. Obtain an addendum opinion regarding the etiology of the Veteran's bilateral foot disabilities. The entire claims file must be made available to and be reviewed by the examiner. The need for an in-person examination is left to the discretion of the examiner. An explanation for all opinions expressed must be provided. The examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the bilateral foot disability had onset in, or is otherwise related to, active military service, to include the use of military issued shoes. 3. All opinions must include a detailed explanation (rationale). The rationale must be consistent with the entire medical opinion and must be clearly stated. (By law, the Board may not rely on any conclusion that is unsupported by a thorough explanation. If the examiner cannot provide an above opinion without resorting to speculation, he/she should explain why an opinion cannot be provided (e.g., lack of sufficient information/evidence, the limits of medical knowledge, etc.) H.M. WALKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board AK 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.