Citation Nr: 21065814 Decision Date: 10/27/21 Archive Date: 10/27/21 DOCKET NO. 16-18 354 DATE: October 27, 2021 REMANDED Entitlement to a rating higher than 20 percent for residuals of frozen right foot (hereinafter right foot disability) is remanded. Entitlement to a rating higher than 20 percent for residuals of frozen left foot (hereinafter left foot disability) is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1979 to October 1982. This appeal comes before the Board of Veterans' Appeals (Board) from a June 2012 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri. In May 2019, the Veteran testified before the undersigned Veterans Law Judge (VLJ). A hearing transcript is associated with the record. In July 2021, the Board remanded the claim for further development. In remanding these matters, the Board makes no finding, implicit or otherwise, as to the credibility of the Veteran's assertions. Neither the Veteran's credibility nor any lack thereof should be presumed in this remand. 1. Entitlement to a rating higher than 20 percent for right foot disability is remanded. 2. Entitlement to a rating higher than 20 percent left foot disability is remanded. To ensure that VA has met its duty to assist, the Board finds that remand is necessary for the following reasons. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c). First, as to issues 1-2, a review of the record discloses that there may be outstanding relevant private treatment records. The record reflects that the Veteran received treatment at Augusta Podiatry Associates, P. C., in May 2013. See VA 21-0820 Report of General Information; see also Medical Treatment Record - Non-Government Facility (June 2013). However, the evidence indicates that the record is incomplete as radiographic results from the May 2013 visit are not associated with the claims file and there is no indication that VA has attempted to obtain those records. Therefore, remand is warranted to afford the Veteran an opportunity to authorize release of records to VA or otherwise provide any relevant outstanding records in his possession. 38 U.S.C. § 5103A(b); 38 C.F.R. § 3.159(c)(1). Second, as to issue 2, an August 2021 VA medical opinion is inadequate. The July 2021 Board decision remanded the appeal for, among other things, a medical opinion on whether the Veteran has arthritis involving either foot associated with his service connected residuals of frozen feet. Next, the originating agency then obtained August 2021 VA cold injury and foot examinations along with opinions. The examination reports disclosed that there was no arthritis of the right foot based on imaging/x-ray studies. However, the examination reports reflects positive x-ray findings for arthritis of the left foot, specifically the fifth proximal interphalangeal (PIP) joint. An August 2021 VA medical opinion addressed whether the Veteran left foot arthritis is associated with his service-connected frozen foot, left. It concluded that: There is no objective evidence of osteoarthritis of the left foot or toe until 08/2021. This was detected almost 40 years post-service. The osteoarthritis detected in the LT 5th PIP joint is more than likely related to wear and tear, age-related changes, and excess weight (BMI > 30). Therefore, it is less likely as not that the osteoarthritis of the LT 5th PIP joint is a sign or symptom of the Veteran's residuals of frozen feet to the left foot. The more likely causes are osteoarthritic changes due to aging, wear and tear over time, and obesity. A nexus has not been established. https://www.arthritis.org/diseases/osteoarthritis. The Board finds that this opinion is inadequate to decide the left foot matter because the clinician does not provide any rationale to support the conclusion that: (1) arthritis is less likely due to service-connected left frozen foot or (2) the Veteran's left 5th PIP joint arthritis is related to other factors. 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. See Stefl v. Nicholson, 21 Vet. App. 102, 124-25 (2007). To the extent that the opinion obliquely references information from the Arthritis Foundation as contained via the link provided in the opinion, this is not a rationale but only data that may support the conclusions reached. In other words, while there are clear conclusions with supporting data, the opinion lacks a reasoned medical explanation connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). Also, the opinion, while noting a link to the Arthritis Foundation addressing osteoarthritis, does not attempt to discuss that information vis-a-via any facts specific to this Veteran. See Bailey v. O'Rourke, 30 Vet. App. 54, 60 (2018) (a medical rationale based solely on general medical literature without discussing the specific facts pertaining to a veteran's condition or individual circumstances is inadequate). When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that it is adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Given the above, remand is required. A remand by the Board imposes upon the Secretary of VA a concomitant duty to ensure compliance with the terms of the remand. Where remand orders of the Board are not complied with, the Board errs in failing to ensure compliance. Stegall v. West, 11 Vet. App. 268 (1998). The matters are REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for all non-VA medical providers seen for his service-connected right and left foot disability since November 2010, to include Augusta Podiatry Associates, P. C. Make two requests for the authorized records from all identified sources, unless it is clear after the first request that a second request would be futile. 2. Obtain an addendum medical opinion to address whether the Veteran's left 5th PIP joint arthritis is at least as likely as not proximately due to or the result of his service-connected residuals of frozen left foot. A complete rationale is required. It is noted that left frozen foot need not be the only cause of the arthritis, but rather is may share in causation. If another etiology if more likely the cause, this must be fully explained. The claims file along with a copy of this remand should be reviewed. 3. Ensure that the VA medical opinions obtained include a complete rationale for the conclusions reached. The medical opinions must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). 4. Readjudicate. C.A. SKOW Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Edwards 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.