Citation Nr: 21066652 Decision Date: 11/01/21 Archive Date: 11/01/21 DOCKET NO. 17-08 345 DATE: November 1, 2021 REMANDED Entitlement to service connection for a bilateral leg disorder, to include bilateral knee disorders, and to include as secondary to bilateral flat feet, is remanded. Entitlement to a total rating based on individual unemployability due to service connected disability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1978 to April 1978. These matters come to the Board of Veterans' Appeals (Board) on appeal from February 2013, September 2014, and November 2015 rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO). Jurisdiction of this appeal is currently with the RO in St. Petersburg, Florida. The Veteran testified at a video conference hearing before the undersigned Veterans Law Judge (VLJ) of the Board in February 2020. A transcript of the hearing has been associated with the claims file. This case was most recently before the Board in February 2021, at which time the appeal was remanded to the Agency of Original Jurisdiction (AOJ) for further development. The case has now been returned to the Board for appellate action. In addition, in a June 2021 rating decision, the AOJ granted service connection for bilateral flat feet and assigned an initial rating for this condition. To date, the Veteran has not submitted a notice of disagreement with this decision. As this decision represents a full grant of the benefits sought with respect to his claim for service connection, such issue is no longer before the Board for consideration. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1977). 1. Service Connection Bilateral Leg Disorder The Veteran contends that his bilateral leg disorder is etiologically related to his active service. Specifically, the Veteran and his attorney assert that his bilateral leg disorder is secondary to his bilateral flat feet. See Board Hearing Transcript, February 27, 2020. As noted above, the Veteran's claim for entitlement to service connection for bilateral flat feet was granted in a June 2021 rating decision and service connection is currently in effect for bilateral flat feet. The Veteran was afforded a VA examination for his claim for entitlement to service connection for a bilateral leg disorder in July 2021. At that time, the VA examiner opined that the Veteran's claimed bilateral leg disorder was less likely than not proximately due to or the result of the Veteran's service connected condition. In this regard, the examiner noted that the bilateral leg condition and bilateral flat feet are not medically related as the bilateral leg condition is a separate entity entirely from the bilateral flat feet and unrelated to it. The examiner noted that research indicated there was an association between flat foot and knee pain in older adults, but that a thorough review of the medical literature failed to demonstrate a causal relationship between the two. Therefore, a nexus was not established. The Board finds that July 2021 VA opinion inadequate to decide the claim. In this regard, the examiner failed to adequately provide supporting rationale for the conclusions reached. Rather, the examiner provided a circular opinion that the bilateral leg disorder was unrelated to his bilateral flat feet because it was unrelated, without further explanation. In addition, the examiner provided an opinion as to whether a pre-existing condition was aggravated by service rather than providing a secondary service connection opinion. See El-Amin v. Shinseki, 26 Vet. App. 136 (2013). Accordingly, the Board concludes that an additional VA examination for the Veteran's claimed bilateral leg disorder should be afforded. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). 2. Entitlement to a TDIU Regarding the TDIU issue, the Board notes that the issue of entitlement to a TDIU is inextricably intertwined with the claim remanded herein. Harris v. Derwinski, 2 Vet. App. 180, 183 (1991). Hence, a determination on the claim for TDIU should be deferred pending final disposition of the claim of entitlement to service connection for a bilateral leg disorder. The matters are REMANDED for the following action: 1. The Veteran should be given the opportunity to identify any outstanding private or VA treatment records relevant to the claims on appeal. After obtaining any necessary authorization from the Veteran, all outstanding records should be obtained, to include updated VA treatment records. For private treatment records, make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and his representative and afford him an opportunity to submit any copies in their possession. For federal records, all reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 2. Following the receipt of outstanding records, obtain an etiology opinion as to the Veteran's claimed bilateral leg disorder from an appropriate medical professional. The record must be made available to the examiner The record, to include a copy of this Remand, should be made available to the examiner, and all indicated tests should be conducted. Further physical examination is left to the discretion of the examiner. The examiner should respond to the following questions: Thereafter, the examiner is asked to furnish an opinion with respect to the following questions: (A) Is at least as likely as not (50 percent or greater probability) that the Veteran's bilateral leg disorder, to include bilateral knee pain, had its onset during any period of service, or is otherwise related to such period of service? (B) Is at least as likely as not (50 percent or greater probability) that the bilateral leg disorder, to include bilateral knee pain, was caused and or permanently worsened by service-connected bilateral flat feet? A rationale should be provided for all opinions offered. If it is not possible to provide a specific opinion regarding the above questions, 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). The 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; 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, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. KRISTY L. ZADORA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Mariah N. Sim, 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.