Citation Nr: 21066977 Decision Date: 11/03/21 Archive Date: 11/03/21 DOCKET NO. 12-21 507 DATE: November 3, 2021 REMANDED Entitlement to a compensable rating for residuals of a left foot injury is remanded. REASONS FOR REMAND The Veteran had active military service from June 1985 to December 1992. This matter comes to the Board of Veterans' Appeals (Board) from a rating decision of a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ). In March 2014, the Veteran testified before the undersigned Veterans Law Judge at a Board videoconference hearing. In July 2017, the Board, in pertinent part, denied entitlement to an increased rating for a left foot disability. However, pursuant to a joint motion for partial remand (JMPR), the United States Court of Appeals for Veterans Claims (Court) vacated the Board's decision in September 2018. The Board has remanded this case multiple times, most recently in April 2021. Unfortunately, the Board must remand this matter again. 1. Increased rating for residuals of a left foot disability The Veteran contends that his service-connected left foot disability is more severe than currently rated. The September 2018 JMPR found that since the record contained contradictory evidence regarding whether the Veteran had degenerative joint disease of the left foot, an opinion must be obtained in order to address any left foot arthritis as it relates to the Veteran's service-connected foot disability. The September 2018 JMPR also found that that any neurological impairment of the Veteran's left foot needed to be addressed. The Veteran is service connected for a left foot disability under the applicable Diagnostic Code 5284 for residuals of a foot injury; the Veteran was initially service connected for residuals of a fracture of the left little (5th) toe. See January 1993 rating decision. But see also June 2010 rating decision (recharacterized as residuals of foot injury). Pursuant to a July 2020 Board remand the Veteran underwent VA nerve and foot examinations in October 2020. Thereafter, VA obtained a medical opinion in December 2020 addressing any arthritis and neurological impairment in the Veteran's left foot. The December 2020 examiner opined that the Veteran currently had left foot degenerative foot disease without evidence for neurological impairment. The examiner opined that it is less likely than not the degenerative joint disease of the left foot is due to the service-connected left foot injury previously rated as fracture of the left 5th toe. The examiner provided no rationale for his opinion. The examiner also noted that the Veteran's October 2020 neurological examination documented normal lower neurological examination and no signs of left foot impairment. In the April 2021 Board remand, the Board directed VA to obtain an addendum medical opinion to determine whether the Veteran's degenerative foot arthritis and apparent neurological residuals were related to his service-connected foot residuals. In June 2021, the Veteran underwent a VA examination. The examiner documented degenerative or traumatic arthritis in the left foot. The examiner found the clinical examination did not evidence any neurological impairment of the left foot. The examiner reasoned that the VA March 2021 podiatry note did not find evidence of any neurological impairment of the left foot. The examiner stated that all the medical evidence had been reviewed in detail including the October 2020 neurological examination. The examiner further opined that the left foot arthritis is less likely as not caused or aggravated beyond its natural progression by his service-connected left foot residuals. The examiner reasoned that there is no medical nexus established. The Veteran was fully ambulatory and had good muscle tone and strength. The Veteran had no muscle atrophy which would result from neurological impairment. The Board finds that the April 2021 VA examiner's opinion is not adequate for adjudication. First, the examiner failed to adequately address the evidence in the record regarding a neurological impairment in the Veteran's left foot. As noted in the April 2021 Board remand, the October 2020 VA noted mild paresthesias and/or dysesthesias and mild numbness in the lower extremity. Simply noting that the October 2020 VA examination reviewed is not adequate. Rather, the examiner must sufficiently explain why the findings in the October 2020 examination (of numbness and mild paresthesias and/or dysesthesias of the left lower extremity) were wrong or provide adequate reasoning that these neurological findings was not caused or aggravated by the Veteran's service-connected residuals of a left foot injury. Further, the examiner's rationale as to why the degenerative arthritis in the left foot was not related to his left foot residuals was not adequate. The rationale that there is no medical nexus between the left foot residuals and the arthritis is conclusionary without adequate explanation. The medical rationale that the Veteran was fully ambulatory and had good muscle tone and strength, does not address the fact that the Veteran has left foot arthritis and whether the etiology is related to his service-connected left foot injury residuals. As such, the Board finds that the June 2021 VA medical opinion is not adequate VA must obtain a new VA medical opinion to provide an adequate medical opinion with fully articulated rationale and in compliance with the Court's order. Finally, in the Veteran's representative's informal hearing presentation (IHP), the Veteran's representative challenged the competence of the June 2021 examiner. Therefore, given VA's duty to assist, a remand is necessary to obtain information regarding the examiner's qualifications. See Francway v. Wilkie, 930 F.3d 1377 (2019). Upon remand, the AOJ should obtain documentation showing any and all known qualifications for the VA examiner providing VA medical opinion, associate the documents with the record; and provide them to the Veteran and his representative for review. The matters are REMANDED for the following action: 1. Obtain an addendum medical opinion from an appropriate clinician regarding the nature and severity of the Veteran's service-connected left foot disability. The examiner must address the following: (a.) Whether the Veteran has any neurological impairment associated with his left foot disability (with consideration of the complaints of numbness and tingling in the left foot on prior examinations, including an April 2010 VA examination report and October 2020 notation of numbness and mild paresthesias and/or dysesthesias of the left lower extremity) i. The examiner must address the October 2020 neurological examination that the Veteran had radiculopathy from the lumbar spine that radiated to the Veteran's left foot and whether that neurological impairment is in any way etiologically related to (proximately due to or aggravated by) his service-connected left foot disability. (b.) The examiner must provide an opinion regarding whether the Veteran's left foot arthritis is at least as likely as not caused by or aggravated by his service-connected left foot residuals. (c.) The examiner must include a complete medical rationale for all opinions provided. 2. To the extent possible, request information/credentials of the VA examiner demonstrating that he/she is qualified to offer the opinion regarding the Veteran's left foot injury residuals (such as a curriculum vitae or similar demonstrable other credentialing documents (which may be redacted as warranted)); and provide them, as allowed by law, to the Veteran and his representative. S. L. Kennedy Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Robert Batten 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.