Citation Nr: 21068118 Decision Date: 11/09/21 Archive Date: 11/09/21 DOCKET NO. 11-15 057A DATE: November 9, 2021 REMANDED Entitlement to service connection for bilateral foot disabilities, to include pes planus and hallux valgus, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from May 1997 to May 2001. This appeal comes before the Board of Veterans' Appeals (Board) from a July 2010 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded this matter in September 2014, November 2017, October 2020, and July 2021 for additional evidentiary development including obtaining adequate VA examinations of the Veteran's bilateral foot disabilities. The Board noted that while the Veteran's mild pes planus was noted upon his enlistment examination, the Veteran also has additional disabilities including hallux valgus, which were not noted on the enlistment examination. The Board remanded the appeal to obtain medical opinions addressing the probability that (1) pes planus was aggravated by the Veteran's military service, (2) other foot disabilities manifested during or were otherwise caused by the Veteran's military service, and (3) the Veteran's service-connected disabilities caused or aggravated his foot disabilities. While VA obtained additional medical opinions including negative nexus opinions, the Board finds the opinions are not adequate and do not substantially comply with the Board's remand directives. First, while the Board requested opinions addressing each foot disability, the negative opinions VA obtained in August 2021 address only pes planus. They do not adequately discuss other disabilities identified by the VA examiners and treatment providers including hallux valgus. Moreover, the Board finds the rationale regarding whether the Veteran's service-connected disabilities aggravated pes planus is conclusory. The opinions focus on aggravation during the Veteran's military service and do not adequately address evidence of worsening pes planus in the years following the Veteran's separation, which the Board specifically cited in its October 2020 remand order. See, e.g., January 2011 treatment records from the International Clinic. On remand, VA should obtain additional medical opinions addressing these deficiencies. In addition to the above, VA should request the Veteran's assistance in obtaining outstanding relevant records. Such records include records from Sandhills Foot Clinic as the March 2018 VA examiner indicated the Veteran was currently being seen there. The Board REMANDS this matter for the following actions: 1. VA should contact the Veteran and all current representatives and request their assistance in identifying any outstanding relevant records including any outstanding relevant records from Sandhills Foot Clinic. VA should make reasonable attempts to obtain all identified outstanding records and associate them with the Veteran's claims file. 2. After associating all outstanding records with the Veteran's claims file, VA should afford the Veteran an examination with an appropriate examiner of the Veteran's bilateral foot disabilities (e.g. pes planus and hallux valgus). VA should provide the examiner with a complete copy of the claims file, to include this remand order. VA should ensure that the examiner follows these directives: 3. The VA examiner should identify all current disabilities associated with the Veteran's feet, to include pes planus and hallux valgus. For the purpose of the examination, a disability includes any functional impairment of earning capacity, to include as due to pain. See Saunders v. Wilkie, 886 F.3d 1356 (2018). 4. For each current foot disability identified, the examiner should opine whether the disability at least as likely as not (an approximate balance of negative and positive evidence) manifested during or was otherwise caused by the Veteran's military service. The examiner should explain why or why not. 5. In regard to diagnoses of arthritis, the VA examiner should opine whether it is at least as likely as not (an approximate balance of negative and positive evidence) that the arthritis manifested to a compensable degree (e.g. any limitation of motion due to pain) within one year of the Veteran's separation from active duty military service. 38 C.F.R. §§ 3.307, 3.309(a). 6. For each current foot disability identified, the examiner should opine whether the disability was at least as likely as not worsened beyond normal progression (aggravated) by the Veteran's service-connected disabilities, to include a back disability, radiculopathy of the lower extremities, and knee disabilities. The aggravation does not have to be permanent as temporary aggravation may support secondary service connection. See Ward v. Wilkie, 31 Vet. App. 233 (2019). The examiner should support the opinion with adequate rational including consideration of the Veteran's lay statements and other evidence indicating the Veteran's foot disabilities have worsened over time. See, e.g., January 2011 treatment records from the International Clinic. 7. If the examiner is unable to provide an opinion on these matters, the examiner must state whether the inability to render an opinion 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). K.A. KENNERLY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Michael Duffy 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.