Citation Nr: 21068252 Decision Date: 11/09/21 Archive Date: 11/09/21 DOCKET NO. 18-21 960 DATE: November 9, 2021 REMANDED Entitlement to service connection for degenerative arthritis of the lumbar spine is remanded. Entitlement to service connection for right foot hallux valgus is remanded. Entitlement to service connection for right hip trochanteric pain syndrome is remanded. Entitlement to service connection for a left knee strain is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1983 to January 1989. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a February 2014 rating decision by the Regional Office (RO) of the Department of Veterans Affairs (VA). The Veteran presented testimony at a Board hearing in July 2021. A transcript of the hearing is associated with the Veteran's claims folder. 1. Entitlement to service connection for degenerative arthritis of the lumbar spine is remanded. Upon review of the claims file, the Board has determined that further development is necessary before the claim can be adjudicated. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. The Veteran was afforded a VA thoracolumbar spine examination in February 2016, wherein a VA examiner opined that her back disability was less likely than not incurred in or caused by service. In rendering this opinion, the examiner noted that the Veteran was involved in a motor vehicle accident in November 1986 and that she complained of right-side lower back pain following the accident. The examiner additionally noted lumbar imaging from April 1987 which noted sacralization of the L5. However, based on an October 1987 Airforce examination where the Veteran denied recurrent back pain, the examiner concluded that her back problem resolved prior to discharge. (2/24/2016, C&P Exam, p. 46). The Board finds that the February 2016 opinion is inadequate for evaluation purposes, as the opinion appears to be based on an inaccurate factual premise. See Reonal v. Brown, 5 Vet. App. 458, 460-61 (1993) (a medical opinion based on inaccurate factual premise has no probative value). In this regard, the examiner cited to an October 21, 1987, Airforce examination as evidence that the Veteran's back pain resolved prior to her discharge. After a review of the record, the Board was unable to locate an October 21, 1987, examination. The Board did, however, find an October 21, 1982, examination, which occurred prior to her in-service motor vehicle accident. (11/5/2013, STR Medical Photocopy, p. 11). Assuming, for the sake of argument, that the examiner was correct and there is an October 1987 examination of record where the Veteran denied recurrent back pain, the examiner's opinion would still be inadequate, as there is evidence in the Veteran's service treatment records that she complained of back pain in November 1988. (11/5/2013, STR Medical, p. 63). Upon remand, the RO should request an addendum opinion regarding the etiology of the Veteran's back disability. In doing so, the examiner should note the Veteran's in-service complaints of low back pain and lumbar imaging noting sacralization of the L5. Additionally, the examiner should note lay evidence provided by the Veteran indicating that she was suffering from back pain prior to the 2011 motor vehicle accident and that she sought treatment for back pain in the 90's from a private clinic. 2. Entitlement to service connection for right foot hallux valgus is remanded. Upon review of the claims file, the Board has determined that further development is necessary before the claim can be adjudicated. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. The Veteran was afforded two VA medical opinions regarding the etiology of her current diagnosis of right foot hallux valgus. The first opinion, which was proffered in February 2016, indicates that her current disability was less likely than not incurred in or caused by service. In rendering this opinion, the examiner cited to an October 21, 1987, Airforce examination where the Veteran denied experiencing foot trouble. The examiner further indicated that there was only one record of foot pain during her period of service. (2/24/2016, C&P Exam, p. 58). As noted in the preceding section, the Veteran's service treatment records do not contain an October 21, 1987, examination. This opinion is therefore inadequate for the same reasons previously discussed. The Board additionally notes that the examiner's finding that the Veteran only complained of foot pain once in 1985 is not supported by the record. Her service treatment records indicate that she complained of bilateral foot pain as early as November 1984 and continued to seek treatment until December 1985. (11/5/2013, STR Medical, p. 78). The Veteran was afforded another VA examination and medical opinion in January 2018, wherein a VA examiner once again opined that her current foot disability was less likely than not incurred in service. In rendering this opinion, the examiner noted the Veteran's in-service complaints of foot pain. However, the examiner indicated that there are no records of foot pain from December 1985 to 2003, and therefore a nexus could not be established. The Board finds that the January 2018 opinion is inadequate for evaluation purposes as the examiner failed to consider lay evidence provided by the Veteran indicating that she has experienced foot pain since being treated in-service. (1/9/2018, C&P Exam, p. 4). VA is required to give "due consideration" to "all pertinent medical and lay evidence" in evaluating a claim for disability. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). Nothing in the regulatory or statutory provisions require both medical and competent lay evidence. Indeed, competent lay evidence can be sufficient in and of itself to substantiate a disability claim. See Buchanan v. Nicholson, 451 F.3d 1331, 1335 (Fed. Cir. 2006). Upon remand, the RO should request an addendum opinion regarding the etiology of the Veteran's foot disability. In doing so, the examiner should note the Veteran's in-service complaints of foot pain and lay evidence indicating that she has experienced foot pain since being treated in-service. 3. Entitlement to service connection for right hip trochanteric pain syndrome is remanded. 4. Entitlement to service connection for a left knee strain is remanded. Upon review of the claims file, the Board has determined that further development is necessary before the claim can be adjudicated. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. As the Veteran claims that her current right hip and left knee disabilities were caused by her claimed back disability, which the Board remanded in this decision, the issues are inextricably intertwined. As such, a remand for the claims for service connection for right hip trochanteric pain syndrome and a left knee strain is required. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's low back disability is at least as likely as not related to a 1986 motor vehicle accident. In rendering an opinion, the examiner must acknowledge and address the following: (a.) The Veteran's in-service complaints of back pain; (b.) In-service lumbar imaging noting sacralization of the L5; (c.) Lay evidence that she sought treatment for back pain in the 1990s at a private clinic (7/19/2021, Hearing Transcript, p. 7); and (d.) Lay evidence that she was experiencing back pain prior to the 2011 motor vehicle accident. (7/19/2021, Hearing Transcript, p. 3) 2. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's foot disability is at least as likely as not related to her in-service complaints of foot pain. In rendering an opinion, the examiner must acknowledge and address the following: (a.) The Veteran's in-service complaints of foot pain; and (b.) Lay evidence indicating that she has experienced foot pain since being treated in-service. (1/9/2018, C&P Exam, p. 4). 3. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal, including the inextricably intertwined issues of entitlement to service connection for right hip trochanteric pain syndrome and a left knee strain. If the benefit sought is not granted to the Veteran's satisfaction, send the Veteran and her representative a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. Eric S. Leboff Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Glenn, Associate 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.