Citation Nr: 21069699 Decision Date: 11/19/21 Archive Date: 11/19/21 DOCKET NO. 18-49 602 DATE: November 19, 2021 REMANDED Entitlement to service connection for a right foot fracture, to include as secondary to bilateral lower extremity peripheral neuropathy and a left second toe amputation, is remanded. Entitlement to special monthly compensation (SMC) based on housebound status pursuant to 38 U.S.C. § 1114(s) prior to September 1, 2016 and from March 31, 2017 forward is remanded. Entitlement to SMC based on the need for aid and attendance pursuant to 38 U.S.C. § 1114(l) prior to October 27, 2018 is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1969 to June 1971. This matter is before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in April 2016 by a Department of Veterans Affairs (VA) Regional Office (RO). During the course of the current appeal, the Veteran was awarded entitlement to SMC pursuant to 38 U.S.C. § 1114(s) from September 1, 2016 to March 3, 2017, and entitlement to SMC pursuant to 38 U.S.C. § 1114(l) from October 27, 2018 forward. As the SMC benefits sought on appeal have been fully granted during the periods listed above, the Board need not address those periods of time. Ab v. Brown, 6 Vet. App. 35 (1993). The issues of entitlement to SMC pursuant to 38 U.S.C. § 1114(s) and 38 U.S.C. § 1114(l) have been recharacterized to reflect the periods where those benefits have already been granted. The Veteran and his spouse testified at a hearing before the undersigned Veterans Law Judge (VLJ) in October 2020. A transcript of the hearing is of record. 1. Entitlement to service connection for a right foot fracture. VA obtained opinions concerning secondary service connection in February 2016. The examiner stated that the claimed right foot fracture was less likely than not caused by either the peripheral neuropathy or the left second toe amputation, stating instead that the fracture was more likely due to a fall caused by the Veteran's nonservice-connected knee disabilities. However, the examiner did not specifically address the question of aggravation. While perhaps an odd question to address given the nature of the disabilities involved, in order to be adequate a secondary service connection opinion must clearly address both causation and aggravation. El-Amin v. Shinseki, 26 Vet. App. 136, 14041 (2013); see also Allen v. Brown, 7 Vet. App. 439 (1995). As such, a remand is necessary so that new secondary service connection opinions may be obtained. 2. Entitlement to SMC under 38 U.S.C. § 1114(s) and 38 U.S.C. § 1114(l). Concerning the issues of entitlement to SMC pursuant to 38 U.S.C. § 1114(s) and 38 U.S.C. § 1114(l), an award of either or both rates of SMC requires consideration of all service connected disabilities. 38 U.S.C. § 1114(l), (s); 38 C.F.R. § 3.350(b), (i). As such, any determination with respect to the service connection claim remanded herein may affect the claims for SMC pursuant to 38 U.S.C. § 1114(s) and 38 U.S.C. § 1114(l), and therefore those issues must be remanded as well. Harris v. Derwinski, 1 Vet. App. 180 (1991). The matters are REMANDED for the following action: 1. Obtain a medical opinion concerning the etiology of the claimed right foot fracture. The examiner should answer the following: a) Is it at least as likely as not (a fifty percent probability or greater) that the right foot fracture was caused by the service-connected (1) diabetic peripheral neuropathy or (2) the left second toe amputation? b) If not, is it at least as likely as not (a fifty percent probability or greater) that the right foot fracture was aggravated (worsened) by the service-connected (1) diabetic peripheral neuropathy or (2) the left second toe amputation? In answering (a) and (b) above, attention is invited to the Veteran's hearing testimony that the fall that caused the right foot fracture was in fact the result of him tripping on carpet due to his left second toe amputation and peripheral neuropathy (labelled "Hearing Transcript" pgs. 3 to 10 uploaded 10/19/20). A detailed rationale for the opinion must be provided. The examiner is reminded that the term "as likely as not" does not mean "within the realm of medical possibility," but rather that the evidence of record is so evenly divided that, in the examiner's expert opinion, it is as medically sound to find in favor of the proposition as against it. If the examiner is unable to offer the requested opinion, it is essential that the examiner offer a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to 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. Jones v. Shinseki, 23 Vet. App. 382 (2010). LESLEY A. REIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Wendell, 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.