Citation Nr: 21070087 Decision Date: 11/23/21 Archive Date: 11/23/21 DOCKET NO. 15-00 711A DATE: November 23, 2021 REMANDED Entitlement to service connection for Morton's neuroma, to include secondary to service-connected bilateral pes planus, is remanded. Entitlement to service connection for degenerative joint disease of the spine, to include secondary to service-connected bilateral pes planus, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from October 1979 to October 1982. These matters come before the Board of Veterans' Appeals (Board) on appeal from a June 2010 rating decision of the Department of Veterans Affairs (VA) Regional Offices (RO) in Cleveland, Ohio. In November 2016 and September 2020, the Veteran testified at a Board hearing. The transcripts are of record. This case was previously before the Board, most recently in March 2021, when remanded the case for further development. 1. Entitlement to service connection for Morton's neuroma, to include secondary to service-connected bilateral pes planus, is remanded. 2. Entitlement to service connection for degenerative joint disease of the spine, to include secondary to service-connected bilateral pes planus, is remanded. Unfortunately, there has not been substantial compliance with the Board's previous remand directives regarding the issues of entitlement to service connection for Morton's neuroma and degenerative joint disease of the spine, to include secondary to service-connected bilateral pes planus. Another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). In March 2021, the Board remanded these issues to the RO because the August 2018 VA examiner provided inadequate rationales that relied on the absence of evidence, failed to consider the Veteran's lay statements, and were conclusory. A medical examination report must contain clear conclusions, supporting data and a reasoned medical explanation connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). In March 2021, the Board ordered new VA medical opinions, directing that: In all opinions rendered, the examiner is advised that the Veteran is competent to report his symptoms and treatment history. The examiner must discuss the Veteran's contentions that he sustained injuries to his back and feet in service from marching and falling while carrying equipment and that his altered gait due to pes planus aggravates these conditions. A complete rationale containing clear conclusions with supporting data and a reasoned medical explanation connecting the two is required for all medical opinions. The examiner should also identify and explain the relevance or significance, as appropriate, of any history, clinical findings, medical knowledge, or literature, etc., relied upon in reaching the conclusion(s). The July 2021 VA examiner opined that the claimed conditions were less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. However, the only rationale against direct service connection offered was that "There is no objective evidence of related complaints or treatment during service." The July 2021 VA medical opinions were even more conclusory than the August 2018 opinions, and are therefore similarly inadequate. The matters are REMANDED for the following actions: In remanding this case, the Board makes no credibility determination, expressed or implied, at this juncture. 1. Obtain an addendum medical opinion from a medical professional with appropriate expertise. The examiner should review the Veteran's claims file. If the examiner determines that an opinion cannot be provided without an examination, the Veteran should be scheduled for one. Based on a review of the record, and a new examination if necessary, the examiner must address the following: (a.) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran's Morton's neuroma and/or degenerative joint disease of the spine is related to active service or is caused by or aggravated by military service? (b.) Is it at least as likely as not (i.e., probability of 50 percent or higher) that Morton's neuroma and/or degenerative joint disease of the spine is proximately due to or the result of the Veteran's bilateral pes planus? (c.) If the answer to (a) is negative, is it at least as likely as not that the Morton's neuroma and/or degenerative joint disease of the spine is aggravated (i.e., permanently, or temporarily worsened) by the bilateral pes planus? (d.) If aggravation is found, the examiner should address the following medical issues: i. The baseline manifestations of the disorder found prior to aggravation; and ii. The increased manifestations which, in the examiner's opinion, are proximately due to the service-connected disorder. The term "at least as likely as not" does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a certain conclusion is so evenly divided that it is as medically sound to find in favor of such a conclusion as it is to find against it. In all opinions rendered, the examiner is advised that the Veteran is competent to report his symptoms and treatment history. The examiner must discuss the Veteran's contentions about sustained injuries to back and feet in service from marching and falling while carrying equipment and an altered gait due to pes planus aggravates these conditions. (Continued on the next page) A complete rationale containing clear conclusions with supporting data and a reasoned medical explanation connecting the two is required for all medical opinions. The examiner should also identify and explain the relevance or significance, as appropriate, of any history, clinical findings, medical knowledge, or literature, etc., relied upon in reaching the conclusion. If the medical professional cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation for why an opinion cannot be rendered. In so doing, the medical professional shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that question. G. A. WASIK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board James Hekel 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.