Citation Nr: 21071222 Decision Date: 11/30/21 Archive Date: 11/30/21 DOCKET NO. 18-28 464 DATE: November 30, 2021 ORDER Entitlement to an initial rating in excess of 20 percent for neck strain with degenerative disc disease and intervertebral disc syndrome is denied. Entitlement to service connection for a disability of the right hand is denied. REMANDED Entitlement to service connection for a bilateral foot disability, to include as due to service-connected disease or injury is remanded. FINDINGS OF FACT 1. The Veteran's neck strain with degenerative disc disease and intervertebral disc syndrome is characterized by subjective complaints of neck pain, spasms, and difficulty driving; objective findings included forward flexion measured, at worst, to 20 degrees, and no ankylosis or incapacitating episodes with prescribed bedrest. 2. The Veteran's right-hand disability was not shown in service or to a compensable degree within one year of service; symptoms of his right hand rheumatoid arthritis were not continuous since service; current right hand rheumatoid arthritis is not causally or etiologically related to service. CONCLUSIONS OF LAW 1. The criteria for an initial rating in excess of 20 percent for neck strain with degenerative disc disease and intervertebral disc syndrome have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.71a, Diagnostic Code 5243 (2021). 2. The Veteran's right hand disability was not incurred in service and may not be presumed to have been incurred in service. 38 U.S.C. §§ 1131, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309 (2021). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Army from December 1975 to November 1978. This matter is before the Board of Veterans' Appeals (Board) on appeal from an August 2017 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a hearing in January 2021. A transcript of that hearing is of record. During the hearing, the VLJ clarified the issues, asked if there was outstanding evidence and held the file open for the submission of evidence. Such actions comply with 38 C.F.R. § 3.103. In June 2021, the Board remanded these issues to the RO for additional development. There has been substantial compliance with the remand instructions regarding the issues of increased ratings for the neck and entitlement to service connection for the right hand. Stegall v. West, 11 Vet. App. 268 (1998); Dyment v. West, 13 Vet. App. 141 (1999). As explained in more detail below, a Stegall violation occurred on the issue of entitlement to service connection for a bilateral foot disability. Increased Ratings Disability evaluations are determined by the application of a schedule of ratings that is based on average impairment of earning capacity. 38 U.S.C. § 1155. Percentage evaluations are determined by comparing the manifestations of a particular disorder with the requirements contained in the VA's Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can practically be determined, the average impairment in earning capacity resulting from such disease or injury and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. VA has a duty to acknowledge and consider all regulations which are potentially applicable through the assertions and issues raised in the record, and to explain the reasons and bases for its conclusion. The Veteran's entire history is reviewed when making a disability determination. See 38 C.F.R. § 4.1. VA must consider whether the Veteran is entitled to "staged" ratings to compensate when his or her disability may have been more severe than at other times during the course of his or her appeal. The evaluation of the same disability under various diagnoses, known as pyramiding, is generally to be avoided. 38 C.F.R. § 4.14. The critical element in permitting the assignment of several ratings under various DCs is that none of the symptomatology for any one of the disabilities is duplicative or overlapping with the symptomatology of the other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). If there is a question as to which evaluation to apply to the Veteran's disability, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. In general, evaluation of a service-connected disability involving a joint rated on limitation of motion requires adequate consideration of functional loss due to pain under 38 C.F.R. § 4.40 and functional loss due to weakness, fatigability, incoordination or pain on movement of a joint under 38 C.F.R. § 4.45. See DeLuca v. Brown, 8 Vet. App. 202 (1995). The provisions of 38 C.F.R. § 4.40 state that disability of the musculoskeletal system is primarily the inability, due to damage or inflammation in parts of the system, to perform normal working movements of the body with normal excursion, strength, speed, coordination and endurance. Functional loss may be due to the absence of part, or all, of the necessary bones, joints and muscles, or associated structures. It may also be due to pain supported by adequate pathology and evidenced by visible behavior of the Veteran undertaking the motion. See 38 C.F.R. § 4.40. The factors of disability affecting joints are reduction of normal excursion of movements in different planes, weakened movement, excess fatigability, swelling and pain on movement. See 38 C.F.R. § 4.45. 1. Entitlement to an initial rating in excess of 20 percent for neck strain with degenerative disc disease and intervertebral disc syndrome The Veteran contends that he is entitled to a higher rating for his neck disability. He is currently assigned a 20 percent disability rating pursuant to 38 C.F.R. § 4.71a, Diagnostic Code 5243. Under Diagnostic Code 5243, the code for intervertebral disc syndrome permits evaluation under either the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever results in the higher evaluation when all disabilities are combined. 38 C.F.R. § 4.71a, Diagnostic Codes 5237, 5242, 5243. Diagnostic Codes for consideration include 5237 (lumbosacral or cervical strain), 5242 (degenerative arthritis of the spine), and 5243 (intervertebral disc syndrome). The Formula for Rating IVDS Based on Incapacitating Episodes provides that a 10 percent rating is warranted when there are incapacitating episodes of IVDS having a total duration of at least one week, but less than two weeks during the past 12 months. A 20 percent rating is warranted when there are incapacitating episodes of IVDS having a total duration of at least two weeks, but less than four weeks during the past 12 months. A 40 percent rating is warranted when there are incapacitating episodes of IVDS having a total duration of at least four weeks, but less than six weeks during the past 12 months. A 60 percent rating is warranted when there are incapacitating episodes of IVDS having a total duration of at least six weeks during the past 12 months. An incapacitating episode is defined as a period of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician. An evaluation can be had either on the total duration of incapacitating episodes over the past 12 months or by combining separate evaluations of the chronic orthopedic and neurologic manifestations along with evaluations for all other disabilities under 38 C.F.R. § 4.25, whichever method resulted in the higher evaluation. Id. Under the General Rating Formula, a 20 percent rating is warranted for forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or the combined range of motion of the cervical spine is not greater than 170 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 30 percent rating is warranted for forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine. A 40 percent rating is warranted for unfavorable ankylosis of the entire cervical spine. A 100 percent rating is warranted for unfavorable ankylosis of the entire spine. Id. Note (1): Evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code. Note (2): For VA compensation purposes, normal forward flexion of the cervical spine is zero to 45 degrees, extension is zero to 45 degrees, right and left lateral flexion is zero to 45 degrees, and left and right lateral rotation is zero to 80 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. Note (3): In exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in Note (2). Provided that the examiner supplies an explanation, the examiner's assessment that the range of motion is normal for that individual will be accepted. Note (4): Round each range of motion measurement to the nearest five degrees. Note (5): For VA compensation purposes, unfavorable ankylosis is a condition in which the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Note (6): Separately evaluate disability of the thoracolumbar and cervical spine segments, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability. The Board notes that the criteria for the evaluation of musculoskeletal disabilities in the VA Rating Schedule have been amended effective February 7, 2021 (the 2021 Regulations); therefore, claims filed on or after February 7, 2021, must be evaluated under the 2021 Regulations. See 85 Fed. Reg. 76453-76469 (November 30, 2020); 85 Fed. Reg. 85523-85524 (December 29, 2020). In this case, although the Veteran's neck claim was filed prior to February 7, 2021, to the extent that the periods on appeal relating to such claims extend beyond February 7, 2021, such claims must be evaluated under both the prior regulations and the 2021 Regulations, and the set of criteria most favorable to the Veteran must be applied. See Kuzma v. Principi, 341 F.3d 1327, 1328-29 (Fed. Cir. 2003). Amended Diagnostic Code 5243 governs Intervertebral Disc Syndrome (IVDS) and provides applies only when there is disc herniation with compression and/or irritation of the adjacent nerve root; assign Diagnostic Code 5242 for all other disc diagnoses. See 38 C.F.R. § 4.71a, Diagnostic Code 5243 (2021). November 2016 VA treatment records reflect that the Veteran's neck had full range of motion and he denied any discomfort. In February 2017, the Veteran reported neck pain. See February 2017 VA treatment records. The Veteran submitted a claim for entitlement to a higher rating for his neck disability in February 2017. The Veteran attended a VA examination in June 2017. He reported chronic pain since his in-service neck injury. The Veteran reported flare-ups usually in the winter as well as dizziness associated with looking up and down. He also reported neck spasms resulting in an abnormal gait. Range of motion testing revealed forward flexion to 35 degrees, extension to 20 degrees, lateral flexion 15 degrees bilaterally, and right lateral rotation to 15 degrees and left lateral rotation to 30 degrees. The combined range of motion was 130 degrees. IVDS without prescribed bedrest was reported. During September 2017 VA treatment, the Veteran reported aching left-sided neck pain within the last year. He had full range of motion upon inspection. The Veteran underwent a cervical discectomy and fusion for his neck in March 2018. See March 2018 VA treatment records. During October 2018 VA treatment, the Veteran reported that the March 2018 neck surgery relieved his neck pain considerably. Examination revealed limited range of motion with no pain. March 2019 VA treatment records reflect that the Veteran had full range of motion in his neck. An MRI revealed asymmetric fullness, but his evaluation was unremarkable. During June 2020 private treatment, the Veteran exhibited normal range of motion. September 2020 VA treatment records reflect that the Veteran had full range of motion in his neck. He denied any new symptoms or concerns. December 2020 VA treatment records reflect that the Veteran had full range of motion in his neck. During his January 2021 Board hearing, the Veteran testified that he believed his neck disability had progressed in severity. March 2021 private treatment records reflect that the Veteran had full range of motion in his neck. The Veteran attended a VA examination in August 2021. He reported daily flare-ups and difficulty turning his neck. There was no guarding or muscle spasms. Range of motion testing revealed forward flexion to 30 degrees, extension to 30 degrees, lateral flexion 30 degrees bilaterally, and lateral rotation to 55 degrees bilaterally. Pain was noted with all movement. The Veteran was able to perform repetitive use testing without any additional loss of motion. Following repeated use, the examiner estimated that forward flexion would be limited to 20 degrees, extension to 20 degrees, lateral flexion to 20 degrees bilaterally, and lateral rotation to 45 degrees bilaterally. During a flare-up, the examiner estimated that forward flexion would be limited to 20 degrees, extension to 20 degrees, lateral flexion 20 degrees bilaterally, and lateral rotation to 40 degrees bilaterally. The worst combined range of motion was 160 degrees. There was no ankylosis and no IVDS. As noted above, a rating in excess of 20 percent is available if the competent medical and other evidence of record reflects no less than either (1) incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months or (2) forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine. See the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes and The General Rating Formula for Diseases and Injuries of the Spine, respectively. Regarding the orthopedic manifestations, the record does not contain evidence of forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine, as such, the general rating criteria do not entitle the Veteran to a rating in excess of 20 percent. Specifically, the June 2017 and August 2021 VA examinations both demonstrated forward flexion greater than 15 degrees. The August 2021 examiner estimated that following repeated use or during a flare-up, the Veteran's forward flexion would still be greater than 15 degrees. The current general rating formula provides for disability ratings without regard to symptoms such as pain, stiffness, or aching. Additionally, all of the VA examiners specifically found that there was no ankylosis. The Board also finds that there is no basis for the assignment of any higher rating based on consideration of any of the factors addressed in 38 C.F.R. §§ 4.40, 4.45 and DeLuca, 8 Vet. App. at 204-7. Competent medical evidence reflects that the currently assigned 20 percent rating properly compensates him for the extent of functional loss resulting from any such symptoms. Although it was noted on the VA examinations that the Veteran exhibited pain on cervical spine motion, the functional loss is not equivalent to limitation of flexion to 15 degrees or less; or, favorable ankylosis of the entire cervical spine to meet the criteria for a 30 percent evaluation. See 38 C.F.R. § 4.71a, Diagnostic Code 5242. Since flexion has not been limited to 15 degrees or less even after repetitive use or during a flare-up; and the Veteran's spine is not ankylosed since he has demonstrated the ability to flex, extend, and laterally flex and rotate, the criteria for a 30 percent evaluation have not been met. Thus, the Board finds that the current initial 20 percent evaluation adequately portrays any functional impairment, pain, and weakness that the Veteran experiences as a consequence of use of his service-connected cervical spine disability. Regarding an evaluation in excess of 20 percent based on incapacitating episodes, the Board again notes that under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, a higher rating of 40 percent is warranted where the evidence reveals incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past 12 months. As noted by the June 2017 VA examiner, the Veteran had a diagnosis of intervertebral disc syndrome but had not had any incapacitating episodes of neck pain in the last 12 months. Furthermore, the August 2021 VA examiner did not find that the diagnosis of intervertebral disc syndrome was appropriate, and also determined that there had not had any incapacitating episodes of neck pain in the last 12 months. Therefore, a higher rating based on incapacitating episodes is not warranted. See 38 C.F.R. § 4.71a, Diagnostic Code 5243 (2020). Thus, for all the foregoing reasons, the Board finds that an initial rating in excess of 20 percent for a cervical spine disability is not warranted. Finally, the Board also acknowledges that Note (1) to the General Rating Formula for Diseases and Injuries of the Spine provide for separate rating(s) for associated neurologic impairment. The Board notes that the Veteran is service connected for left and right upper extremity radiculopathy. The Veteran has not disagreed with the evaluations assigned for right and left upper extremity radiculopathy. Accordingly, these issues are not before the Board. In conclusion, the Board finds that the preponderance of the evidence is against the assignment of an initial rating in excess of 20 percent for a cervical spine disability. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107 (2012); 38 C.F.R. § 3.102 (2020). Service Connection A veteran is entitled to VA disability compensation if there is a disability resulting from personal injury suffered or disease contracted in line of duty in active service, or for aggravation of a preexisting injury suffered or disease contracted in line of duty in active service. 38 U.S.C. §§ 1110, 1131. To establish a right to compensation for a present disability, a Veteran must show: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service" - the so-called "nexus" requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for a disease shown after service, when all of the evidence, including that pertinent to service, shows that it was incurred in-service. 38 C.F.R. § 3.303(d). Service connection for chronic disease may be granted if manifest to a compensable degree within one year of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "Chronic." When the disease identity is established (leprosy, tuberculosis, multiple sclerosis, etc.), there is no requirement of evidentiary showing of continuity. Continuity of symptomatology is required only where the condition noted during service (or in the presumptive period) is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b). Service connection for a recognized chronic disease can also be established through continuity of symptomatology. Walker v. Shinseki, 708 F.3d 1331 (2013); 38 C.F.R. §§ 3.303(b), 3.309. Under applicable criteria, VA shall consider all lay and medical evidence of record in a case with respect to benefits under laws administered by VA. In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Entitlement to service connection for a disability of the right hand The Veteran contends that he is entitled to service connection for a right-hand disability stemming from an in-service motorcycle accident. Service treatment records (STRs) are associated with the claims file. The Veteran hit a clothesline and lacerated his throat in a motorcycle accident in February 1978. He required sutures to the anterior neck. A description of the incident in his personnel records reveals that he suffered two lacerations to his throat that required stitches. No other injuries were noted. During his September 1978 separation examination, the Veteran's upper extremities were determined to be normal. December 2002 VA treatment records reflect that the Veteran reported that he had been diagnosed with rheumatoid arthritis in the 1980's and had corresponding swelling in his hands and feet. During January 2005 VA treatment, the Veteran stated that his job required him to use a lot of hand controls which caused problems with his hand. The Veteran submitted a claim for entitlement to service connection for a right hand disability in February 2017. The Veteran attended a VA examination in June 2017. The Veteran stated that he injured his right hand during the February 1978 motorcycle accident. He stated that there were no obvious abnormalities but that he did have it x-rayed at the time of injury. He reported pain consistently from the time of injury. The examiner noted that the Veteran had psoriatic arthritis of the right hand and arthritis of the fifth MCP joint and second through fifth PIP joint. The examiner determined that the Veteran was not entitled to service connection because, "[t]here is no mechanism for injury or enough evidence from record to support that the [V]eteran's right hand conditions were incurred in or caused by the right-hand condition that occurred during service." On his September 2017 notice of disagreement, the Veteran clarified that he injured his right wrist in the February 1978 motorcycle accident. He stated that he fractured his wrist at the time of the accident and was not aware of the injury until after his discharge. During his January 2021 Board hearing, the Veteran testified that he injured his right wrist when he fell of his motorcycle in service. He explained that he did not have swelling but that his wrist was sore. The Veteran stated that he sought medical attention in the early 1980's and that a private doctor informed him that his wrist was broken. He then required surgery. The Veteran testified that the private records were unavailable because the private doctor had retired. Another opinion was obtained in August 2021. The Veteran explained that his right wrist was sore following an in-service motorcycle accident but that he did not seek medical attention until after separation when he had surgery to repair a fractured bone. In regard to his right hand, the Veteran reported pain and stiffness. The examiner determined that the Veteran had rheumatoid arthritis in the right hand. Following an examination and review of the claims file, the VA examiner determined that the Veteran's right hand disability was less likely than not related to the Veteran's service, to include an in-service motorcycle accident. He explained that the Veteran's right hand disability was secondary to the Veteran's rheumatoid arthritis and that the Veteran's in-service wrist injury would not cause his current issues with his hand and fingers. In this case, the Board accepts the August 2021 VA examiner's opinion that the Veteran's right hand disability is less likely than not related to his service as highly probative medical evidence on this point. The Board notes that the examiner rendered the opinion after thoroughly reviewing the claims file and relevant medical records. The examiner noted the Veteran's pertinent history and provided a reasoned analysis of the case. See Hernandez-Toyens v. West, 11 Vet. App. 379, 383 (1998); Gabrielson v. Brown, 7 Vet. App. 36, 40 (1994). There is no probative medical evidence of record contradicting the findings of the August 2021 VA examiner. The Board has also considered the general lay assertions of record. To the degree that the Veteran has reported a continuity of symptoms since service, he is competent to report his observations and relate what he was told by medical professionals. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). He reported that his right wrist was sore, but he has not reported any continuity of symptoms regarding his right hand and right fingers. Additionally, the Veteran has not indicated that a medical professional provided him with a diagnosis of rheumatoid arthritis during service or immediately thereafter. Id. The Veteran's main contention has been that he injured his right wrist in service and that his current right-hand arthritis is related to the right wrist in-service injury. The Veteran's bare lay assertions are far less probative than the opinion of the VA professional, in part due to the VA medical opinion being far more detailed and reasoned. The Board finds that the probative value of the general lay assertions is outweighed by the clinical evidence of record. In sum, there is no reliable evidence linking the Veteran's right-hand disabilities to service. The contemporaneous records establish that there were no documented manifestations of a right hand disability in service, relevant systems were normal upon separation, there were no manifestations of arthritis within one year of separation, and arthritis was first manifest several years after separation. The Board finds the contemporaneous records to be far more probative and credible than the Veteran's bare assertions. Here, chronic disease (arthritis) was not "noted" during service or within one year of separation within the meaning of section 3.303(b). Service treatment records do not show a combination of manifestations sufficient to identify the disease entity (arthritis), and sufficient observation to establish chronicity at the time. Relevant systems were normal upon separation. Furthermore, the evidence does not establish that rheumatoid arthritis or psoriatic arthritis of the right hand and arthritis of the fifth MCP joint and second through fifth PIP joint were manifest to a compensable degree within one year of separation. 38 C.F.R. §§ 3.307; 3.309. The evidence of record shows that the Veteran's rheumatoid arthritis and psoriatic arthritis of the right hand and arthritis of the fifth MCP joint and second through fifth PIP joint were manifest several years after service. The Veteran was not shown to have rheumatoid arthritis, psoriatic arthritis, or any relevant medically chronic disorder in service, and did not have characteristic manifestations of such a disorder until several years after discharge. The more probative evidence establishes that he did not have a relevant disorder during service or within one year of separation. The evidence establishes that the remote onset of rheumatoid arthritis and psoriatic arthritis of the right hand and arthritis of the fifth MCP joint and second through fifth PIP joint are unrelated to service. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran's claim for service connection for a right hand disability. Since the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107 (b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 5557 (1990); 38 C.F.R. § 3.102. For these reasons, the claim is denied. REASONS FOR REMAND 3. Entitlement to service connection for a bilateral foot disability, to include as due to service-connected disease or injury The Board remanded the claim of entitlement to service connection for a bilateral foot disability in June 2021, as there had been no issuance of a statement of the case (SOC). The Agency of Original Jurisdiction (AOJ) was ordered to adjudicate the Veteran's claim in an SOC. However, the AOJ failed to do so. Instead, the AOJ provided the Veteran with a Supplemental SOC (SSOC), indicating that he did not need to respond. Accordingly, the Veteran did not file a VA Form 9 to perfect the appeal for entitlement to service connection for a bilateral foot disability. Without such a perfected appeal, the Board does not have jurisdiction over this claim. As the AOJ failed to follow the Board's June 2021 remand directive, this claim must be remanded once again so that the AOJ can provide the Veteran with a proper SOC and notice of his need to perfect the appeal. See Stegall v. West, 11 Vet. App. 268 (1998). The matters are REMANDED for the following action: Send the Veteran and his representative a statement of the case that addresses the issues of entitlement to service connection for right and left foot disabilities. If the Veteran perfects an appeal by submitting a timely VA Form 9, the issues should be returned to the Board for further appellate consideration. J.W. FRANCIS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Fitzgerald, 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.