Citation Nr: 21071246 Decision Date: 11/30/21 Archive Date: 11/30/21 DOCKET NO. 13-19 597 DATE: November 30, 2021 REMANDED Entitlement to service connection for a left foot disability, to include as secondary to a right ankle disability is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1982 to June 1992. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2011 rating decision. In October 2017, the Veteran testified before the undersigned Veterans Law Judge (VLJ) at a video-conference hearing. A transcript of that hearing is of record. The Veteran's claims for service connection for a left foot disability and a right ankle disability were remanded by the Board in October 2017, January 2020, and January 2021 for further development. Following the January 2021 remand, a July 2021 rating decision granted service connection for degenerative arthritis right ankle and assigned a 10 percent disability rating, effective February 11, 2011. As this is a full grant of the benefit sought regarding service connection for a right ankle disability, this issue is no longer before the Board. See Grantham v. Brown, 114 F.3d 1156, 1158-59 (Fed. Cir. 1997). Unfortunately, the Veteran's claim for service connection for a left foot disability must be remanded for further development. Although the Board sincerely regrets the additional delay, it is necessary to ensure that there is a complete record upon which to decide the Veteran's claim, so he is afforded every possible consideration. Entitlement to service connection for a left foot disability, to include as secondary to a right ankle disability is remanded. The Veteran's claim for service connection was remanded in January 2021, in part, to schedule him for an examination obtain addendum medical opinions addressing the nature and etiology of all identified left foot disabilities. Of note, the examiner providing the medical opinion was directed to opine whether any identified left foot disability was proximately due to or aggravated by his right ankle disability. In providing the medical opinions, the examiner was instructed to consider and discuss the Veteran's lay statements indicating that his right ankle disability causes his right ankle to "fail" and he falls, and he has injured his left foot due to such, and that his right ankle disability has caused him to alter his gait, and such has resulted in a left foot disability. Lastly, the examiner was instructed to discuss what other factor(s) caused his left foot disability if it is determined that his left foot disability is not related to his right ankle disability. Subsequently, the Veteran was provided a June 2021 Foot Conditions, Including Flatfoot (Pes Planus) Disability Benefits Questionnaire. The examination report demonstrates that the Veteran has a diagnosis of left foot degenerative arthritis. Diagnostic imaging from June 2021 showed moderate osteoarthritis of the left foot with osteophytes and sclerosis at the first metatarsal head and first metatarsophalangeal joint. Degenerative changes were also noted in the cuneiform and navicular bones and the second and third distal interphalangeal joints. A corresponding June 2021 medical opinion concludes that the Veteran's left foot disabilities, including, but not limited to, mild hallux valgus deformity of the great toe with moderate flexion deformity of fourth and fifth toes, early spur formation in the plantar aspect of the calcaneus, and left naviculocuneiform post-traumatic degenerative joint disease is less likely than not proximately due to or the result of the his right ankle disability including, but not limited to, sprain, any anterior tarsal tunnel syndrome hypersensitivity to the right lateral ankle, right ankle instability, anterolateral tenderness of the right ankle, and old avulsive fracture fragment of the tibia. A June 2021 X-ray shows that the Veteran has moderate osteoarthritis of his left ankle. The medical opinion states that the Veteran began experiencing pain in his left foot in 2012, which is well after his discharge from active service. In responding to the directive to consider and discuss the Veteran's lay statements indicating that his right ankle disability causes his right ankle to "fail" and he falls, and he has injured his left foot due to such, and that his right ankle disability has caused him to alter his gait, and such has resulted in a left foot disability, the June 2021 examiner stated that he began experiencing pain in his left foot in 2012, which is well after his discharge from active service and a June 2021 X-ray showed that he has moderate osteoarthritis of the left foot. In opining on what other factor(s) caused the Veteran's left foot disability, the June 2021 examiner provided the same reasoning regarding the onset of his left foot pain and his June 2021 diagnosis of moderate osteoarthritis of the left foot. A separate June 2021 medical opinion states that the Veteran's left foot disability is less likely than not aggravated beyond its natural progression by his right ankle disability as a June 2021 X-ray revealed that he had moderate osteoarthritis of the left foot. The rationale concludes that the Veteran's diagnosed left foot arthritis is less likely than not proximately due to or the result of his service-connected condition. An August 2021 addendum medical opinion provides that the Veteran's right ankle disability, an opposite injury, does not cause osteoarthritis in the left foot. Osteoarthritis is caused by joints wearing down over time as you slowly lose the smooth cushioning cartilage. Although the Veteran claims that he has an injured left foot due to a right foot or ankle injury from a fall, osteoarthritis is a progressive disease. Therefore, it is opined that these are still negative opinions in both scenarios. For the following reasons, the Board finds that the above medical opinions are inadequate. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (holding that when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate); see also Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992) (reflecting that the Board is free to assess medical evidence and is not obligated to accept a physician's opinion). Therefore, new medical opinions are necessary to fully address the nature and etiology of the Veteran's left foot disability. The June 2021 medical opinion concerning whether the Veteran's left foot disability was proximately caused by his right ankle disability is inadequate as there is no showing that the examiner considered the Veteran's lay statements regarding the impact of his right ankle in causing him to fall and alter his gait. See Miller v. Wilkie, 32 Vet. App. 249 (2020) (holding that the Board errs when it relies on an examination that fails to consider the veteran's relevant statements and the Board is silent on the credibility of these statements). The June 2021 medical opinion regarding whether the Veteran's left foot disability was aggravated beyond its natural progression by his right ankle disability is inadequate because it fails to provide any meaningful analysis or discussion of the medical or lay evidence of record. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A] medical opinion must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions.") In finding that the examiner also failed to meaningfully discuss what other factor(s) caused the Veteran's left foot disability. See Stegall v. West, 11 Vet. App. 268, 271 (1998); see also D'Aries v. Peake, 22 Vet. App. 97, 105 (2008) (holding that only substantial rather than strict compliance with the Board's remand directives is required under Stegall). Lastly, the August 2021 medical opinion addressing whether the Veteran's left foot disability was proximately caused by or aggravated by his right ankle disability is inadequate. The medical opinion states that osteoarthritis is caused by joints wearing down over time as smooth cushioning cartilage is lost. However, the medical opinion does not consider the impact of his reported altered gait as a result of a right ankle disability on his left foot disability. Miller, 32 Vet. App. 249. The matters are REMANDED for the following action: 1. Obtain the Veteran's VA treatment records for the period from March 2021 to the present. 2. After the above development is completed, obtain addendum medical opinions concerning the nature and etiology of the Veteran's left foot disability. The examiner providing the opinions must review the claims file. The examiner must: (a.) Identify all current left foot disabilities found to be present, including, but not limited to mild hallux valgus deformity of the great toe with moderate flexion deformity of fourth and fifth toes, early spur formation in the plantar aspect of the calcaneus, and left naviculocuneiform posttraumatic degenerative joint disease, moderate osteoarthritis of the left foot with osteophytes and sclerosis at the first metatarsal head and first metatarsophalangeal joint, and degenerative changes in the cuneiform and navicular bones and the second and third distal interphalangeal joints. (b.) Opine whether any identified left foot disability, is/are at least as likely as not (50 percent probability or greater) proximately due to the Veteran's service-connected degenerative arthritis right ankle. (c.) Opine whether any identified left foot disability is/are at least as likely as not (50 percent probability or greater) aggravated, i.e., worsened beyond its natural progression, by the Veteran's service-connected degenerative arthritis right ankle. The examiner must consider and discuss the Veteran's lay statements that his right ankle disability causes his right ankle to "fail" and he falls as a result. He has injured his left foot due to such falls. Further, his right ankle disability has caused him to alter his gait, which has resulted in a left foot disability. If the examiner determines that it is less likely than not that any of the Veteran's left foot disabilities is/are less likely than not related to his service-connected degenerative arthritis right ankle, the examiner should discuss what other factor(s) caused the left foot disability. A complete rationale must be provided for all opinions and conclusions reached. P.M. DILORENZO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Mussey, Sean 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.