Citation Nr: 21073995 Decision Date: 12/13/21 Archive Date: 12/13/21 DOCKET NO. 17-33 233 DATE: December 13, 2021 REMANDED Entitlement to service connection for bilateral pes planus (claimed as flatfeet and pain) to include as secondary to service connected bilateral knee disabilities is remanded. Entitlement to a rating in excess of 10 percent for patellofemoral syndrome with subluxation of the right knee is remanded. Entitlement to a rating in excess of 10 percent for patellofemoral pain syndrome with limited motion of the right knee is remanded. REASONS REMAND The Veteran had active duty for training (ACTDUTRA) from January 2001 to June 2001 and active duty from January 2004 to May 2004 with additional service in the Army National Guard. This matter comes before the Board of Veterans' Appeals (Board) on appeal from rating decisions dated July 2014 and July 2015. The Veteran's claims on appeal were remanded by the Board in June 2021. The issue of entitlement to service connection for a left knee disability was granted in an August 2021 Regional Office (RO) rating decision effective April 7, 2014, the date of claim. As this represents a complete grant of the claim of service connection for a left knee disability, that issue is no longer on appeal before the Board. See generally Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997); Barrera v. Gober, 122 F.3d 1030 (Fed. Cir. 1997). The Veteran testified at a virtual Board hearing before the undersigned Veterans Law Judge in August 2020. A copy of the transcript is of record. 1. Entitlement to service connection for bilateral pes planus (claimed as flatfeet and pain) to include as secondary to service connected bilateral knee disabilities is remanded. At her August 2020 virtual Board hearing, the Veteran contended that her bilateral pes planus is related to service on a direct basis due to harm caused by the boots she wore during active duty. In that regard the Veteran noted that while she complained to her commanding officer about pain and bought her own inserts for the boots, she did not go to sick hall for treatment. The Veteran also asserted that her bilateral pes planus is related to service on a secondary basis as a result of her service connected knee disabilities and indicated that her podiatrist told her that her feet problems were connected to knee problems. In June 2021, the Board remanded the Veteran's bilateral pes planus claim for a new VA examination and nexus medical opinion. While a new examination was conducted and medical opinion obtained in July 2021, the Board finds that the July 2021 VA medical opinion is inadequate for adjudication purposes. Specifically, in reaching negative nexus opinions regarding the different theories of entitlement, the examiner did not consider the Veteran's lay statements that she experienced pain, required orthotic inserts for her boots and did not know she had flatfeet until she left service. Accordingly, the Board finds that remand for an addendum medical opinion which considers the full record, to include the Veteran's lay statements of in service incurrence and symptomatology is warranted. 2. Entitlement to a rating in excess of 10 percent for patellofemoral syndrome with subluxation of the right knee is remanded. 3. Entitlement to a rating in excess of 10 percent for patellofemoral syndrome with pain and limited motion of the right knee is remanded. In September 2021 correspondence, the Veteran contends that the July 2021 Knee VA examination was not properly conducted. Specifically, she contends that while the examiner interviewed her, they failed to measure her range of motion using a goniometer, which is classified in 38 C.F.R. § 4.46 as "indispensable" in the measurement of limitation of motion for increased rating claims. As the "accurate measurement of the... excursion of joints... should be insisted upon," the Board finds that remand is warranted. The matters are REMANDED for the following action: 1. Associate with the claims file any outstanding VA treatment records. 2. After the above development is completed, forward the Veteran's claims file to the July 2021 VA examiner for review and to obtain a supplemental opinion regarding the Veteran's bilateral pes planus disability. If that examiner is no longer available, the claims file should be forwarded to another appropriate examiner for review and opinion. If, and only if, it is determined by the medical professional providing the opinion that a physical examination is necessary to provide the requested opinion, then such should be scheduled. The examiner should be asked to provide an opinion to the following: 3. Is there clear and unmistakable (undebatable) evidence that the Veteran's bilateral pes planus preexisted service? 4. If so, is there clear and unmistakable (undebatable) evidence that the Veteran's preexisting bilateral pes planus was not aggravated by service ("aggravated" means a worsening beyond the natural progression)? 5. If there is not clear and unmistakable evidence that the Veteran's bilateral pes planus disability preexisted service or was not permanently aggravated by service, is it at least as likely as not (a probability of 50 percent or greater) that the Veteran's pes planus had its onset in service or is otherwise related to service, to include as a result of boots issued to the Veteran? 6. If not, is at least as likely as not the Veteran's bilateral pes planus was (i) directly caused, or (ii) aggravated (i.e., worsened beyond natural progression) by her service-connected bilateral knee disabilities? 7. Schedule the Veteran for a VA examination with an examiner other than the July 2021 VA examiner to determine the nature and current severity of her service- connected right knee disabilities. The claims file must be made available to and reviewed by the examiner prior to the examination. All necessary tests should be conducted, and the examiner should review the results of any testing prior to completion of the report. The examination must be conducted in accordance with the current disability benefits questionnaire or examination worksheet applicable to the disability. Ranges of motion in active motion, passive motion, weight-bearing, and non - weightbearing, for the right knee must be conducted with the use of the goniometer, as appropriate. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he or she should clearly explain why that is so. The examiner should also provide an opinion concerning the functional impairment of the Veteran's service-connected right knee disability. The examiner should specifically indicate that a goniometer is utilized during the examination. A comprehensive rationale for all opinions is to be provided. All pertinent evidence, including both lay and medical, should be considered. If an opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training). Jennifer White Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Alexander 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.