Citation Nr: 21075256 Decision Date: 12/20/21 Archive Date: 12/20/21 DOCKET NO. 19-03 325 DATE: December 20, 2021 REMANDED Entitlement to service connection for a right foot disorder is remanded. Entitlement to service connection for a left knee disorder is remanded. Entitlement to service connection for a right knee disorder is remanded. Entitlement to service connection for a headache disorder is remanded. Entitlement to service connection for a lumbar spine disorder, to include as secondary to bilateral knee and right foot disorders, is remanded. REASONS FOR REMAND The Veteran served on active duty in the Marine Corps from July 1980 to July 1983. This matter comes before the Board of Veterans' Appeals (Board) on appeal of November 2017 and February 2018 rating decisions issued by a regional office (hereinafter agency of original jurisdiction or AOJ) of the Department of Veterans Affairs (VA). The Veteran testified before the undersigned Veterans Law Judge at a May 2021 videoconference hearing, a transcript of which has been attached to the record. 1. Entitlement to service connection for a right foot disorder is remanded. The Veteran asserts that his current right foot disorder is due to his active service, specifically an incident in which he dropped an artillery round on his foot. The Board observes that the Veteran has not been afforded a VA examination for this claim. A VA medical examination is required when there is competent evidence of a current disability, evidence of an in-service event, injury or disease, indication that a current disability may be service related (to include secondary service connection), and there is otherwise insufficient medical evidence to make a decision. McLendon v. Nicholson, 20 Vet. App. 79, 81-83 (2006). The threshold for determining whether the evidence "indicates" that there "may" be a nexus between a current disability and an in-service event, injury, or disease is a low one. Id. at 83. In this case, the Veteran's service treatment records indicate that in July 1982, the Veteran reported to sickbay with complaints of swelling of the big toe on his right foot after dropping an object on it. The treating clinician noted slight swelling and a large hematoma under the nail of the right great toe. June 2017 imaging notes a normal right great toe except for old trauma on the distal tuft of the first toe, and at the May 2021 hearing the Veteran reported right foot issues since separation from service. As such, the Board finds that in this case the "low" bar of McLendon has been cleared, and that remand is required in order to afford the Veteran a VA examination. 2. Entitlement to service connection for a left knee disorder is remanded. 3. Entitlement to service connection for a right knee disorder is remanded. The Veteran's service treatment records indicate he was treated once for complaints of right knee pain and swelling, as well as twice for left knee pain, including a diagnosis of recurrent left knee strain. At the May 2021 Board hearing, the Veteran reported continuing knee swelling and pain post-service. He was afforded a November 2017 VA knee examination, during which the examiner noted a diagnosis of bilateral knee strain. In providing a negative nexus opinion, the examiner noted the Veteran's separation examination was silent for knee issues and characterized his inservice knee injuries as mild and self-limiting. Unless the Board finds the lay statements not competent or not credible, an examiner's opinion must address the Veteran's relevant lay statements in order to include enough detail to inform the Board's decision. Failure to do so renders that opinion inadequate. Miller v. Wilkie, 32 Vet. App. 249, 258-60 (2020). An adequate medical opinion should address the Veteran's lay description of the onset of his symptoms as well as an explanation of whether "the veteran's assertions are generally inconsistent with medical knowledge or implausible" and whether "the Veteran's reports about symptoms or an inservice injury align with how the disease or disability is known to develop." Id. at 259-260. An examiner's opinion must address the Veteran's relevant lay statements in order to include enough detail to inform the Board's decision, and failure to do so renders that opinion inadequate. Id. at 258-60. As such, the Board finds the VA examiner opinion inadequate, and remand for an addendum addressing the Veteran's lay statements is required. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). 4. Entitlement to service connection for a headache disorder is remanded. The Veteran has asserted that his current headache disorder first manifested in active service. The AOJ afforded the Veteran a November VA headache examination, during which the examiner opined that the Veteran reported the onset of migraines at age 12. After reviewing the Veteran's service treatment records, which include several headache complaints but no formal diagnosis of migraines, the examiner concluded that the Veteran's migraines preexisted and were not aggravated by his active service. In a November 2018 addendum opinion, the same examiner reiterated that the Veteran's subjective headache complaints were not diagnosed inservice as migraines. The Board finds this opinion inadequate. During the May 2021 hearing, the Veteran indicated that while he had experienced headaches prior to service they were not debilitating like those that manifested in and post-service. Given this testimony as well as his entrance examination and report of medical history's silence with regard to headaches, it is not clear and unmistakable that his current headache disorder preexisted service. See 38 U.S.C. § 1111. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). As the current claim is best characterized as one of direct service connection, remand for a new medical opinion utilizing the proper standard is required. 5. Entitlement to service connection for a lumbar spine disorder, to include as secondary to bilateral knee and right foot disorders, is remanded. At the May 2021 hearing, the Veteran and his representative clarified that his claim of entitlement to service connection for a lumbar spine disorder was one of secondary service connection to his bilateral knee and right foot disorders. As the claims for bilateral knee and right foot disorders issues are being remanded to the AOJ for further development, the Board will defer consideration of the back issue at this time. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (two issues are "inextricably intertwined" when the adjudication of one issue could have "significant impact" on the other issue). The matters are REMANDED for the following action: 1. Obtain all VA and relevant private treatment records and attach them to the claims file. 2. Schedule the Veteran for a VA examination with an appropriate clinician in order to determine the nature and etiology of his right foot disorder. After reviewing the claims file, the examiner should identify any current right foot disorders by diagnosis, and for each such disorder, opine whether it is at least as likely as not (50 percent or greater probability) that any such disorder first manifested in or is otherwise etiologically related to the Veteran's active service. In providing the requested opinion(s), the examiner is asked to discuss VA imaging revealing an old trauma on the distal tuft of the first toe and bilateral calcaneal spurs, as well as the Veteran's testimony and service treatment records indicating he dropped an object on his right foot inservice. A full rationale must be provided for any opinion offered. 3. Forward the Veteran's claims file to a qualified VA examiner for an addendum opinion regarding the nature and etiology of his bilateral knee disorder(s). The need for an additional examination is left to the discretion of the examiner. The examiner is requested to first clarify the Veteran's knee diagnoses, to include imaging revealing small chronic and degenerative changes as well as enthesitis bilaterally and chronic fragmentation of the tibial tuberosity consistent with prior Osgood-Schlatter in the left knee. For each diagnosed left and/or right knee disorder, the examiner is asked to opine whether the disorder is at least as likely as not (50 percent probability or greater) manifested in or is otherwise due to his active service. In so opining, the examiner is specifically asked to address the Veteran's lay statements that his bilateral knee pain began in and continued after his active service. The examiner is asked whether there is any medical reason to accept or reject the Veteran's contention that his inservice knee injuries, to include a diagnosis of a recurrent left knee strain, represented the onset of his current knee disorder(s). A full rationale must be provided for any opinion offered. 4. Schedule the Veteran for an examination with an appropriate VA clinician to determine the nature and etiology of his diagnosed headache disorder. After reviewing the Veteran's claims file, the examiner should opine whether it is at least as likely as not (50 percent probability or greater) that the disorder manifested inservice or is otherwise related to his active service. The examiner is asked to address the Veteran's report of worsening post-service headache symptoms that are similar to those he claims manifested inservice, as well as whether there is any medical reason to accept or reject his contention that they are due to his exposure to firing howitzers during service as a field artilleryman. A full rationale must be provided for any opinion offered. T. MAINELLI Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. C. Schumacher, Associate 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.