Citation Nr: 21076222 Decision Date: 12/22/21 Archive Date: 12/22/21 DOCKET NO. 14-33 960 DATE: December 22, 2021 REMANDED Entitlement to service connection for residuals of a left great toe injury is remanded. Entitlement to service connection for a kidney disability is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1967 to July 1970, to include service in the Republic of Vietnam. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In March 2018, the Veteran testified before a Veterans Law Judge (VLJ) who is no longer available to decide the appeal. A copy of the transcript from that hearing is of record. In November 2021, the Veteran was notified of his right to request another hearing before a different VLJ. The Board notified the Veteran of this fact and provided him the opportunity to testify at another hearing, but he did not request another hearing. Thus, as indicated in the letter sent to the Veteran, the Board will proceed under the assumption that he does not wish to appear for another hearing before the Board. These matters were previously remanded by the Board in June 2018 and July 2020. They have since been returned to the Board for further appellate review. 1. Entitlement to service connection for residuals of a left big toe injury is remanded. In June 2021, the Veteran presented for a VA examination regarding his left great toe. The examiner opined that the Veteran's left great toe disability was less likely than not incurred in or caused by service as there were no service treatment records that showed the left great toe disability was incurred in or caused by service. The examiner stated that there was insufficient information to determine if the toe injury was caused by the June 1970 incident, because there are no STRs that show that the left big toe disability was incurred in or caused by an in-service injury, event, or illness. He then stated that it was less likely that not that the claimed condition was caused by the claimed in-service injury, event, or illness because a nexus has not been established. The Board finds this opinion to be inadequate, as it appears to be internally inconsistent, and there is no explanation or rationale provided as to how the examiner reached his conclusions. It remains unclear what other information might be needed to allow for a determination whether the current toe injury is related to the June 1970 in-service incident documented in the Veteran's service treatment records, or why the examiner discounted the Veteran's report of experiencing toe pain and symptoms since service. On remand, a supplemental medical opinion should be sought. 2. Entitlement to service connection for a kidney disability is remanded. As the kidney disability is claimed as secondary to the medication taken by the Veteran to self-treat his left big toe disability, a decision on the claim of entitlement to service connection for a left great toe disability could significantly impact the claim for service connection for a kidney disability, they are found to be intertwined. The appeal seeking service connection for a kidney disability must therefore also be remanded. The matters are REMANDED for the following action: 1. Refer the file to an appropriate medical professional(s) ("clinician") to obtain a supplemental medical opinion pertaining to the Veteran's left great toe and kidney disability claims. If the clinician determines that an opinion cannot be provided without additional examination, one should be scheduled, and the Veteran provided with notice. The clinician is asked to address the following: (a) Is it at least as likely as not (50 percent or greater probability) that any current left great toe disability (i.e., present at any point from December 2010 to the Present) is related to an in-service injury, event, or disease, to include the June 1970 injury to his left great toe documented in the Veteran's service treatment records? If and only if the clinician answers the above in the affirmative (i.e., it is at least as likely as not that a current left great toe disability arose during or is related to service), the clinician should address the following: (b) Is it at least as likely as not that any currently diagnosed kidney disability is proximately due to (caused by) the Veteran's left great toe disability? (c) Is it at least as likely as not that any currently diagnosed kidney disability has been aggravated beyond its natural progression by (defined as any increase in disability) the Veteran's left great toe disability? The clinician is advised that aggravation here is defined as any increase in disability. If aggravation is present, the clinician should indicate, to the extent possible, the approximate level of disability (baseline) before the onset of the aggravation. The clinician's attention is directed to the Veteran's testimony at the March 2018 Board hearing that his doctors have told him that his use of ibuprofen to self-medicate his foot disabilities. A complete rationale must be provided for all opinions or conclusions stated. If the clinician cannot provide an opinion without resort to speculation, they must state whether the need to speculate is due to a deficiency in the state of general medical knowledge; the clinician's own expertise, or; whether additional facts are required and note what, if any, additional evidence would permit such an opinion to be made. 2. After completing the above, and conducting any further development deemed necessary in light of the expanded record, readjudicate the issues of entitlement to service connection for a left big toe disability and a kidney disability. If any of the benefits sought are not granted to the Veteran's satisfaction, issue him and his representative a supplemental statement of the case and allow them an opportunity to respond before returning the appeal the Board, if in order. A. SOLOMON Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Jarman, 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.