Citation Nr: 21077008 Decision Date: 12/28/21 Archive Date: 12/28/21 DOCKET NO. 17-66 917 DATE: December 28, 2021 REMANDED The claim of entitlement to service connection for a bilateral foot condition (claimed as collapsing arches of the left and right foot) is remanded. REASONS FOR REMAND The Veteran had honorable active duty service in the United States Navy from August 1976 to May 1980. These matters come before the Board of Veterans' Appeals (Board) from a January 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge (VLJ) in March 2020. A written transcript of that hearing has been prepared and is associated with the evidence of record. The Board previously remanded these matters in July 2020 and June 2021 to develop adequate medical opinion evidence to adjudicate the claims. Although regrettable, additional remand is required for substantial compliance with the Board's previous remand instructions. See Stegall v. West, 11 Vet. App. 268, 270-71 (1998). The claim of entitlement to service connection for a bilateral foot condition (claimed as collapsing arches of the left and right foot) is remanded. The Veteran contends that he has bilateral collapsing arches due to his service. He contends that his duties aboard an aircraft carrier required him to traverse considerable distances on steel decks and ladders, which was hard on his feet. See March 2016 Notice of Disagreement (NOD). Alternatively, he contends that his bilateral foot condition is secondarily related to his service-connected left knee disability (residuals of a lateral tibial fracture), as it caused him to overcompensate from a pin placed in his left knee during service. The Veteran's claim has been broadened to include any bilateral foot condition encompassed by the Veteran's symptoms. See July 2020 Board Remand. The Veteran has submitted multiple lay statements indicating that he experiences pain in his arches, especially when walking without shoes, such as on a flat tile floor, and that it feels as though he is "walking on marbles." See e.g., September 2015 lay and buddy statements. The Veteran testified to the Board that he had foot pain during service but acknowledged that he did not seek medical treatment for his feet during service. Development of the Veteran's claim (which he filed in August 2015) has included completion of a VA examination in August 2020 and multiple medical opinions, including addendum reports dated October 2020 and July 2021. Regrettably, the medical opinions of record are not adequately responsive to the Board's directives, particularly as to aggravation of the Veteran's foot conditions and appear to conflict with other medical evidence of record. For example, the Board has sought opinions to assess whether the Veteran's foot conditions were aggravated beyond their natural progression by another of the Veteran's service-connected conditions. The Board has expressly noted that "aggravation" in this context includes any incremental increase (beyond natural progression) in non-service-connected disabilities resulting from service-connected conditions regardless of permanence. The July 2021 clinician opined that there had been no permanent worsening in the Veteran's foot condition, relying on a 2019 VA treatment note of some improvement in the Veteran's condition, which is inadequate for the Board's purposes. Further, the examiner provided conclusory rationale for her opinion as to secondary service connection and did not adequately address whether the Veteran's abnormal gait and 3-centimeter leg length discrepancy due to his left leg condition could have caused or aggravated his identified arch conditions and pain. The matters are REMANDED for the following action: 1. Obtain a medical opinion from an appropriate clinician, preferably a podiatrist, regarding the questions below. A new in-person or tele-health examination should be scheduled if necessary to provide the requested opinions. The clinician shall be advised to consider all prior VA and private examinations and opinions, all prior remands and remand instructions, and all of the Veteran's medical records to include service treatment records. The clinician shall be advised to consider the Veteran's lay statements regarding onset and continuity of symptoms in forming these opinions. The examiner must address the following questions: (a.) For each of the Veteran's identified bilateral foot conditions that relate to and/or are capable of causing arch pain, opine whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran's bilateral foot condition/pain with functional loss is proximately due to or the result of the Veteran's active duty service. (b.) For each of the Veteran's identified bilateral foot conditions that relate to and/or are capable of causing arch pain, opine whether it is at least as likely as not that the Veteran's bilateral foot condition/pain with functional loss is caused by or aggravated beyond its natural progression by an already service-connected disability (specifically, to include the Veteran's left knee condition). Here, the term "aggravation" refers to a any incremental increase in disabilityany additional impairment of earning capacity during the period on appealin non-service-connected disabilities resulting from service-connected conditions regardless of its permanence, beyond its natural progression, as contrasted to temporary or intermittent flare-ups of symptomatology which resolve with return to the baseline level of disability. See Ward v. Wilkie, 31 Vet. App. 233 (2019). (Continued on the next page) A complete rationale must be provided for any and all opinions offered. If any requested opinion cannot be provided without resorting to mere speculation, the examiner must fully explain why this is the case and identify what, if any, additional evidence or information might allow for a more definitive opinion. 2. Following completion of the foregoing, the Agency of Original Jurisdiction (AOJ) should review the record, perform any necessary development, and readjudicate the claim on appeal. If the appeal is denied, the AOJ should issue an appropriate Supplemental Statement of the Case (SSOC), afford the Appellant and his representative an opportunity to respond, and return the case to the Board. B. MULLINS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Hart, 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.