Citation Nr: 21005473 Decision Date: 02/01/21 Archive Date: 02/01/21 DOCKET NO. 11-32 483 DATE: February 1, 2021 REMANDED Entitlement to service connection for a cervical spine disability is remanded. Entitlement to service connection for a left ankle disability is remanded. Entitlement to service connection for a right ankle disability is remanded. Entitlement to service connection for a right heel disability is remanded. REASONS FOR REMAND The Veteran had had a period of active duty for training (ACDUTRA) in the Army from July to November 1982, and served on active duty in the Air Force from February 1984 to June 1992 (with service in Germany), from February to November 2003 (with service in Southwest Asia, including Qatar and Pakistan), and from May to November 2006 (with service in Southwest Asia, including the United Arab Emirates). This matter comes before the Board of Veterans Appeals (Board) on appeal from a August 2010 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In May 2016, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A copy of the hearing transcript has been associated with the electronic claims file. The Board previously considered this appeal in September 2016, December 2017 and April 2020 and remanded these issues for further development including obtaining addendum VA examination opinions. The case returned to the Board for further appellate review. 1. Entitlement to service connection for a cervical spine disability is remanded. 2. Entitlement to service connection for a left ankle disability is remanded. 3. Entitlement to service connection for a right ankle disability is remanded. 4. Entitlement to service connection for a right heel disability is remanded. Although the Board sincerely regrets the additional delay, another remand is required in the present case. Unfortunately, there has not been substantial compliance with the Board's previous remand directives regarding the issues remaining on appeal. Stegall v. West, 11 Vet. App. 268, 271 (1998). Pursuant to the September 2016 Board’s remand, the Veteran was afforded VA examinations for a neck disability, bilateral ankle disability, and a right heel disability in November 2016. On VA examination in November 2016, the examiner noted that the Veteran’s current x-rays and diagnosis included a cervical strain. The VA examiner did not document the October 2013 diagnosis for mild degenerative changes of the cervical spine. Private treatment records from June 2016 indicate diagnoses for primary osteoarthritis of both ankles and feet. However, the Board notes that November 2016 VA examiner overlooked these diagnoses and found that the Veteran did not have any current diagnoses for the bilateral ankles or right heel. In its December 2017 Remand, the Board found that the November 2016 VA examinations contain inadequate medical opinions regarding the issues of service connection for a neck disability, bilateral ankle disability, and a right heel disability. In its April 2020 remand, the Board found the July 2019 medical opinion inadequate regarding the issue of service connection for a neck disability as its medical opinion again did not address the October 2013 medical evidence as directed in the December 2017 remand. The July 2019 medical opinions for Foot Conditions, including Flatfoot (Pes Planus) and for Ankle Condition, were also found inadequate regarding the issues of service connection for a bilateral ankle disability and right heel disability as once again did not address the June 2016 medical evidence. In April 2020 an addendum medical report was associated with the Veteran’s file. The April 2020 VA examiner first asserted that the July 2019 examiner was not available, that he had reviewed the July 2019 examiner’s reports and that the Board’s request was already addressed in those reports. He then asked that the previous examiners’ report be re-reviewed. His answer was the same for each of the issues on appeal. The April 2020 examiner did not, as directed, address whether the prior October 2013 diagnosis of mild degenerative changes of the cervical spine was related to service or comment on the Veteran’s March 1993 complaint of neck pain in his service treatment records; whether the prior diagnosis in June 2016 private treatment records indicating a diagnosis of primary osteoarthritis of both ankles and feet was at least as likely as not related to the Veteran’s service or specifically comment on the Veteran’s August 1991 treatment for a sprained ankle, or the Veteran’s April 1988 right heel contusion and the June 2016 private treatment records indicating primary osteoarthritis of both feet, specially addressing whether those prior diagnoses are related to service. As the examination report did not respond to the Board's April 2020 directives, the Board finds the April 2020 medical opinions inadequate regarding the issues of service connection for cervical spine disability, bilateral ankle disability and right heel disability. Once VA undertakes to provide a VA examination, it must ensure that the examination is adequate. Barr v. Nicholson, 21Vet. App.303, 312 (2007). Without further clarification, the Board is without medical expertise to determine the nature and etiology of the claimed disabilities. Colvin v. Derwinski, 1 Vet. App. at 171 (1991). In light of the above, the Board finds that addendum opinions must be obtained for the claims of service connection for the cervical spine, ankles and right heel. The matters are REMANDED for the following action: 1. Arrange to obtain an addendum medical opinion by the VA examiner who examined the Veteran in July 2019 in connection with his claim for service connection for his neck disability. If that individual is not available, document that fact in the record, and arrange to obtain an addendum opinion from an appropriate physician, other than the April 2020 VA examiner, based on claims file review (if possible). Only arrange for the Veteran to undergo examination if one is deemed necessary in the judgment of the physician designated to provide the addendum opinion. The contents of the entire election claims file, to include a complete copy of this remand, must be made available to the designated individual, and the addendum opinion/examination report should reflect consideration of the Veteran’s documented medical history and assertations. The appropriate examiner must offer an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the current condition of neck pain and mild degenerative changes is related to the Veteran’s time in service. Even if there is no current pathology or diagnosis, the examiner must express an opinion as to whether the prior October 2013 diagnosis of mild degenerative changes of the cervical spine was related to service. In offering the opinion, the examiner is asked to specifically comment on the Veteran’s March 1993 complaint of neck pain in his service treatment records. A rationale for all opinions offered is requested as the Board is precluded from making any medical findings. The examiner is reminded that merely stating that it is his or her opinion that the neck disability is or is not connected to service is not sufficient. 2. Arrange to obtain an addendum medical opinion by the VA examiner who examined the Veteran in July 2019 in connection with his claim for service connection for bilateral ankle disability. If that individual is not available, document that fact in the record, and arrange to obtain an addendum opinion from an appropriate physician, other than the April 2020 VA examiner, based on claims file review (if possible). Only arrange for the Veteran to undergo examination if one is deemed necessary in the judgment of the physician designated to provide the addendum opinion. The contents of the entire election claims file, to include a complete copy of this remand, must be made available to the designated individual, and the addendum opinion/examination report should reflect consideration of the Veteran’s documented medical history and assertations. The appropriate examiner must offer an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the current condition of bilateral ankle disability is related to the Veteran’s time in service. Even if there is no current pathology, the examiner must discuss whether the prior diagnosis in June 2016 private treatment records indicating a diagnosis of primary osteoarthritis of both ankles and feet was at least as likely as not related to service. In offering the opinion, the examiner is asked to specifically comment on the Veteran’s August 1991 treatment for a sprained ankle. A rationale for all opinions offered is requested as the Board is precluded from making any medical findings. The examiner is reminded that merely stating that it is his or her opinion that the bilateral ankle disability is or is not connected to service is not sufficient. 3. Arrange to obtain an addendum medical opinion by the VA examiner who examined the Veteran in July 2019 in connection with his claim for service connection for right heel disability. If that individual is not available, document that fact in the record, and arrange to obtain an addendum opinion from an appropriate physician, other than the April 2020 VA examiner, based on claims file review (if possible). Only arrange for the Veteran to undergo examination if one is deemed necessary in the judgment of the physician designated to provide the addendum opinion. The contents of the entire election claims file, to include a complete copy of this remand, must be made available to the designated individual, and the addendum opinion/examination report should reflect consideration of the Veteran’s documented medical history and assertations. The appropriate examiner must offer an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the current condition of right heel disability is related to the Veteran’s time in service. Even if there is no current pathology or diagnosis the examiner must specifically comment on the Veteran’s April 1988 right heel contusion and the June 2016 private treatment records indicating primary osteoarthritis of both feet, specially addressing whether those prior diagnoses are related to service. A rationale for all opinions offered is requested as the Board is precluded from making any medical findings. The examiner is reminded that merely stating that it is his or her opinion that the right heel disability is or is not connected to service is not sufficient. H. SEESEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Romero-Sanchez, 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.