Citation Nr: 21006046 Decision Date: 02/03/21 Archive Date: 02/03/21 DOCKET NO. 16-29 905 DATE: February 3, 2021 REMANDED Entitlement to service connection for a right foot disability, to include hammer toe, arthritis, fracture of the second great toe, and calcaneal spurs, is remanded. Entitlement to service connection for a left foot disability, to include hammer toe, arthritis, fracture of the second great toe, and calcaneal spurs, is remanded. Entitlement to service connection for a skin disability, to include skin tags and dermatitis, is remanded. REASONS FOR REMAND The Veteran had active military service from September 1964 to April 1966 and from November 1990 to May 1991. He also had service in the reserves with periods of active duty for training (ADT) and inactive duty training (IDT). This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) located in Waco, Texas. In November 2018, the Board denied the Veteran’s claims for a bilateral hand condition and remanded the above claims for further development. The Veteran’s claim for right ear hearing loss was previously granted and will not be addressed further. Regarding the bilateral foot claims, in November 2018, the Board remanded the Veteran’s claims for left and right foot disabilities with very specific remand instructions. The Board finds the September 2019 VA medical opinions are confusing and convoluted. Additionally, the opinions do not adequately apply the correct legal standard regarding presumption of soundness. Further, the examiner’s rationale appears to rely solely on the absence of records in order to come to the conclusion that the Veteran’s medical conditions both: 1) clearly and unmistakably preexisted service and 2) were not related to service. Accordingly, a remand is required to obtain an addendum medical opinion. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007); Kowalski v. Nicholson, 19 Vet. App. 171, 179 (2005) (a VA examination must be based on an accurate factual premise); see also Stegall v. West, 11 Vet. App. 268 (1998) (A remand by the Board confers upon the claimant, as a matter of law, the right to compliance with the remand order). Regarding the skin claim, the September 2019 VA examiner did not provide an etiology opinion for the Veteran’s previously diagnosed dermatitis. The examiner passively mentioned the condition in the rationale for his opinion regarding skin tag removal residuals and asteatotic eczema. The examiner also concluded that the Veteran’s skin tags and asteatotic eczema are resolved and have no current symptoms but did not indicate whether symptoms were present at any time during the appeal period (June 2013 to present). Accordingly, a remand is required to obtain an addendum medical opinion. See Id. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician other than the September 2019 examiner regarding the nature and etiology of the Veteran’s bilateral foot disorders. Access to records in the Veteran’s electronic claims file should be made available to the examiner for review in connection with his or her opinion. A VA examination may be provided if deemed appropriate. The clinician is to identify all foot disorders diagnosed since June 2013. Thereafter, opinions should be provided for the following: (a.) Did a left or right foot disability clearly and unmistakably exist prior to the Veteran’s active service? (b.) If a left or right foot disability is found to have clearly and unmistakably existed prior to active service, is it also clear and unmistakable that such disability was NOT aggravated (permanently worsened beyond its natural progress) by active service? (c.) If a left or right foot disability did not clearly and unmistakably exist prior to military service and was not aggravated by service, is it least as likely as not (a 50 percent or greater probability) that the disability had its onset during service, or is otherwise related to such service? The examiner is advised that clear and unmistakable evidence is an onerous evidentiary standard and means that the evidence is undebatable. However, it does not require the absence of conflicting evidence. Vanerson v. West, 12 Vet. App. 254 (1999); Kent v. Principi, 389 F.3d 1380, 1383 (Fed. Cir. 2004). The clinician should provide a rationale for all opinions rendered, including reference to the pertinent evidence of record. 2. Obtain a SEPARATE addendum opinion from an appropriate clinician other than the September 2019 examiner regarding the nature and etiology of the Veteran’s skin disability. Access to records in the Veteran’s electronic claims file should be made available to the examiner for review in connection with his or her opinion. A VA examination may be provided if deemed appropriate. The clinician is to identify all skin disabilities diagnosed since June 2013, to include skin tags, residuals scars from removal of skin tags, and/or dermatitis. Thereafter, the clinician is to provide an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran’s skin disability was incurred in service or is otherwise causally related to the Veteran’s active service, to include the Veteran noted treatment for a rash during his Southwest Asia service. The clinician should provide a rationale for all opinions rendered, including reference to the pertinent evidence of record. MARTIN B. PETERS Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Williams, 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.