Citation Nr: 21006622 Decision Date: 02/04/21 Archive Date: 02/04/21 DOCKET NO. 15-01 438 DATE: February 4, 2021 REMANDED Entitlement to service connection for a right knee disability is remanded. Entitlement to service connection for a right foot disability is remanded. Entitlement to service connection for a left foot disability is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1994 to October 1998. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Nashville, Tennessee, which, inter alia, denied service connection for right knee and bilateral foot disabilities. This matter was previously before the Board in October 2018. At that time, the Board, inter alia, remanded the claims for further evidentiary development, to include VA examinations. The Board notes that the Veteran’s appeal also contained service connection claims for back and neck disabilities, which were granted in a May 2020 rating decision. Those awards constitute a full grant of the disabilities sought, and those appeals have been resolved. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997) (holding that where an appealed claim for service connection is granted during the pendency of the appeal, a second notice of disagreement must thereafter be timely filed to initiate appellate review of the claim concerning “downstream” issues, such as the compensation level assigned for the disability and the effective date). 1. Entitlement to service connection for a right knee disability is remanded. 2. Entitlement to service connection for a right foot disability is remanded. 3. Entitlement to service connection for a left foot disability is remanded. The Veteran contends that he developed increasing pain in his knees and feet during active duty. He contends that he visited sick bay for such pain, however, he was told that the pain was not due to serious injury. He asserts that he ignored the pain without seeking medical treatment until approximately 2012. See March 2012 Statement in Support of Claim. Pursuant to the Board’s October 2018 remand instructions, the Veteran was afforded VA examinations for his right knee and feet in August 2019. The examiner noted diagnoses of right knee patellofemoral pain syndrome and bilateral pes planus. The Veteran reported that during a PT session, he experienced swelling and soreness in his right knee. He also reported foot pain and swelling during active duty. After examination of the Veteran and review of the claims file, the examiner rendered negative etiological opinions regarding the Veteran’s right knee and feet. Regarding the Veteran’s right knee, the examiner opined, There are no records found in the records presented for review of any diagnosis or treatment of right knee condition during and since his military service so it is less likely than not that his current right knee condition was incurred during his military service. With regard to the Veteran’s bilateral foot disability, the examiner determined, Claimant while in the military had received evaluations on feet in: 11/4/94, 11/7/94, 12/15/95 and 2/10/97. In [n]one of these in service evaluation[s] [o]f the claimant’s fee[t] was there a diagnosis of pes planus and only on 11/29/11 was he diagnosed or being treated for pes planus so it is less likely than not that his current right [and left] foot pes planus was incurred during his military service. The Board finds that the VA examinations are inadequate. In the Board’s October 2018 remand, the examiner was directed to address the Veteran’s lay statement regarding the onset of his knee and feet disabilities to be during active service and the continuity of symptomatology since that time. The examiner, however, failed to address such in each of his rationales. While the Board greatly regrets further delay, remand is required for an addendum medical opinion for full compliance with the Board’s previous remand instructions. Stegall v. West, 11 Vet. App. 268, 270-71 (1998). Accordingly, the matters are REMANDED for the following action: 1. Obtain an addendum medical opinion regarding the nature and etiology of the Veteran’s right knee disability. Access to the Veteran’s electronic VA claims file must be made available to the examiner for review in connection with the opinion. After reviewing the record, provide an opinion, with supporting rationale, as to the following: Is it at least as likely as not that the Veteran’s current right knee disability had its inception during his period of active service or is otherwise causally related to an in-service disease or injury? In providing the requested opinion, the examiner should reference any relevant evidence of record, to include the Veteran’s lay statement indicating that he developed increasing pain in his knee during active duty which has persisted since that time. In providing the requested opinion, the clinician should consider the Veteran’s reported symptoms in service and thereafter, including the onset, progression and severity of the Veteran’s reported symptoms. If there is any medical reason to accept or reject the proposition that the Veteran’s reported symptoms in service and thereafter represented the onset of his current disability, this should be noted. Stated another way, do the Veteran’s reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran’s reports generally inconsistent with medical knowledge or implausible? 2. Obtain an addendum medical opinion regarding the nature and etiology of the Veteran’s right and left foot disabilities. Access to the Veteran’s electronic VA claims file must be made available to the examiner for review in connection with the opinion. After reviewing the record, provide an opinion, with supporting rationale, as to the following: Is it at least as likely as not that the Veteran’s current right and left foot disabilities had their inception during his period of active service or are otherwise causally related to an in-service disease or injury? In providing the requested opinion, the examiner should reference any relevant evidence of record, to include the Veteran’s lay statement indicating that he developed increasing pain in his feet during active duty which has persisted since that time. In providing the requested opinion, the clinician should consider the Veteran’s reported symptoms in service and thereafter, including the onset, progression and severity of the Veteran’s reported symptoms. If there is any medical reason to accept or reject the proposition that the Veteran’s reported symptoms in service and thereafter represented the onset of his current disability, this should be noted. Stated another way, do the Veteran’s reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran’s reports generally inconsistent with medical knowledge or implausible? A complete explanation must be provided for any opinion offered. K. Conner Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Ruddy, 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.