Citation Nr: 21007977 Decision Date: 02/11/21 Archive Date: 02/11/21 DOCKET NO. 18-45 974 DATE: February 11, 2021 REMANDED Entitlement to service connection for a left foot and toenail disability is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1968 to April 1970. This case is before the Board of Veterans Appeals (Board) on appeal from a March 2017 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In May 2020, the Board remanded this claim to obtain a VA examination and nexus opinion. Regrettably, the opinion is inadequate for adjudication purposes, and therefore, the claim must be remanded once again. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (when VA undertakes to provide a VA examination or obtain an opinion, it must ensure that the examination or opinion is adequate.) Further, after consideration of the Veteran’s reported symptoms and diagnoses, the Board has recharacterized the claim of service connection for a left foot disability as a claim for service connection for a left foot and toenail disability. See Clemons v. Shinseki, 23 Vet. App. 1 (2009) (holding that, in determining the scope of a claim, the Board must consider the claimant’s description of the claim, the symptoms described, and the information submitted or developed in support of the claim). Entitlement to service connection for a left foot and toenail disability is remanded. The Veteran stated that during service he worked on the ship docks unloading mail and other supplies for a period of three to six months without protective shoes. He reported that it was during this time when he suffered injuries to his feet, including deformities to his toenails. See VA Form 9. He contends that he has experienced pain and problems with his left foot and toenails ever since his discharge from active duty service. See Notice of disagreement (NOD). The service treatment records (STRs) contain several entries related to the Veteran’s left great toe and toenail. Specifically, a June 1968 entry noted that the Veteran should do “hot soaks” for his toe, and a July 1968 entry noted that the Veteran presented with an infected toe. He was scheduled for a podiatry appointment the following week where it was determined that he had a ram horn nail, left hallux nail, which was partially removed. He was scheduled for a permanent left nail removal to take place after advanced individual training. In October 1968, the Veteran presented complaining of throbbing intensity in his left great toe, with the examiner noting that he had a large horn on his left great toe which hurt when in touches the top of his boot. The clinician referred the Veteran to podiatry, noting that his left great toe horn nail had been filed and cut down several times and to evaluate for removal of nail and nail bed. At an October 1968 podiatry consult, the Veteran was diagnosed with deformed onychauxis (a nail disorder that causes toenails to grow abnormally thick). The podiatrist noted that the left great toenail had been mechanically reduced but stated that the Veteran needed a matrixectomy (partial nail removal). In this case, the March 1970 separation medical examination is blank but in an accompanying report of medical history, the Veteran noted that he was not currently experiencing foot trouble. Post service treatment records from the Shreveport VA medical center (VAMC) dated from February 2019 to July 2020 contain entries related to the Veteran’s left foot and toenails. Significantly, the Veteran was diagnosed with onychomycosis, a fungal infection of the toenails. See Dorland’s Illustrated Medical Dictionary at 1322 (32nd ed. 2012). Further, treatment records note that the Veteran had a matrixectomy in 1974 (four years post-service). See May and October 2019 and April 2020 VA treatment notes. The Veteran also reported foot pain for over thirty years which he described as an aching pain along the soles of his feet which occasionally awakens him. In August 2020, the VA examiner diagnosed the Veteran with pes planus and opined that it was less likely than not related to service, reasoning that there were no medical records indicating that he was seen post service for any left foot problem and noted that the record only contained the Veteran’s statement that he experienced left foot problems after service. She opined that there was no correlation between any left foot injury sustained during service and his current pes planus because there were no medical records reflecting post service treatment for a left foot disability. However, as noted above, the Veteran was seen after service at the VAMC for complaints related to his left foot and toenails. Therefore, the Board finds the August 2020 VA opinion inadequate because it is based on an inaccurate factual premise. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (An opinion based upon an inaccurate factual premise has no probative value). Accordingly, the Veteran must be afforded a new examination which evaluates his left foot and toenails. An opinion should be obtained as to whether it is at least as likely as not that the Veteran’s currently diagnosed pes planus and onychomycosis (and any other left foot or toenail disability found on examination) are etiologically related to service, including the in-service diagnosis of deformed onychauxis. This matter is REMANDED for the following actions: 1. Obtain updated VA treatment records. 2. After the above records have been associated, schedule the Veteran for an examination with an appropriate provider to determine the nature and etiology of his currently diagnosed pes planus and onychomycosis. Following a complete review of the evidence of record, and with consideration of the Veteran’s lay statements, assuming the statements are credible for the limited purpose of the request herein, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s pes planus and onychomycosis and any other left foot or left toe/toenail disability found on examination, are etiologically related to service, including the in-service diagnosis of onychauxis. In rendering his opinion, the examiner should review and consider the in-service notations referencing the left foot and toenail which are described in detail above. Jennifer White Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Alison M. Mecone, 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.