Citation Nr: 21010534 Decision Date: 02/25/21 Archive Date: 02/25/21 DOCKET NO. 15-13 033 DATE: February 25, 2021 REMANDED Entitlement to service connection for bilateral foot disability, to include pes planus, is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1989 to May 1998. This matter comes to the Board of Veterans’ Appeals (Board) from a July 2013 rating decision. In July 2018 and June 2020, the Board remanded the matter for further development, to include obtaining a VA examination and medical opinions. Entitlement to service connection for bilateral foot disability, to include pes planus, is remanded. The Veteran contends her bilateral foot disabilities, to include pes planus, are related to service. Alternatively, the Veteran contends her bilateral foot disabilities are secondary to her service-connected low back disability and bilateral patellofemoral syndrome. In connection with the Board’s June 2020 remand, a VA medical opinion was obtained in August 2020; however, the opinions are insufficient to adjudicate the Veteran’s claims. With regard to direct service connection, although the examiner opined that the Veteran’s bilateral foot disabilities were less likely than not incurred in, or caused by, her military service, the rationale focuses exclusively on whether her currently-diagnosed pes planus had its onset during her active duty, and does not address whether her pes planus is otherwise related to her military service, to include her in-service bilateral foot problems. As for secondary service connection, although the examiner opined that the Veteran’s bilateral pes planus was less likely than not caused or aggravated by her service-connected low back disability and bilateral patellofemoral syndrome, the rationale provided is internally inconsistent. One hand, the examiner reasoned that, if the Veteran’s pes planus was caused or aggravated by her low back disability and bilateral patellofemoral syndrome, it would have manifested sooner than 2004, and that additional patient encounters would be expected. On the other hand, the opinion provider stated that there is no pathophysiological mechanism to ties the Veteran’s pes planus to her service-connected low back disability and bilateral patellofemoral syndrome. The Court has held that a medical examination report must not contain only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (“[A] medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions.”). Given the deficiencies noted above, the Board finds that new VA medical opinions are necessary. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The matter is REMANDED for the following actions: 1. Obtain the Veteran’s VA treatment records from June 2020 to present. 2. Obtain an addendum opinion from a medical professional with appropriate expertise to address whether the Veteran’s bilateral foot disabilities, to include pes planus, are related to her military service, or whether such are secondary to her service-connected disabilities. The record must be sent to, and reviewed by, the medical professional. The need for an additional examination is left to the discretion of the medical professional selected to write the opinion. Following a review of the entire record, the medical professional should address the following: a) Is it at least as likely as not (50 percent or better probability) that the Veteran’s current bilateral foot disabilities, to include pes planus, had their onset during her active duty service, or were otherwise caused by her military service, to include consideration of her in-service complaints and treatment for bilateral foot problems? b) Is it at least as likely as not (50 percent or better probability) that the Veteran’s current bilateral foot disabilities, to include pes planus, were caused or aggravated by her service-connected disabilities, to include her service-connected low back disability, bilateral patellofemoral syndrome, and/or bilateral plantar fasciitis? Please note that causation and aggravation are two separate inquires and both must be answered. A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. 3. Thereafter, and after any further development deemed necessary, the issues on appeal should be readjudicated. Stephanie M. Owen Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board James R. Springer, 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.