Citation Nr: 21011499 Decision Date: 03/02/21 Archive Date: 03/02/21 DOCKET NO. 14-31 048A DATE: March 2, 2021 REMANDED Entitlement to service connection for a bilateral foot disability, to include as secondary to a service-connected back disability, is remanded. REASONS FOR REMAND The Veteran served on active duty from April 2002 to February 2010. The Board most recently remanded the claim in October 2020 for further development. There has not been substantial compliance with the remand directives and the claim must be remanded again. Stegall v. West, 11 Vet. App. 268 (1998). The November 2020 VA opinion obtained in accordance with the October 2020 remand is inadequate as to both direct and secondary service connection. Despite the Board’s specific directives, the examiner improperly based the negative opinion on direct service connection to due to a lack of evidence of treatment. The examiner did not consider the Veteran’s credible reports of continuous symptoms since service. The rationale on secondary service connection was improper because the examiner addressed an incorrect standard for aggravation; “beyond its natural course.” Aggravation in the context of secondary service connection under 38 C.F.R. § 3.310 means any increase in disability. The rationale for aggravation was also improper because it was based, in part, on causation theory. Accordingly, a new opinion is necessary. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate VA examiner, (preferably from a different VA examiner than the November 2020 and August 2020 examinations) to determine the nature and likely etiology the Veteran’s foot disability. Copies of all pertinent records must be made available to the examiner for review. If the examiner determines that an opinion cannot be provided without an examination, (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) one should be scheduled. Based on the review of the record (and examination if needed), the examiner should answer the following:  (a.) Is it at least as likely as not that the Veteran’s plantar fasciitis is related to an in-service injury, event, or disease during service, to include as due to working on a steel surface on the flight deck of his ship? Why or why not? The examiner should consider and discuss as necessary the Veteran’s credible lay testimony that his bilateral foot pain began during his active duty service and have continued since. The lack of treatment, in service or after, cannot be the sole basis for a negative opinion. (b.) If the answer to (a) is no, is it at least as likely as not that the Veteran’s plantar fasciitis (i) caused or aggravated (defined as any increase in disability) by his service-connected back disability? Why or why not? The examiner must provide reasons for each opinion given. If the examiner is unable to provide an opinion without resort to speculation, he or she should explain why this is so and what, if any, additional evidence would be necessary before an opinion could be rendered. 2. Confirm that the VA medical opinion provided comports with this remand, specifically that the standard for the secondary aggravation opinion is any increase in disability, not the standard of beyond the natural progression as noted on the examination form itself. If not, get an addendum. M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S.E. Bresler, 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.