Citation Nr: 21011751 Decision Date: 03/02/21 Archive Date: 03/02/21 DOCKET NO. 16-01 060 DATE: March 2, 2021 REMANDED Entitlement to service connection for bilateral toe disability is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1989 to November 1993 with additional service in the Reserves. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2014 rating decision. In August 2018 and July 2020, the Board remanded this matter for additional development. Entitlement to service connection for bilateral toe disability is remanded. When the matter was last remanded by the Board in July 2020, it was to obtain a new VA examination to address both the Veteran’s pre-existing pes cavus (noted on the Veteran’s August 1989 enlistment examination) as well as his in-service treatment of bilateral ingrown toenails and contentions of ingrown toe nail trouble since service due to ill-fitting military-issued boots. The resulting October 2020 VA examination opinion addressed the pes cavus and the bilateral toe condition, but further noted that with regard to the toe condition it was really a “skin” condition and that a “skin” VA examination would be more appropriate. In any case, the October 2020 VA examiner opined that it is less likely as not that the Veteran’s bilateral toe condition arose during or as a result of his service. The VA examiner explained that the Veteran had a left ingrown toenail in January 1990 with no evidence that the condition was chronic or recurrent in service. The VA examiner explained that the service treatment records are silent for right toe complaints. The VA examiner noted that there are no post-service treatment records for this issue and concluded that there was insufficient evidence to associate the condition with service. The Board finds the October 2020 VA examination is inadequate to resolve the issue of the Veteran’s bilateral toe claim. It does not appear the VA examiner considered or otherwise addressed the Veteran’s claim that he was issued too-small military boots, that he had marched over 20 miles in such boots, or that he had ongoing issues with ingrown toenails. Rather, the VA examiner solely relied on the lack of documentation of ingrown toenails in the Veteran’s service treatment records and post-service treatment records without adequately addressing the Veteran’s reports that he had recurrent problems with ingrown toenails in service related to ill-fitting boots and since that time. See Dalton v. Nicholson, 21 Vet. App. 23 (2007). The Veteran reported that he was issued boots that were too small and after a 25-mile hike, he had to report to sick call because his toenails had grown through the sides of his big toes. He was further advised to treat the issue himself by trimming his toenails. The Veteran reported that he sought treatment for the issue after service but did not keep the treatment records. In addition, it does not appear the VA examiner considered the Veteran’s August 1993 report of ingrown toenails on or around separation. The VA examiner noted the Veteran’s reports of foot trouble in August 1993 upon separation from service but reported that there was no description of foot complaints. However, a handwritten addendum to the August 1993 Report of Medical History at the time of separation from service shows that the Veteran reported that his foot complaints were foot cramps and ingrown toenails. For the above reasons, remand is warranted to obtain additional VA medical opinion. As acknowledged by the VA examiner, moreover, this examination ought to be completed by a skin examiner. The matters are REMANDED for the following action: 1. Obtain any additional VA treatment records, to include VA treatment records from May 2013 to the present. 2. After outstanding treatment records are obtained to the extent possible, ask an appropriate skin examiner to review the Veteran’s file. The necessity of an in-person examination is left to the discretion of the examiner. The examiner should opine regarding whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s ingrown toenail disability had an onset in service or is otherwise related to service. The examiner should consider all medical and lay evidence of record, including the January 1990 STR, the August 1993 report of medical history at the time of separation along with addendum noting complaints of ingrown toenails, the Veteran’s reports that he had recurrent problems with ingrown toenails in service and since that time, the Veteran’s report that he went to sick call during service and was advised to treat the issue himself by trimming his toenails, the Veteran’s report that he sought treatment for the issue after service but did not keep the treatment records, and the Veteran’s contention that his current ingrown toenails are related to boots that were too tight in the toe box which caused problems during a 25-mile march in service. If the Veteran’s reports are discounted, the examiner should provide a rationale for doing so (e.g., whether there is any medical reason to accept or reject his contentions). The examiner is asked to explain the reasons behind any opinions expressed. The examiner is reminded that the term “as likely as not” does not mean “within the realm of medical possibility,” but rather that the evidence of record is so evenly divided that, in the examiner’s expert opinion, it is as medically sound to find in favor of the proposition as it is to find against it. 3. After the above development, and any additionally indicated development, has been completed, readjudicate the issue on appeal. Shereen M. Marcus Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Purcell, 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.