Citation Nr: 21012310 Decision Date: 03/04/21 Archive Date: 03/04/21 DOCKET NO. 07-22 369 DATE: March 4, 2021 REMANDED Entitlement to service connection for a bilateral foot disorder, to include as secondary to service-connected disabilities is remanded. Entitlement to service connection for a cervical spine disorder, to include as secondary to service-connected disabilities is remanded. REASONS FOR REMAND The Veteran had active military service from April 1980 to December 1980. This case comes before the Board of Veterans’ Appeals (Board) on appeal of a January 2005 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Cleveland, Ohio. The Veteran testified at Board hearings in August 2011, February 2018, and October 2020 before the three undersigned veterans law judges (VLJ). See Arneson v. Shinseki, 24 Vet. App. 379 (2011). Transcripts of the hearings are associated with the record. Unfortunately, a remand is warranted to fulfill the Board’s November 2011 directives to obtain adequate opinions addressing the Veteran’s claims. 1. Entitlement to service connection for a bilateral foot disorder, to include as secondary to service-connected disabilities is remanded. The Veteran has testified at hearings that he sustained an injury in dropping a bomb on one or both of his feet and this resulted in foot disability. See October 2020 Hearing Transcript. The Veteran has also asserted that his foot disability arose in service as a result of low back pain. See August 2011 Hearing Transcript. The Veteran also asserted that his bilateral foot disability was caused or aggravated by his service-connected lumbar spine disability. The Board remanded the appeal in November 2011 to obtain examinations and opinions addressing his contentions. Following the November 2011 remand, the Veteran was examined in March 2013 regarding his claimed bilateral foot disability. See March 2013 Examination. The examiner addressed the Veteran’s contentions of incurring foot disability in service, finding his assertions of dropping a bomb on either or both feet to be inconsistent with development of bilateral metatarsalgia and plantar fasciitis. The examiner noted no evidence of this injury or treatment for or complaints of left foot injury or disease. The examiner did note extensive reports of pain in the right foot, but that X-ray imaging in service showed normal results for the right foot. The examiner also indicated that the Veteran’s foot disability pre-existed service and was not aggravated by service but did not include rationale that corresponds to these findings. No foot disability was present when the Veteran was examined on entrance. See March 1980 Examination. While the examiner was directed to determine if lumbar spine disability caused or aggravated bilateral foot disability, it appears the examiner selected the wrong response. The examiner also did not address whether the Veteran’s reports of bilateral foot pain in service was related to his current metatarsalgia and plantar fasciitis. Instead, they found his assertions of dropping a bomb on one or both feet would not have caused his current disabilities. The Veteran reported “foot trouble” on discharge and has asserted that he experienced pain in both feet in service. The examiner did provide an opinion that medical literature does not support the assertion that his currently diagnosed metatarsalgia and plantar fasciitis was due to or aggravated by service-connected lumbar spine disability. While this may be true, this statement does not offer sufficient rationale in support the opinion, or any specific explanation that correspond with the examiner’s findings. Monzingo v. Shinseki, 26 Vet. App. 97, 105-7 (2012) (finding an opinion adequate as long as it is based on correct facts and sufficiently informs the Board of the medical expert’s judgment on a medical question and the “essential rationale” for the opinion). The examiner also did not address April 1980 service records showing a notation that appears to read “palpable pain in the plantar myofascial.” See April 1980 Service Record. Given the examiner’s diagnosis of plantar fasciitis, the rationale provided in support of their opinion is inadequate for adjudication purposes. In light of the deficiencies cited above in the March 2013 examination report, the Board finds this opinion did not satisfy the directives from the August 2011 remand. See Stegall v. West, 11 Vet. App. 268 (1998); Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The Board finds an addendum opinion is necessary to decide this claim. 2. Entitlement to service connection for a cervical spine disorder, to include as secondary to service-connected disabilities is remanded. In written submissions and his testimony at the August 2011 hearing, he asserted that he injured his neck when he fell from the tank due to striking his head. Afterward, he was placed in a neck brace for a while, but it never cleared up See June 2018 Hearing Testimony; August 2011 Hearing Testimony. The Veteran reported at the October 2020 hearing that he fell 12 to 13 feet and landed on his head and neck. The Veteran reported that he underwent imaging and that the results showed a chipped bone in his neck. See October 2020 Hearing Transcript. The Veteran also reported to his private physician that he fell from one tank onto the deck of an adjacent tank and that he landed on his buttocks and low back. See July 2007 Medical Opinion. Service records do not show treatment for a fall from 12 or 13 feet and imaging results in service do not show a chipped bone in his cervical spine. The reports of service from 1979 to 1983 are in contradiction of his Certificate of Discharge. Further, service records show the Veteran reported in April 1980 he had a spinal injury in November 1979 and that he had worn a neck brace. See April 1980 Service Record. Following the November 2011 remand, the Veteran was examined in March 2013 regarding his claimed neck disability. See March 2013 Examination. The examiner appears to have accepted as true the Veteran’s report of injury of his cervical spine in Advanced Individual Training on active duty in 1979; however, the Veteran did not enter active duty until April 1980. The March 2013 examiner opined that the Veteran’s cervical spine was not due to service based on a lack of treatment for cervical injury or disease. The examiner also provided an opinion that medical literature does not support the assertion that his currently diagnosed cervical spine strain was due to or aggravated by service-connected lumbar spine disability. While this may be true, this statement does not offer sufficient rationale in support the opinion, or any specific explanation that correspond with the examiner’s findings. Monzingo, supra. The March 2013 examiner also indicates that a cervical spine disability pre-existed service and was not aggravated by service. This response appears to be in error because the examiner provided rationale regarding aggravation by service-connected disability and no cervical spine disability was noted when the Veteran was examined on entrance. See March 1980 Examination. Given the Veteran’s assertions and the deficiencies cited above in the March 2013 examination report, the Board finds this opinion did not satisfy the directives from the August 2011 remand. See Stegall, 11 Vet. App. at 268; Barr, 21 Vet. App. at 311. An addendum opinion is necessary to decide this claim. The matters are REMANDED for the following action: Obtain additional VA opinions to determine the nature and etiology of any cervical spine and bilateral foot disorders. The claims file, including this remand, must be made available to the examiner for review. All appropriate tests and studies should be conducted, and any consultations deemed necessary should be accomplished. After reviewing the record and examining the Veteran, the examiner should address the following for each of the Veteran’s cervical spine, right foot and left foot disorders: (a) Is it at least as likely as not (i.e., probability of 50 percent) that any current cervical spine disability is etiologically related to the Veteran’s active military service? The examiner should specifically comment on the Veteran’s report of injury to his cervical spine in November 1979 that necessitated a neck brace. (b) If the answer to (a) is no, is it at least as likely as not (i.e., probability of 50 percent) that any current cervical spine disability is proximately due (caused by) to the Veteran’s service-connected lumbar spine disability? (c) If the answer to (b) is no, is it at least as likely as not (i.e., probability of 50 percent) that any current cervical spine disability has been aggravated beyond its normal progression by the Veteran’s service-connected lumbar spine disability? (d) Is it at least as likely as not (i.e., probability of 50 percent) that any right or left foot disability is etiologically related to the Veteran’s active military service? The examiner should specifically comment on the Veteran’s reports of bilateral foot pain since his discharge from service. (e) If the answer to (a) is no, is it at least as likely as not (i.e., probability of 50 percent) that any right or left foot disability is proximately due (caused by) to the Veteran’s service-connected lumbar spine disability? (f) If the answer to (b) is no, is it at least as likely as not (i.e., probability of 50 percent) that any right or left foot disability has been aggravated by the Veteran’s service-connected lumbar spine disability? The examiner is informed that aggravation is defined for legal purposes as any increase in disability. If aggravation is present, the clinician should indicate, to the extent possible, the approximate level of lumbar spine disorder (i.e., a baseline) before the onset of the aggravation. The examiner is requested to provide a complete rationale for any opinion expressed, based on the examiner’s clinical experience, medical expertise, and established medical principles. If an opinion cannot be made without resort to speculation, the examiner should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made. J. B. FREEMAN Veterans Law Judge Board of Veterans’ Appeals ERIC S. LEBOFF Veterans Law Judge Board of Veterans’ Appeals M.E. LARKIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Trickey 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.