Citation Nr: 21012433 Decision Date: 03/04/21 Archive Date: 03/04/21 DOCKET NO. 14-17 489 DATE: March 4, 2021 REMANDED Entitlement to service connection for a left knee disability is remanded. Entitlement to service connection for a bilateral foot disability is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1983 to June 1991. These matters come before the Board of Veterans’ Appeals (Board) on appeal from an April 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran and his spouse testified at a hearing before a Decision Review Officer (DRO) in December 2015. A copy of the hearing transcript has been associated with the record. The Board previously remanded the appeal in January 2018 and in August 2019 for record development and for VA examinations to determine the nature and etiology of any diagnosed left knee and bilateral feet disabilities. After the August 2019 Board remand, the Veteran was afforded a VA examination; however, the Board finds that the examination did not substantially comply with Board remand directives, and was inadequate for decisional purposes. See Stegall v. West, 11 Vet. App. 268 (1998); Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). 1. Entitlement to service connection for a left knee disability and a bilateral foot disability is remanded. The August 2019 Board decision requested a VA examiner to determine whether it is at least as likely as not that the Veteran’s current left knee disability was incurred in or caused by service. The Board requested the VA examiner to consider the Veteran’s lay statements, to include statements associated with the June 2012 claim, and to include an analysis of the Veteran’s service treatment records (STRs). The Board specifically asked to review the January 1985 complaint of pain in the back of the Veteran’s thigh, the May 1986 treatment for a left hamstring injury, and the January 1985 treatment for a right hamstring injury which noted that the Veteran was unable to bear weight equally due to pain. It was also requested to determine whether it is at least as likely as not that the Veteran’s left knee disability manifested within one year of service separation and whether the Veteran had continuous symptoms of arthritis since service separation. The December 2019 VA examiner opined in part from the requested information. The examiner opined that it was less than likely as not that the Veteran’s knee disability incurred in or was caused by the hamstring strain during service. The examiner explained that the Veteran’s left hamstring injury in 1985 and 1986 were less than likely as not a cause of left or right knee disability. The examiner furthered that the hamstring is a muscle of the posterior, back portion of the thigh. The examiner reported that the Veteran had a strain injury and was adequately treated with rest, crutches, anti-inflammatory medicine, and muscle relaxers. The examiner further explained that the Veteran was afforded a physical examination in 1986 and was found to be fit for duty. Additionally, there was no mention of a knee disability at discharge. The examiner further reported that the x-ray in about 2011 was the first x-ray noted since discharge from active duty. In this x-ray, patellar spurring was noted. The examiner noted that the patellar spurring would not have been noted at the hamstring site since patellar spurring is a finding of osteoarthritis, which is the boney aspects of the body, and not of the muscles. The examiner did not address whether the Veteran’s left knee disability had manifested within one year of service separation and whether the Veteran had continuous symptoms of arthritis since service separation. Thus, this issue must be remanded for an addendum opinion to obtain the requested information. Regarding the Veteran’s bilateral foot disability, the Board had requested to determine whether it is at least as likely as not that the Veteran’s bilateral foot disability had incurred in or caused by service. The Board asked the VA examiner to consider the Veteran’s lay statements as to any instances of in-service bilateral foot pain or injury, which included the statements associated with the June 2012 claim. It was also requested to determine whether it is at least as likely as not that the Veteran’s bilateral foot disability manifested within one year of service separation and whether the Veteran had continuous symptoms of arthritis since service separation. The December 2019 examiner noted that the Veteran was diagnosed with flat foot in 1983. The examiner opined that the Veteran’s bilateral foot disability was at least as likely as not an aggravation of a congenital or pre-existing condition. The examiner explained that there was no evidence that flat foot was acquired or pre-existing and that there was no evidence of it at the entry or the exit examination reports. The examiner did not follow the remand instructions and instead provided an opinion regarding whether the Veteran had a pre-existing condition and whether an injury or an event had aggravated the Veteran’s bilateral foot disability. There is no indication that the Veteran’s bilateral foot pre-existed service. Moreover, the examiner did not include the Veteran’s lay statements in any opinion. The Board finds this opinion inadequate and thus a new addendum opinion is necessary to obtain an adequate opinion. The matters are REMANDED for the following action: 1. Obtain an addendum opinion by an appropriate clinician to determine whether it is at least as likely as not (a 50 percent or greater probability) that degenerative arthritis of the left knee manifested within one year of service separation, and whether the Veteran had continuous symptoms of arthritis since service separation. The examiner should consider, but no limit review to, the Veteran’s lay statements as to the onset and continuity of his symptoms, as well as a July 2009 VA treatment note showing that the Veteran had reported experiencing joint pain in his knees for the past seven years. A complete rationale for all opinions and conclusions should be provided with references to findings in the claims file. 2. Obtain an addendum opinion by an appropriate clinician to determine whether it is at least as likely as not (a 50 percent or greater probability) that the currently diagnosed bilateral foot disability to include degenerative arthritis, hallux valgus, pes planus, and heel spurs of the bilateral feet were incurred in or caused by service. The VA examiner should consider the Veteran’s lay statements as to any instances of in-service bilateral foot pain or injury, to include statements associated with the June 2012 claim. The examiner is not to opine on whether the Veteran’s disability pre-existed service and whether it was aggravated during military service. Determine whether it is at least as likely as not (a 50 percent or greater probability) that degenerative arthritis of the bilateral feet manifested within one year of service separation, and whether the Veteran had continuous symptoms of arthritis since service separation. The examiner should consider the Veteran’s lay statements as to the onset and continuity of his symptoms. A complete rationale for all opinions and conclusions should be provided with references to findings in the claims file. 3. After all development has been completed, the AOJ should readjudicate the claim. If the benefits sought remain denied, the Veteran and his representative should be furnished a supplemental statement of the case, and be given an opportunity to submit written or other argument in response before the claims file is returned to the Board for further appellate consideration. Thomas H. O'Shay Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Imam, 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.