Citation Nr: 21012828 Decision Date: 03/05/21 Archive Date: 03/05/21 DOCKET NO. 17-36 124 DATE: March 5, 2021 REMANDED Entitlement to service connection for a psychiatric disorder is remanded. Entitlement to service connection for pes planus is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1976 to June 1980. This matter comes before the Board of Veterans Appeals (Board) from two Statements of the Case (SOC) both from May 2017 by a Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge in December 2019. A transcript of the hearing is associated with the claims file. The Board determined in a March 2020 decision that New and Material Evidence (NME) had been received since the final October 2012 rating decision which denied service connection for pes planus. The March 2020 decision also remanded the issues of service connection for pes planus and a psychiatric disorder for further development to include VA examinations. Once VA undertakes to provide examinations, it must provide adequate ones. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). 1. Entitlement to service connection for a psychiatric disorder is remanded. The Veteran maintains his psychiatric condition is a direct result of his military service, and any post service events, or injuries only exacerbated the condition that started in service. The March 2020 VA examiner says of the Veteran in his report, “He reported his symptoms of depression began after the death of his daughter in 1989.” This statement directly contradicts what the Veteran testified to at the December 2019 Board hearing where the Veteran said, I had a daughter that was born in February 1979. I came home and she had complications with her birth. It was something to do with the spine when she was born that caused it. And I ended up getting a compassionate reassignment and I never returned to Fort Worth, Texas. So, during that time, I kept it to myself, but I actually did have to take care of her, make sure she was fine. But me personally, I wasn’t fine, and I didn't go get help until she died. The Court has held that a medical opinion is inadequate if it does not consider the Veteran's report of symptoms and history (even if recorded in the course of the examination). Dalton v. Peake, 21 Vet. App. 23 (2007). The March 2020 VA exam was requested as part of the Board’s remand order, but is inadequate for adjudication purposes, because it is either based on inaccurate facts or failed to consider the Veteran’s Board hearing testimony. 2. Entitlement to service connection for pes planus is remanded. The Veteran claims that he is entitled to service connection for pes planus, which has been identified in the medical evidence of record as a congenital defect. 38 C.F.R. § 4.57 distinguishes between congenital diseases and congenital defects. The regulations make it clear that it is essential to make an initial distinction between bilateral flatfoot as a congenital or as an acquired condition. The congenital condition, with depression of the arch, but no evidence of abnormal callosities, areas of pressure, strain or demonstrable tenderness, is a congenital abnormality which is not compensable or pensionable On the other hand, pes planus as an acquired condition can be distinguished. Attention should be given to anatomical changes, as compared to normal, in the relationship of the foot and leg, particularly to the inward rotation of the superior portion of the os calcis, medial deviation of the insertion of the Achilles tendon, the medial tilting of the upper border of the astragalus. This is an unfavorable mechanical relationship of the parts. A plumb line dropped from the middle of the patella falls inside of the normal point. The forepart of the foot is abducted, and the foot everted. The plantar surface of the foot is painful and shows demonstrable tenderness, and manipulation of the foot produces spasm of the Achilles tendon, peroneal spasm due to adhesion about the peroneal sheaths, and other evidence of pain and limited motion. For the Board to make an informed decision on service connection it needs to know which type of pes planus the Veteran has in this case according to the VA guidelines cited above. The VA examiner needs to explain which type of flat foot the Veteran has by re-examining the Veteran in person or reviewing the medical observations from prior examinations using the regulation guidelines above to reach a medical determination as to whether the Veteran has pes planus as a congenital defect or as an acquired condition. The characteristics described in the June 2020 examination seem to more closely describe an acquired condition based on the regulation factors, but the examiner categorized the Veteran’s pes planus as congenital. Unfortunately, remand of the Veteran's claims for service connection for pes planus and a psychiatric disability is warranted. Although the Board regrets the additional delay, further development of the record is required before the Board may render a decision in the instant case. The matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from July 2020 to the Present. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any pes planus disability. The examiner must opine: a) Is the Veteran’s pes planus a congenital defect or an acquired condition? The examiner must address the prior opinions indicating the Veteran’s pes planus was congenital and 38 C.F.R. § 4.57 for guidance as to what constitutes congenital versus acquired pes planus. b) If the Veteran’s pes planus is a congenital defect, did the Veteran experience a superimposed disease or injury to his feet during service that resulted in additional disability? c) If the Veteran’s pes planus is an acquired condition, is it at least as likely as not that the Veteran’s pes planus disability was aggravated (non-temporary increase in severity) by any in-service injury, event, or disease. 3. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any psychiatric disability, to include depression and anxiety disorder. The examiner must consider and discuss the Veteran’s testimony that his depression started in service due to his daughter’s birth defect and ongoing health struggles. The examiner must opine whether it is at least as likely as not that the symptoms of his current psychiatric disabilities began during service or were otherwise related to an in-service injury, event, or disease. A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. H. SEESEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Black, 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.