Citation Nr: 21013453 Decision Date: 03/09/21 Archive Date: 03/09/21 DOCKET NO. 15-00 711A DATE: March 9, 2021 REMANDED Entitlement to service connection for Morton's Neuroma, to include secondary to service-connected bilateral pes planus is remanded. Entitlement to service connection for degenerative joint disease of the spine, to include secondary to service-connected bilateral pes planus is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from October 1979 to October 1982. In November 2016 and September 2020, the Veteran testified at a Board hearing. The transcript is of record. In December 2017, the Board remanded the case for further development. Stegall v. West, 11 Vet. App. 268, 271 (1998). 1. Entitlement to service connection for Morton's Neuroma and degenerative joint disease of the spine, to include secondary to service-connected bilateral pes planus The Veteran contends that his Morton’s Neuroma and degenerative joint disease of the spine are secondary to pes planus. As the Veteran is service connected for pes planus, a remand is necessary to obtain opinions based on theory of secondary service connection for the above listed conditions. Additionally, a remand is necessary for addendum opinions addressing direct service connection. The Veteran underwent VA examinations in August 2018 for his Morton’s Neuroma and degenerative joint disease of the spine. The examiner provided negative nexus opinions; however, the provided rationales are inadequate as they relied on the absence of evidence, failed to consider the Veteran’s lay statements and were conclusory. A medical examination report must contain clear conclusions, supporting data and a reasoned medical explanation connecting the two. See Nieves- Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The matters are REMANDED for the following action: 1. In remanding this case, the Board makes no credibility determination, expressed or implied, at this juncture 2. Acquire updated VA and/or private treatment records. If such records are unavailable, the Veteran’s claim file must be clearly documented to that effect and the Veteran notified in accordance with 38 C.F.R. § 3.159(e). 3. Obtain an addendum medical opinion from a medical professional with appropriate expertise. The examiner should review the Veteran’s claims file. If the examiner determines that an opinion cannot be provided without an examination, the Veteran should be scheduled for one. Based on a review of the record, and a new examination if necessary, the examiner must address the following: (a.) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran’s Morton’s Neuroma and/or degenerative joint disease of the spine is related to active service or is caused by or aggravated by military service. (b.) Is it at least as likely as not (i.e., probability of 50 percent or higher) that Morton’s Neuroma and/or degenerative joint disease of the spine is proximately due to or the result of the Veteran’s bilateral pes planus? (b.) If the answer to (a) is negative, is it at least as likely as not that the Morton’s Neuroma and/or degenerative joint disease of the spine is aggravated (i.e., permanently or temporarily worsened) by the bilateral pes planus? (c.) If aggravation is found, the examiner should address the following medical issues: 1) the baseline manifestations of the disorder found prior to aggravation; and 2) the increased manifestations which, in the examiner's opinion, are proximately due to the service-connected disorder. The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a certain conclusion is so evenly divided that it is as medically sound to find in favor of such a conclusion as it is to find against it. In all opinions rendered, the examiner is advised that the Veteran is competent to report his symptoms and treatment history. The examiner must discuss the Veteran’s contentions that he sustained injuries to his back and feet in service from marching and falling while carrying equipment and that his altered gait due to pes planus aggravates these conditions. A complete rationale containing clear conclusions with supporting data and a reasoned medical explanation connecting the two is required for all medical opinions. The examiner should also identify and explain the relevance or significance, as appropriate, of any history, clinical findings, medical knowledge or literature, etc., relied upon in reaching the conclusion(s). If the medical professional cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation for why an opinion cannot be rendered. In so doing, the medical professional shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). G. A. WASIK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. A. Prinsen 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.