Citation Nr: 21013861 Decision Date: 03/10/21 Archive Date: 03/10/21 DOCKET NO. 14-27 925A DATE: March 10, 2021 REMANDED Entitlement to service connection for degenerative arthritis of the right foot is remanded. Entitlement to service connection for degenerative arthritis of the left foot is remanded. Entitlement to service connection for multiple sclerosis (MS) is remanded. REASONS FOR REMAND The Veteran, who has achieved veteran status by the award of service connection for a disability, had active duty for training (ACDUTRA) from July 1973 to September 1973. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a July 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In December 2017, a hearing was held before the undersigned. A transcript of the hearing is of record. The case was previously before the Board in March 2018 and January 2020 when it was remanded for further development. In the January 2020 remand, the issue of entitlement to service connection for left ankle degenerative arthritis was also remanded. Following subsequent development, in a January 2021 rating decision, the RO granted service connection for left ankle degenerative joint disease and assigned a 10 percent rating effective June 20, 2012. As this constitutes a full grant of the benefit sought on appeal, the issue has been resolved and is no longer before the Board. Degenerative Arthritis of the Right Foot and of the Left Foot The Veteran is seeking service connection for degenerative arthritis of the right foot and the left foot. VA is obligated to provide an examination and/or opinion where the record contains competent evidence that the claimant has a current disability, the record indicates that a disability or signs or symptoms of disability may be associated with active service or service-connected disability, and the record does not contain sufficient information to make a decision on the claim. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79 (2006). Following the January 2020 remand, private treatment records were obtained in February 2020. These records include primary care records which indicate a diagnosis of degenerative arthritis in the right foot and the left foot. While the Veteran’s service treatment records are negative for a diagnosis of a bilateral foot condition; August 1973 records note the Veteran’s statements that a trailer dropped on his left ankle and foot, and in an August 1973 Report of Medical History, the Veteran stated that he had foot trouble. In his August 2014 VA Form 9, the Veteran stated that he had problems with his bilateral feet while in the Army. At his hearing before the Board in December 2017, the Veteran stated he had been diagnosed with arthritis in both feet since 1973 after basic training. He indicated he had no problems before he entered service and during basic training exercises, he suffered an injury to his leg. To date, the Veteran has not been provided a VA examination to determine the nature and etiology of any bilateral foot degenerative arthritis, as such, a remand is warranted. Id. MS In the January 2020 remand, the Board directed that an addendum medical opinion be obtained regarding the Veteran’s MS. A VA examination and medical opinion were provided in October 2020. The examiner indicated that the Veteran had a diagnosis of MS but provided a diagnosis of Charcot-Marie-Tooth Syndrome, a different disability. The examiner indicated that it was less likely than not that the Veteran’s MS was caused by exercise and training performed during active duty for training from July 1973 to August 1973. The examiner stated that Charcot-Marie-Tooth Syndrome is a hereditary neuromuscular degenerative disease and was highly unlikely caused by exercise and training in service. Further, the leg cramps that the Veteran complained of in August 1973 was an isolated complaint and that there was no evidence to support the Veteran’s statement that his muscles and tendons were destroyed in the bottom of his ankle and foot in 1978 and current evidence refuted that statement. In McClain v. Nicholson, 21 Vet. App. 319, 321 (2007), the United States Court of Appeals for Veterans Claims (Court) held that the requirement of the existence of a current disability is satisfied when a claimant has a disability at the time he files his claim for service connection or during the pendency of that claim, even if the disability resolves prior to adjudication of the claim. As the record reflects that the Veteran has been diagnosed with MS during the appeal period, the Board finds that remand is warranted for clarification from the October 2020 VA examiner to specifically address the Veteran’s MS. All Issues The Veteran should be afforded the opportunity to identify or submit any additional evidence on remand. The matters are REMANDED for the following actions: 1. Ask the Veteran to complete a VA Form 21-4142 for any recent treatment providers who have treated him for his bilateral foot degenerative arthritis and MS. Make two requests for any authorized records, unless it is clear after the first request that a second request would be futile. 2. After obtaining any additional records, provide the Veteran an appropriate VA examination to determine the nature, extent, and etiology of any degenerative arthritis of the right foot and of the left foot. The electronic claims file must be made available to the examiner for review in connection with the examination. All indicated tests should be conducted, including any diagnostic testing, and the reports of any such studies incorporated into the examination reports to be associated with the claims file. The examiner should render an opinion, consistent with sound medical judgment, as to whether it is at least as likely as not (a 50 percent or greater probability) that any diagnosed disability of the bilateral feet, including degenerative arthritis, is related to the Veteran’s service, to include exercise and training performed during ACDUTRA from July 1973 to September 1973. The examiner is asked to consider the record, to include the service treatment records, which indicate that in August 1973, the Veteran stated that a trailer dropped on his left ankle and foot, and in an August 1973 Report of Medical History, the Veteran stated that he had foot trouble. The examiner is also asked to consider the Veteran’s statements at his hearing before the Board in December 2017, when he stated he had been diagnosed with arthritis in both feet since 1973 after basic training. He indicated he had no problems before he entered service and during basic training exercises, he suffered an injury to his leg. A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. 3. Also obtain an addendum medical opinion from the examiner who conducted the October 2020 VA examination of the Veteran’s MS. If the examiner is unavailable, another clinician with sufficient experience and expertise should provide the requested opinion. Another examination need only be performed if deemed necessary by the clinician providing the opinion. The electronic claims file must be made available to the examiner. Based on the factual evidence of record, the examiner is specifically asked to provide an opinion as to whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran’s diagnosed MS (as shown in private treatment records and the February 2019 VA examination) was caused by exercise and training performed during ACDUTRA from July 1973 to August 1973 or otherwise due to disease or injury during this period of ACDUTRA. The examiner is asked to consider the record, to include the service treatment records which include the August 1973 Medical Board Report of Medical History, where the Veteran complained of suffering from cramps in his legs. The examiner must also consider the Veteran’s statements that he was told he had MS in 1978 and that he was told that the muscles and tendons in the bottom of his ankle and foot were destroyed. A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. M. SORISIO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Bonnie Yoon, 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.