Citation Nr: 21021536 Decision Date: 04/13/21 Archive Date: 04/13/21 DOCKET NO. 13-09 285A DATE: April 13, 2021 ORDER Entitlement to service connection for right hallux limitus, as secondary to service-connected open dislocation of metatarsophalangeal joint right great toe and fractured based of third metatarsal, is granted. REMANDED An initial rating in excess of 10 percent for right foot injury residuals, including open dislocation of metatarsophalangeal joint right great toe, fractured based of third metatarsal and hallux limitus, is remanded. FINDING OF FACT The Veteran’s right hallux limitus is proximately due to his open dislocation of metatarsophalangeal joint right great toe and fractured based of third metatarsal. CONCLUSION OF LAW The criteria for entitlement to secondary service connection for right hallux limitus are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Marine Corps from July 1998 to August 2003, with service in Iraq and Kuwait. His awards and decorations include the Presidential Unit Citation and the Iraq Campaign Medal with one Bronze Star. This matter comes before the Board of Veterans’ Appeals (Board) from an April 2012 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In March 2016, the Veteran testified before the undersigned Veterans Law Judge. In May 2016 and November 2019, the Board remanded the matter for further development. 1. Entitlement to service connection for right hallux limitus, as secondary to service-connected open dislocation of metatarsophalangeal joint right great toe and fractured based of third metatarsal, is granted. The issue of entitlement to secondary service connection for hallux limitus is raised by the record and is an aspect of the increased rating claim on appeal. See Morgan v. Wilkie, 31 Vet. App. 162, 164 (2019) (schedular rating concepts, including secondary service connection, are critical components of VA’s duty to maximize benefits). Secondary service connection is warranted for a disability that is proximately due to or has been aggravated by a service-connected disability. 38 C.F.R. § 3.310. When the Veteran presented for a VA foot examination in February 2020, he was diagnosed with hallux limitus. See February 2020 VA examination. The examiner opined that the Veteran’s hallux limitus was a continuation of his service-connected right foot injury residuals. In this regard, the Board notes that the Veteran’s current service-connected right foot disability is described as “open dislocation of metatarsophalangeal joint right great toe and fractured based of third metatarsal,” and hallux limitus is not currently listed as part of his service-connected disability. See, e.g., July 2016 Rating Decision - Codesheet. The Board finds that a medical nexus has been established by the February 2020 VA examiner, warranting secondary service connection for this condition. 38 C.F.R. § 3.310(a). REASONS FOR REMAND 2. An initial rating in excess of 10 precent for right foot residuals is remanded. The Board regrets further delay, but another remand is required, as there has not been substantial compliance with the directives of the November 2019 Board remand. See Stegall v. West, 11 Vet. App. 268 (1998) (a remand confers upon the claimant, as a matter of law, the right to compliance with the remand directives). Specifically, the November 2019 Board remand directed an examiner to identify all right foot disabilities present since June 2010 and explain their relationship to the Veteran’s service and/or their relationship to the Veteran’s service-connected right foot injury residuals. The examiner was specifically asked to address metatarsalgia, hallux rigidus and any arthritic conditions, as indicated in a June 2016 VA examination report; however, the Board notes that report also contains right foot diagnoses of pes planus and hammer toe. In the resultant February 2020 VA examination report, the examiner merely noted that there was no presence of metatarsalgia. arthritis or hallux rigidus based on records review, which is inadequate, as the June 2016 VA examination report diagnosing these conditions was not discussed. Moreover, the examiner did not address diagnosed pes planus or right hammer toe. Thus, an addendum opinion is warranted on remand. Outstanding treatment records should also be secured. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records. 2. With any necessary assistance from the Veteran, obtain any relevant outstanding private treatment records. 3. Then obtain an addendum opinion, preferably from a podiatrist, addressing the etiology of diagnosed right foot disorders other than the Veteran’s service-connected open dislocation of metatarsophalangeal joint right great toe, fractured based of third metatarsal, and right hallux limitus. The claims file, including a copy of this remand, must be provided to the examiner in conjunction with the requested opinion. (a.) Diagnose all right foot disabilities other than open dislocation of metatarsophalangeal joint right great toe, fractured based of third metatarsal, and right hallux limitus present since June 2010, even if resolved, to include (1) metatarsalgia, (2) hallux rigidus, (3) traumatic arthritis, (4) pes planus, and (5) hammer toe. If no such diagnoses are found, please reconcile your findings with the June 2016 VA examination report and VA and private treatment records. Additionally, if the diagnosis of metatarsalgia is not found, please reconcile your findings with the Veteran’s March 2016 Board testimony, where he specifically endorses pain in the ball of his foot. See Board Hearing Transcript at 7. Please note that merely stating these conditions do not exist without providing a robust rationale will render the examination inadequate and will be returned due to the same. (b.) For each right foot disability so diagnosed, please opine whether it is at least as likely as not that such disability: (1) had its onset in service or is otherwise the result of the Veteran’s service; (2) is proximately due to his service-connected open dislocation of metatarsophalangeal joint right great toe, fractured based of third metatarsal, and right hallux limitus; or (3) has been aggravated (worsened beyond natural progression) by his service-connected open dislocation of metatarsophalangeal joint right great toe, fractured based of third metatarsal, and right hallux limitus. A complete rationale must be provided. If unable to provide a medical opinion without speculation, provide a statement as to whether there is any additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. S. BUSH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. J. Rogers, 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.