Citation Nr: 21021721 Decision Date: 04/13/21 Archive Date: 04/13/21 DOCKET NO. 14-07 042A DATE: April 13, 2021 REMANDED Entitlement to service connection for a right foot disability, to include as secondary to the service-connected lumbar spine disability, is remanded. Entitlement to service connection for a left foot disability, to include as secondary to the service-connected lumbar spine disability, is remanded. Entitlement to service connection for a right knee disability, to include as secondary to the service-connected lumbar spine disability, is remanded. Entitlement to service connection for a left knee disability, to include as secondary to the service-connected lumbar spine disability, is remanded. Entitlement to service connection for a right shoulder disability, to include as secondary to the service-connected lumbar spine disability, is remanded. Entitlement to service connection for a left shoulder disability, to include as secondary to the service-connected lumbar spine disability, is remanded. Entitlement to a total disability rating due to individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1972 to November 1975. The Veteran appeared at a hearing before the undersigned Veterans Law Judge in September 2016. The Board of Veterans’ Appeals (Board) remanded the matters for further development in November 2017, May 2019, and October 2020. 1. Entitlement to service connection for a bilateral foot disability, to include as secondary to the service-connected lumbar spine disability is remanded. The Veteran was provided with a VA examination in January 2021. The examiner noted the Veteran had congenital pes cavus instead of acquired pes cavus. The examiner noted acquired pes cavus is a result of spinal cord disease and those causing neuropathy. A negative nexus opinion was provided, in part, because the examiner determined the Veteran had congenital pes cavus. It was also noted that plantar fasciitis is a natural progression of pes cavus. However, the Board notes the June 2019 VA examiner diagnosed the Veteran with acquired pes cavus. In light of a conflicting diagnosis, the examiner did not provide supporting rationale to support the contrary findings. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). This is especially so because acquired pes cavus could be related to a spinal cord disease according to the VA examiner. Unfortunately, there has also not been substantial compliance with the Board’s previous remand directives, and another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). The Board directed the examiner to provide nexus opinions for any foot conditions diagnosed during the appellate period, which began in April 2011. The Board notes the Veteran has been diagnosed with Morton’s neuroma. See August 2012 VA examination; February 2019 VA examination. The January 2021 VA examiner failed to address the previous diagnoses for Morton’s neuroma in the nexus opinion. For the foregoing reasons, a new VA medical opinion is necessary to address the etiology of the bilateral foot disability. 2. Entitlement to service connection for a bilateral knee disability, to include as secondary to the service-connected lumbar spine disability, is remanded. Unfortunately, there has not been substantial compliance with the Board’s previous remand directives, and another remand is required. Id. The Board directed the examiner to provide nexus opinions for any knee conditions diagnosed during the appellate period, which began in April 2011. The Board notes the Veteran has been diagnosed with bilateral knee strains. See August 2012 VA examination; February 2019 VA examination. The January 2021 VA examiner failed to address the previous diagnoses for bilateral knee strains in the nexus opinion. For the foregoing reason, a new VA medical opinion is necessary to address the etiology of the bilateral knee disability. 3. Entitlement to service connection for a bilateral shoulder disability, to include as secondary to the service-connected lumbar spine disability is remanded. Unfortunately, there has not been substantial compliance with the Board’s previous remand directives, and another remand is required. Id. The Board directed the examiner to provide nexus opinions for any shoulder conditions diagnosed during the appellate period, which began in April 2011. The Board notes that the Veteran has been diagnosed with bilateral shoulder strains and bilateral bursitis. See February 2019 VA examination. The January 2021 VA examiner failed to address the previous diagnoses for bilateral strain and bursitis diagnoses in the nexus opinion. For the foregoing reason, a new VA medical opinion is necessary to address the etiology of the bilateral shoulder disability. 4. Entitlement to TDIU is remanded. The Board further finds that adjudication of the TDIU issue must be deferred, as it is inextricably intertwined with the issue being remanded herein. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following action: 1. Afford the Veteran a VA addendum opinion with a qualified medical professional regarding the nature and etiology of the Veteran’s bilateral foot disabilities. The claims file should be made available to the examiner. The examiner is asked to address the following: (a.) Provide diagnoses for any foot disorder diagnosed since April 2010; If the examiner disagrees with a diagnosis already established in the medical records, he/she should so state and explain why. (b.) If the Veteran does not now have, but previously had a foot disorder, when did that disorder resolve; (c.) The examiner must opine whether it is at least as likely as not (50 percent probability or greater) that any diagnosed disorder is etiologically related to active service. Consideration and discussion of causation must include the Veteran’s 1973 parachute accident; and (d.) The examiner must opine whether it is at least as likely as not that any diagnosed disorder was caused by or aggravated beyond its natural progression by the lumbar spine disorder. A complete rationale for all opinions expressed should be provided. The examiner must explain the relevance or significance, of any history, clinical findings, medical knowledge or literature, etc., relied upon in reaching his or her conclusions, by detailing how such medical knowledge applies to the Veteran specifically. 2. Afford the Veteran a VA addendum opinion with a qualified medical professional regarding the nature and etiology of the Veteran’s bilateral knee disabilities. The claims file should be made available to the examiner. The examiner is asked to address the following: (a.) Provide diagnoses for any knee disorder diagnosed since April 2010; If the examiner disagrees with a diagnosis already established in the medical records, he/she should so state and explain why. (b.) If the Veteran does not now have, but previously had a knee disorder, when did that disorder resolve; (c.) The examiner must opine whether it is at least as likely as not (50 percent probability or greater) that any diagnosed disorder is etiologically related to active service. Consideration and discussion of causation must include the Veteran’s 1973 parachute accident; and (d.) The examiner must opine whether it is at least as likely as not that any diagnosed disorder was caused by or aggravated beyond its natural progression by the lumbar spine disorder. (e.) A complete rationale for all opinions expressed should be provided. The examiner must explain the relevance or significance, of any history, clinical findings, medical knowledge or literature, etc., relied upon in reaching his or her conclusions, by detailing how such medical knowledge applies to the Veteran specifically. 3. Afford the Veteran a VA addendum opinion with a qualified medical professional regarding the nature and etiology of the Veteran’s bilateral shoulder disabilities. The claims file should be made available to the examiner. The examiner is asked to address the following: (a.) Provide diagnoses for any shoulder disorder diagnosed since April 2010; If the examiner disagrees with a diagnosis already established in the medical records, he/she should so state and explain why. (b.) If the Veteran does not now have, but previously had a shoulder disorder, when did that disorder resolve; (c.) The examiner must opine whether it is at least as likely as not (50 percent probability or greater) that any diagnosed disorder is etiologically related to active service. Consideration and discussion of causation must include the Veteran’s 1973 parachute accident; and (d.) The examiner must opine whether it is at least as likely as not that any diagnosed disorder was caused by or aggravated beyond its natural progression by the lumbar spine disorder. A complete rationale for all opinions expressed should be provided. The examiner must explain the relevance or significance, of any history, clinical findings, medical knowledge or literature, etc., relied upon in reaching his or her conclusions, by detailing how such medical knowledge applies to the Veteran specifically. A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. N. Quarles, 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.