Citation Nr: 21022432 Decision Date: 04/15/21 Archive Date: 04/15/21 DOCKET NO. 18-47 854 DATE: April 15, 2021 REMANDED Entitlement to service connection for bilateral pes planus is remanded. Entitlement to service connection for bilateral hallux valgus, including as secondary to bilateral pes planus, is remanded. REASONS FOR REMAND The Veteran had active service from January 1997 to January 2001. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a January 2018 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In a January 2019 decision, the Board denied the Veteran’s claims. The Veteran appealed that decision to the United States Court of Appeals for Veterans Claims (Court), which in a November 2020 Order and pursuant to a Joint Motion for Remand (JMR), vacated the January 2019 denial and remanded the case to the Board. In a March 2021 correspondence, the Veteran requested that Adam Werner be removed as his representative and requested that he represent himself. Therefore, the Board recognizes the Veteran as unrepresented. In the November 2020 JMR, the parties agreed that the Board relied on an inadequate medical opinion in its denial. The matters were remanded for the Board to obtain an adequate medical opinion. In that regard, the Veteran’s pes planus preexisted service and therefore an opinion regarding whether the pes planus was aggravated by service is required. The Veteran was afforded a VA examination in March 2017 where the examiner opined that the Veteran’s pes planus was less likely than not related to service. The examiner reasoned that severe pes planus was noted on the entrance examination and although he had sick visits for the condition during service, “symptomatic expression of a preexisting condition is not evidence of worsening of disease state . . .[t]here would be no evidence of progression of the preexisting condition to attribute to service.” The Board finds that a remand is required to obtain an opinion regarding whether the preexisting pes planus was aggravated by service. While on remand, the examiner should also address whether the Veteran’s claimed bilateral hallux valgus was caused or aggravated by the claimed bilateral pes planus. The matters are REMANDED for the following action: Obtain a medical opinion from the March 2017 VA examiner regarding the etiology of the Veteran's bilateral pes planus and hallux valgus (or if that examiner is not available, from a suitable medical practitioner familiar with disabilities of the feet). The Veteran's electronic claims folder, including a copy of this remand, must be available to the examiner for review. The clinician is requested to offer an opinion as the following: (a) Whether the Veteran’s preexisting bilateral pes planus (noted on entry examination) increased in severity during his active duty service. (b) If it is determined that the preexisting bilateral pes planus loss disability as likely as not increased in severity during service, then whether it is clear and unmistakable (obvious, manifest, and undebatable) that the preexisting bilateral pes planus WAS NOT aggravated during service; or whether it is clear and unmistakable (obvious, manifest, and undebatable) that any increase in service was due to the natural progress. There is no aggravation of a preexisting disease or injury if the condition underwent no increase in severity during service on the basis of the evidence of record pertinent to the manifestations of the disability prior to, during, and subsequent to service. 38 C.F.R. § 3.306 (b). Also, intermittent or temporary flare-ups during service of a preexisting injury or disease do not constitute aggravation; rather, the underlying condition, as contrasted with symptoms, must have worsened. Hunt v. Derwinski, 1 Vet. App. 292, 297 (1991). Accordingly, "a lasting worsening of the condition" - that is, a worsening that existed not only at the time of separation but one that still exists currently is required. Routen v. Brown, 10 Vet. App. 183, 189 (1997). (c) Whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s claimed bilateral hallux valgus was incurred in or otherwise related to service. (d) If not, whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s claimed bilateral hallux valgus was caused or aggravated by his bilateral pes planus. If aggravation found, provide baseline manifestations and any increased manifestations due to the bilateral pes planus. A complete rationale for all opinions must be provided. Michael A. Pappas Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Baskerville, LaRita 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.