Citation Nr: 21023545 Decision Date: 04/20/21 Archive Date: 04/20/21 DOCKET NO. 16-18 878 DATE: April 20, 2021 REMANDED Entitlement to service connection for bilateral pes planus is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from October 1993 to September 2004. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously before the Board in December 2019. In the December 2019 decision, the Board directed the RO to ask the Veteran to identify any and all health care providers who provided treatment for his bilateral pes planus, obtain any outstanding VA treatment records and afford the Veteran a VA examination to determine whether his preexisting pes planus was aggravated by his military service. Specifically, the examiner was asked to address whether there was any increase in the severity of the Veteran’s bilateral pes planus during service, and if so, the examiner should also discuss whether any increase was due to the natural progression of the disorder or whether it represented a chronic worsening of the underlying pathology. In February 2020, the RO sent a letter to the Veteran to identify any and all health care providers who provided treatment for the bilateral pes planus. The evidence of records indicates the Veteran did not respond. In June 2020, the RO obtained the Veteran’s VA treatment records and associated them with the claims file. The Veteran was afforded a VA examination in July 2020; however, the examiner’s rationale was inadequate for adjudicative purposes. The examiner’s opinion was not fully informed since it relied on present day findings without explaining how those findings did or did not show an increase of severity of the Veteran’s bilateral pes planus during service. Once VA undertakes the effort to provide an examination when developing a service connection claim, the examination must be an adequate one. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Accordingly, the RO did not substantially comply with the December 2019 Board remand directives and another remand is required to obtain an adequate aggravation opinion. Stegall v. West, 11 Vet. App. 268, 271 (1998). While the Board regrets the delay, a remand is required before the Board can make a fully informed decision on the issue of the Veteran’s bilateral pes planus claim. The matters are REMANDED for the following action: 1. Schedule the Veteran for an in-person VA examination by an appropriate examiner to determine the nature and etiology of the Veteran’s bilateral pes planus. 2. Provide the examiner the Veteran’s complete claims file, including the December 2019 Remand and this Remand, for review. The examination report should reflect that such review was accomplished. 3. The examiner should note that the Veteran is competent to attest to factual matters of which he has first-hand knowledge. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should state this with a fully reasoned explanation. It should also be noted that the presumption of soundness does not apply for pes planus, as the disorder was noted at the time of the Veteran’s enlistment examination. 4. The examiner is requested to opine whether it is at least as likely as not (probability of 50 percent or more) that the Veteran’s preexisting pes planus was aggravated by his military service. In so doing, the examiner should address whether there was any increase in the severity of the disorder during service. If so, the examiner should also discuss whether any increase was due to the natural progression of the disorder or whether it represented a chronic worsening of the underlying pathology. In responding to this question, the examiner should note that temporary or intermittent flare-ups of a preexisting injury or disease are not sufficient to be considered “aggravation in service” unless the underlying condition, as contrasted with symptoms, has worsened. 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 conclusion is so evenly divided that it is as medically sound to find in favor of conclusion as it is to find against it. 5. A complete rationale must be provided for any and all opinions offered. All appropriate studies and consultations should be accomplished, and all clinical findings should be reported in detail. If any requested opinion cannot be provided without resorting to mere speculation, the examiner must fully explain why this is the case and identify what, if any, additional evidence or information might allow for a more definitive opinion. 6. After completing the foregoing and any other development necessary, readjudicate the Veteran’s claim. 7. If any benefit sought on appeal remains denied, a Supplemental Statement of the Case (SSOC) should be furnished to the Veteran and his representative, and he and his representative should be afforded a reasonable opportunity to respond. Cynthia M. Bruce Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Agarwal, 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.