Citation Nr: 21023612 Decision Date: 04/21/21 Archive Date: 04/21/21 DOCKET NO. 15-11 432 DATE: April 21, 2021 REMANDED Entitlement to service connection for diabetes mellitus is remanded. Entitlement to service connection for a stroke is remanded. Entitlement to service connection for a lumbar spine disorder is remanded. Entitlement to service connection for a left knee disorder is remanded. Entitlement to service connection for a right knee disorder is remanded. Entitlement to service connection for hypertension is remanded. Entitlement to service connection for a left hip disorder is remanded. Entitlement to service connection for a right hip disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1966 to March 1969. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2013 rating decision. This case was before the Board in January 2019. The Veteran’s claims were remanded for additional development. The appeal was returned to the Board and the claims were remanded again in November 2020 to obtain addendum medical opinions. The appeal has now been returned to the Board for further appellate review. This claim has been advanced on the docket pursuant to 38 C.F.R. § 20.900. The Veteran contends that he has had continuing pain in his feet since his military service and the pain in his feet has caused all of his claimed conditions. Specifically, he maintains that he had to change how he bears his weight on his feet, which put excess pressure on his knees, hips, and back; and he gained weight due to being unable to exercise because of severe pain in his feet, which caused weight gain that resulted in diabetes mellitus, hypertension, and stroke, and impacted his knees, hip, and back. 1. Entitlement to service connection for diabetes mellitus is remanded 2. Entitlement to service connection for a stroke is remanded 3. Entitlement to service connection for a lumbar spine disorder is remanded 4. Entitlement to service connection for a left knee disorder is remanded 5. Entitlement to service connection for a right knee disorder is remanded 6. Entitlement to service connection for hypertension is remanded 7. Entitlement to service connection for a left hip disorder is remanded 8. Entitlement to service connection for a right hip disorder is remanded A remand confers on the claimant, as a matter of law, the right to compliance with the remand order and imposes upon the VA a concomitant duty to ensure compliance with the remand. See Stegall v. West, 11 Vet. App. 268 (1998). Consistent with this, when the Board has remanded a claim to obtain a VA medical opinion that opinion must be adequate in order to comply with the remand. Once VA has provided a VA examination, it is required to provide an adequate one, regardless of whether it was legally obligated to provide an examination in the first place. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). In January 2021, VA obtained addendum opinions considering whether the Veteran’s service-connected bilateral foot condition caused or aggravated his claimed conditions. The examiner opined that current chronic obesity could not be confirmed due to service-connected plantar fasciitis based on the current available records. The examiner ultimately determined that the Veteran’s weight gain was a choice independent of his service-connected foot condition. The examiner stated there was no nexus or aggravation nexus established. The examiner provided this same statement for each of the claimed conditions. In addition for the orthopedic conditions, the examiner opined that there was no clear link in the scientific literature to suggest that injury to one joint would impact another absent major muscle or nerve injury, leg length discrepancy of more than 5cm or obvious Trendelenburg gait. The examiner’s opinion is inadequate, however, because it failed to consider the Veteran’s statements, the statements of his wife, a certified nursing assistant, and the May 2015 opinion of R.F.B., MD. Medical evidence is considered probative when it is factually accurate, fully articulated, and provides sound reasoning for the conclusion. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The examiner did not address important information available in the record, and therefore, did not consider all the facts. Furthermore, in making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and recurrence of symptoms. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). The record establishes that the Veteran experienced a significant increase in weight after he suffered in-service pain in his feet. The Veteran’s February 1966 entrance examination reported his weight as 150 pounds. In May 1966, the Veteran was issued a physical profile for his feet due to a calcaneal stress fracture. His profile restricted any running, marching, or physical training that would bear weight on his heels. A November 1968 separation examination, conducted approximately four months before he was discharged in March 1969, reported his weight as 195 pounds. A November 1968 report of medical history documented the Veteran’s report that he had recently gained weight and experienced foot trouble and swollen or painful joints. In September 2012, the Veteran submitted correspondence in which he expressed that, over the years, he has struggled with unhealthy changes in his weight, but due to pain in his feet and knees he had been unable to maintain a regular exercise schedule. He reported that all efforts to control his weight through countless gyms, exercise programs, and strength training regimens all were cut short or abandoned because of his unbearable foot and knee pain. The Veteran also stated that he trained himself to run on his toes to protect his heels to the detriment of his knees and hips. In October 2012, the Veteran’s spouse, a certified nursing assistant, submitted correspondence in which she stated that the Veteran’s knees began to suffer from the way he had to walk to compensate for the pain in his heels. She reported that, because he was unable to walk or exercise, the Veteran gained 100 pounds and was diagnosed with diabetes. She further stated that it is her belief that all of the Veteran’s medical problems started at his feet. In May 2015, the Veteran submitted a March 2015 letter from a doctor who stated that, due to the Veteran’s bilateral calcaneal injuries in service, he has had chronic, daily bilateral heel pain that is made worse with any degree of ambulation. According to the doctor, these injuries have drastically affected his quality of life. The January 2021 examiner did not address any of this evidence in the opinions provided. The examiner also did not address the continuing weight problems the Veteran had during his military service, including his weight gain after injury, and following his discharge. Instead the examiner focused on whether the Veteran’s current obesity could have been avoided through other means such as diet. The question for consideration is not whether the Veteran’s service-connected disabilities caused the Veteran to be obese today. The question is (1) whether the Veteran became obese or had his obesity worsened at any point due to his service-connected condition and then (2) whether that obesity caused or aggravated his other conditions. Even if the Veteran could have lost weight over the years, he gained significant weight during and after service and whether that weight gain was caused or worsened by his foot disability is relevant to his current claim. Furthermore, the January 2021 examiner determined that there was a lack of evidence that the Veteran altered his gait to a level that would have impacted his knees, hips, or back. However, the examiner did not address the Veteran’s statement that he altered the way he walked and ran in order to not place weight on his heels. Although the record does not establish a “Trendelenburg gait,” the examiner needed to address whether continually placing excess weight on the front of the foot and toes caused or aggravated the Veteran’s problems with the knees, hips, and back. That question has not been answered. The Veteran is competent to explain how he adjusted weight bearing to compensate for the pain in his feet, as this was his personal experience. For the foregoing reasons, the January 2021 addendum opinions are inadequate, and remand is warranted for further development. The matters are REMANDED for the following action: Obtain an addendum medical opinion. The examiner must review the entire claims file, to include this remand. Only if determined necessary by the examiner, should the Veteran be scheduled for another VA examination. If the examiner determines that another VA examination is necessary, any evaluations, studies, or tests deemed necessary by the examiner should be accomplished and any such results must be included in the examination report. The examiner must provide the following opinions: (a.) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s lack of exercise due to his service-connected bilateral foot condition caused or aggravated the Veteran’s weight gain or obesity at any time and, if so, (b.) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s weight gain or obesity resulting from the service-connected bilateral foot condition caused, or aggravated, the Veteran’s diabetes mellitus, stroke, lumbar spine disorder, left knee disorder, right knee disorder, hypertension, left hip disorder, and right hip disorder. If the answer to (a.) above is positive, the examiner should provide separate opinions for each of the Veteran’s claimed disorders on appeal. (c.) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s altered displacement of weight on his feet resulting from the service-connected bilateral foot condition (i.e. continually placing excess weight on the front of the foot and toes) caused, or aggravated the Veteran’s left knee disorder, right knee disorder, left hip disorder, right hip disorder, and lumbar spine disorder. In providing the opinions, the examiner must address the Veteran’s contentions, the statement and opinion of the Veteran’s wife, and the May 2015 opinion of R.F.B., MD. The examiner must be advised that the Veteran is competent to report symptoms and treatment and that his reports, including his reports as to the onset and chronic nature of his symptoms, must be considered, along with the other evidence of record, in formulating the requested opinions. The Veteran has the right to submit additional evidence and argument on the matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). P. Saindon Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Temple, 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.