Citation Nr: 21024613 Decision Date: 04/23/21 Archive Date: 04/23/21 DOCKET NO. 12-21 507 DATE: April 23, 2021 REMANDED Entitlement to a compensable rating for residuals of a left foot injury is remanded. REASONS FOR REMAND The Veteran had active military service from June 1985 to December 1992. This matter comes to the Board of Veterans’ Appeals (Board) from a rating decision of a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ). In March 2014, the Veteran testified before the undersigned Veterans Law Judge at a Board videoconference hearing. In July 2017, the Board, in pertinent part, denied entitlement to an increased rating for a left foot disability. However, pursuant to a joint motion for partial remand (JMPR), the United States Court of Appeals for Veterans Claims (Court) vacated the Board’s decision in September 2018. In April 2019 and July 2020, the Board remanded this matter for further development. Unfortunately, the Board must remand this matter again. 1. Increased rating for residuals of a left foot disability is remanded. The Veteran contends his service-connected left foot disability is more severe than it is currently rated. The September 2018 JMPR found that since the record contained contradictory evidence regarding whether the Veteran had degenerative joint disease of the left foot, an opinion must be obtained in order to address any left foot arthritis as it relates to the Veteran’s service-connected foot disability. The September 2018 JMPR also found that that any neurological impairment of the Veteran’s left foot needed to be addressed. The Veteran is service connected for a left foot disability under the applicable Diagnostic Code 5284 for residuals of a foot injury; the Veteran was initially service connected for residuals of a fracture of the left little (5th) toe. See January 1993 rating decision. But see also June 2010 rating decision (recharacterized as residuals of foot injury). Pursuant to a July 2020 Board remand the Veteran underwent VA nerve and foot examinations in October 2020. Thereafter, VA obtained a medical opinion in December 2020 addressing any arthritis and neurological impairment in the Veteran’s left foot. The December 2020 examiner opined that the Veteran currently had left foot degenerative foot disease without evidence for neurological impairment. The examiner opined that it is less likely than not the degenerative joint disease of the left foot is due to the service-connected left foot injury previously rated as fracture of the left 5th toe. The examiner provided no rationale for his opinion. The examiner also noted that the Veteran’s October 2020 neurological examination documented normal lower neurological examination and no signs of left foot impairment. The Board finds that the December 2020 examiner’s opinion is not adequate for adjudication. First, the examiner provided no rationale as to why the Veteran’s degenerative arthritis of the left foot was not due to the Veteran’s currently service-connected left foot disability. Further, although the examiner stated the October 2020 nerve examination found no evidence of neurological impairment, that is contradicted by the October 2020 nerve examination. The October 2020 VA nerve examination found that the Veteran had mild paresthesias and/or dysesthesias and mild numbness in the left lower extremity. The examiner noted that the Veteran had clinical findings of lumbar radiculopathy at the sciatic nerve into the left foot. The Board notes that while the neurological impairment in the left foot may not be related to the Veteran’s service-connected left foot disability, the evidence in record indicates that the Veteran has neurological impairment affecting the left foot. The Board cannot rely on a medical rationale that is contradictory to evidence in the record nor on an opinion that lacks medical rationale. Thus, a remand is required in order to obtain an addendum opinion that is adequate. The matters are REMANDED for the following action: 1. Obtain an addendum medical opinion from an appropriate clinician regarding the nature and severity of the Veteran’s service-connected left foot disability. The examiner must address the following: (a.) Whether the Veteran has any neurological impairment associated with his left foot disability (with consideration of the complaints of numbness and tingling in the left foot on prior examinations, including an April 2010 VA examination report) i. The examiner must address the October 2020 neurological examination that the Veteran had radiculopathy from the lumbar spine that radiated to the Veteran’s left foot and whether that neurological impairment is in any way etiologically related to (proximately due to or aggravated by) his service-connected left foot disability. (b.) The examiner must provide an opinion regarding whether the Veteran’s left foot arthritis is at least as likely as not caused by or aggravated beyond its natural progression by his service-connected left foot residuals.   (c.) The examiner must include a complete medical rationale for all opinions provided. S. L. Kennedy Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Robert Batten 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.