Citation Nr: 21025245 Decision Date: 04/27/21 Archive Date: 04/27/21 DOCKET NO. 17-15 304 DATE: April 27, 2021 REMANDED Entitlement to a compensable rating for residuals of a stress fracture of the right third metatarsal is remanded. Entitlement to service connection for residuals of a left ankle sprain is remanded. REASONS FOR REMAND The Veteran served honorably in the Army from December 1988 to March 1996. She testified in support of these claims during a recent February 2021 “virtual” hearing before the undersigned Veterans Law Judge (VLJ) of the Board. A transcript of the proceeding is of record. Following the hearing, the Board held the record open for 30 additional days to allow her time to obtain and submit additional supporting evidence – including treatment records concerning the continuing issues with her right foot and for a medical nexus opinion linking her left ankle disability to the sprains/strains she sustained to this ankle during her service. To this end, in March 2021, at least as concerning her right foot disability, she submitted clinical progress notes detailing treatment a private podiatrist, Dr. A. M., of the Foot Specialist Group, Inc., intended to pursue from September 2015 onward and that since has occurred. 1. Entitlement to a compensable rating for residuals of a stress fracture of the right third metatarsal is remanded. The Veteran testified during her recent February 2021 virtual hearing that her last VA examination for her stress fracture of the third metatarsal on her right foot was in 2014, so some 7 years ago. She added that, in the years since, this disability has worsened appreciably – as evidenced by the podiatrist’s records she submitted within 30 days following the hearing discussing the course of treatment that was instituted beginning in September 2015 owing to the recurring issues with this foot. Therefore, she needs to be reexamined to reassess the severity of this disability. See Snuffer v. Gober, 10 Vet. App. 400, 403 (1997). 2. Entitlement to service connection for residuals of a left ankle sprain/strain is remanded. The Veteran also testified during her recent February 2021 virtual hearing that she has experienced chronic pain in her left ankle since spraining it at least twice, if not more, during her service. Her service treatment records (STRs) confirm she sprained this ankle several times during her service. A VA compensation examiner concluded in July 2014 that the Veteran’s then current left ankle disability was unrelated to her ankle sprains in service, but the Veteran more recently testified during her hearing that she since has continued having recurring issues with this ankle that she still believes are nonetheless attributable to her sprains in service. More medical comment consequently is needed to assist in making this important determination. Accordingly, these claims are REMANDED for the following additional development and consideration: 1. If there are outstanding treatment or other records relevant to these claims – including concerning the treatment the Veteran has received from her private podiatrist (Dr. A. M. of the Foot Specialist Group, Inc.) since September 2015, have the Veteran complete the necessary authorization and obtain these additional records. Also, appropriately notify the Veteran and her representative if unable to obtain records she identifies with the required amount of information. 2. After obtaining all additional treatment or other relevant records, schedule the Veteran for another VA compensation examination by an appropriate clinician to reassess the severity of the service-connected residuals of the stress fracture of her right third metatarsal (right foot disability). To this end, the examiner must provide a full description of the disability and report all signs and symptoms necessary for evaluating this disability under the applicable rating criteria. (a.) In so doing, the examiner must test the Veteran’s active motion, passive motion, and pain with weight-bearing and without weight-bearing. If it is not possible to provide a specific measurement, without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), the examiner (does not have the knowledge or training), or whatever other reason precludes responding. (b.) The examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. If it is not possible to provide a specific measurement based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment due to flare-ups based on the other evidence of record and the Veteran’s statements.   If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), the examiner (does not have the knowledge or training), or whatever other reason precludes responding. 3. Also have the Veteran reexamined for additional medical comment concerning whether it is at least as likely as not (50 percent or greater probability) she has current left ankle disability due to her left ankle sprains or strains in service. The examiner’s attention is drawn to the Veteran’s credible testimony during her recent February 2021 virtual hearing attesting that she has experienced chronic left ankle pain since spraining/straining this same ankle at least twice, if not more, during her service. To assist in making this important determination, the claims file, including a complete copy of this remand, must be made available to the examiner for review and consideration of the relevant history.   When responding, whether favorably or unfavorably, it is essential the examiner provide explanatory rationale – preferably citing to evidence in the file supporting conclusions and/or accepted medical authority. KEITH W. ALLEN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. B. Kucera 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.