Citation Nr: 21026113 Decision Date: 04/29/21 Archive Date: 04/29/21 DOCKET NO. 09-00 068 DATE: April 29, 2021 REMANDED Entitlement to service connection for a left foot disability is remanded. Entitlement to service connection for a right knee disability is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1994 to October 1996. In January 2020, the Board remanded the issues of entitlement to service connection for a left foot disability, a left knee disability, a right knee disability, chronic sinusitis, sleep apnea, and headaches. In a January 2021 rating decision, service connection was granted for chronic sinusitis, evaluated as 30 percent disabling effective April 11, 2014, and as 10 percent disabling effective October 28, 2020; and headaches, evaluated as noncompensable effective April 11, 2014. As this represents a full grant of the benefits sought, the issues of entitlement to service connection for chronic sinusitis and headaches are no longer before the Board. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997) (noting that a grant of service connection extinguishes appeals before the Board). By filing a timely VA Form 10182, , Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran appealed the assigned evaluations in the modernized review system, known as the Appeals Modernization Act (AMA), and therefore, those issues will not be the subject of the instant legacy Board decision. In a January 2021 supplemental statement of the case, service connection was denied for sleep apnea and disabilities of the left foot, left knee, and right knee, so those issues remain on appeal. On his timely VA Form 10182, the Veteran opted the claims of entitlement to service connection for sleep apnea and a left knee disability into the AMA system by identifying the January 2021 supplemental statement of the case. Consequently, those issues will not be the subject of the instant legacy Board decision. 1. Left Foot The Veteran seeks service connection for a left foot disability, presenting several instances of possible in-service causation. He has stated that while repelling from a repelling tower, he “landed wrong fast and hard.” He stated that doctors determined that he had hair line fractures in both feet, ankles, and that he dislocated his right knee. See Correspondence, received 11/20/2013. Additionally, the Veteran has contended that he injured his left foot while onboard during a “weapons off-load at the end of Mediterranean sea cruise.” See VA Form 9, received 1/20/2017. According to an examining clinician, in 2008, the Veteran was found to have left foot plantar fasciitis, which has continued through the period on appeal. See October 2020 C&P Exam, received 1/11/2021. The Veteran’s service treatment records show that on 29 February 1996 he was seen for complaint of bilateral foot pain, which was found to be questionable plantar fasciitis. He was educated on the use of insoles. See STR, received 9/8/2005. The examining clinician opined that the Veteran’s left foot plantar fasciitis was less likely than not related to service because “review of records however did not show any evaluation of foot condition during service.” See C&P Exam, received 1/11/2021. As this statement is factually inaccurate, the Board finds that this medical opinion is inadequate. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that a medical opinion based upon an inaccurate or incomplete factual premise is not probative); Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (holding that, once VA provides an examination, it must be adequate). Consequently, a remand is required to obtain a new medical opinion. On remand, a new medical opinion is required to determine the nature and etiology of the Veteran’s left foot disability, to include plantar fasciitis, accounting for the record evidence and accepted medical principles. 38 C.F.R. § 3.159(c)(4). 2. Right Knee The Veteran seeks service connection for a right knee disability, essentially contending that it was dislocated during service. He has reported that after repelling from the repelling tower at Fort Riley, Kansas, he was told that he had dislocated his right knee. See Correspondence, received 11/20/2013. He has also reported that, during a takedown while training with a roommate, he dislocated his right knee. Id. He has identified his right knee injuries as occurring at Fort Riley and again at Camp Howze, in South Korea. See Correspondence, received 6/5/2013. During an October 2020 VA examination, the Veteran reported that he started having increased bilateral knee pain in 1997, which progressively worsened. It was noted that recent X-rays revealed severe arthritis in both knees. The Veteran was found to have bilateral knee strain with onset in 1997. See October 2020 C&P Exam, received, 1/11/2021. The examining clinician opined that it was less likely than not that the Veteran’s right knee strain was related to active duty service because “review of records however did not show any evaluation or diagnosis of any knee condition during service.” See C&P Exam, received 1/11/2021. The Board finds this medical opinion problematic because it failed to address the Veteran’s report that he dislocated his right knee on two occasions during service and his report that he had increased knee pain within one year of separation from service. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that a medical opinion based upon an inaccurate or incomplete factual premise is not probative). Consequently, a remand is required to obtain a new medical opinion. On remand, a new medical opinion is required to determine the nature and etiology of the Veteran’s right knee disability, to include right knee strain or arthritis. These matters are REMANDED for the following actions: 1. Obtain a medical opinion from an appropriately qualified clinician to determine the nature and etiology of the Veteran’s left foot disability, to include plantar fasciitis, addressing whether it is at least as likely as not that the Veteran’s left foot disability, to include plantar fasciitis, had its onset during active duty service or etiologically is otherwise directly related to service. The claims file should be made available to the reviewing clinician, and the reviewing clinician should review the claims file in forming the requested opinion. The Board leaves it to the reviewing clinician’s discretion whether the Veteran should be re-examined to provide an adequate opinion. The Board points out that on 29 February 1996 the Veteran was seen for questionable bilateral plantar fasciitis. The reviewing clinician should provide a detailed rationale that fully explains all the reasons for the given opinion. A discussion of the facts and medical principles involved would be of considerable assistance to the Board. In rendering this opinion, the reviewing clinician is advised that the Veteran is competent to report his symptoms and history. Such reports must be acknowledged and considered in formulating any opinion. If the reviewing clinician rejects the Veteran’s reports, an explanation for the rejection must be provided. The reviewing clinician is not to improperly discount the Veteran’s lay statements or mistakenly rely on an absence of medical evidence in the record to support the rendered conclusions. If an opinion cannot be provided without resorting to mere speculation, the reviewing clinician must provide a complete explanation for why an opinion cannot be rendered. In so doing, the reviewing clinician must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. 2. Obtain a medical opinion from an appropriately qualified clinician to determine the nature and etiology of the Veteran’s right knee disability, to include right knee strain or arthritis, addressing whether it is at least as likely as not that the Veteran’s right knee disability, to include right knee strain or arthritis, (1) began during active service, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service. The claims file should be made available to the reviewing clinician, and the reviewing clinician should review the claims file in forming the requested opinion. The Board leaves it to the reviewing clinician’s discretion whether the Veteran should be re-examined to provide an adequate opinion. The Board points out that the Veteran reports having dislocated his right knee on two occasions during service. The reviewing clinician should provide a detailed rationale that fully explains all the reasons for the given opinion. A discussion of the facts and medical principles involved would be of considerable assistance to the Board. In rendering this opinion, the reviewing clinician is advised that the Veteran is competent to report his symptoms and history. Such reports must be acknowledged and considered in formulating any opinion. If the reviewing clinician rejects the Veteran’s reports, an explanation for the rejection must be provided. The reviewing clinician is not to improperly discount the Veteran’s lay statements or mistakenly rely on an absence of medical evidence in the record to support the rendered conclusions. If an opinion cannot be provided without resorting to mere speculation, the reviewing clinician must provide a complete explanation for why an opinion cannot be rendered. In so doing, the reviewing clinician must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. 3. Readjudicate the claim. DONNIE R. HACHEY Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Leanne M. Innet, 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.