Citation Nr: 21027372 Decision Date: 05/05/21 Archive Date: 05/05/21 DOCKET NO. 16-14 352 DATE: May 5, 2021 REMANDED Entitlement to service connection for right foot hallux valgus, to include as secondary to service connected right foot pes planus, is remanded. Entitlement to service connection for left foot hallux valgus, to include as secondary to service connected right foot pes planus, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from September 1967 to September 1969. This matter comes before the Board of Veterans' Appeals (Board) on appeal from March 2013 and May 2015 rating decisions issued by a Department of Veterans Affairs Regional Office (RO). Subsequent to the March 2013 and May 2015 denials by RO, the Veteran appealed the claims to the Board, whereupon they were denied in a December 2018 Board decision. The Veteran then appealed his claims to the United States Court of Appeals for Veterans Claims (Court), where the matter was remanded upon an October 2020 Memorandum Decision. The matter has now returned before the Board for adjudication. 1. Entitlement to service connection for right foot hallux valgus is remanded. 2. Entitlement to service connection for left foot hallux valgus is remanded. The Veteran generally contends that his right and left foot hallux valgus are related to service. In the alternative, he alleges that these conditions are secondary to his service connected right foot pes planus. The Board finds that a remand is necessary in order to obtain an etiology opinion for these conditions. The October 2020 Memorandum Decision found that the May 2013 VA etiology opinion, upon which the Board had based its previous denials, provided an inadequate rationale in that it focused only the Veteran's right foot and did not address the left foot condition and only addressed the right foot pes planus and did not right foot hallux valgus. The Memorandum Decision also noted that service connection for right foot pes planus had been restored. Therefore, a remand for a new etiology opinion addressing both direct and secondary service connection is necessary. See McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006); 38 U.S.C. § 5103A(d)(2); 38 C.F.R. § 3.159(c)(4)(i). The matters are REMANDED for the following action: 1. Veteran should be given the opportunity to identify any outstanding private or VA treatment records relevant to the claims on appeal. After obtaining any necessary authorization from the Veteran, all outstanding records should be obtained, to include updated VA treatment records. For private treatment records, make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and his representative and afford her an opportunity to submit any copies in their possession. For federal records, all reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 2. Following the receipt of outstanding records, obtain an etiology opinion by an appropriate clinician to determine the nature and etiology of the Veteran's right foot hallux valgus and left foot hallux valgus. The examiner should review the entire claims file and note such review in the opinion. The need for further in-person examination is left to the discretion of the examiner. The examiner should respond to the following questions: (A) Is it at least as likely as not (50 probability or greater) that the Veteran's current right foot hallux valgus had its onset during service or is otherwise related to service? (B) Is it at least as likely as not (50 probability or greater) that the Veteran's current right foot hallux valgus was caused by his service connected right foot pes planus? (C) Is it at least as likely as not (50 probability or greater) that the Veteran's current right foot hallux valgus was aggravated beyond its natural progression by his service connected right foot pes planus? (D) Is it at least as likely as not (50 probability or greater) that the Veteran's current left foot hallux valgus had its onset during service or is otherwise related to service? (E) Is it at least as likely as not (50 probability or greater) that the Veteran's current left foot hallux valgus was caused by his service connected right foot pes planus? (F) Is it at least as likely as not (50 probability or greater) that the Veteran's current left foot hallux valgus was aggravated beyond its natural progression by his service connected right foot pes planus? A rationale should be provided for all opinions offered. If it is not possible to provide a specific opinion regarding the above questions, 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), or the examiner (does not have the knowledge or training). (Continued on the next page) The medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. KRISTY L. ZADORA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Kashif I. Ali, 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.