Citation Nr: 21027718 Decision Date: 05/06/21 Archive Date: 05/06/21 DOCKET NO. 15-18 955 DATE: May 6, 2021 REMANDED Entitlement to a rating in excess of 10 percent for residuals of right foot/ankle injury is remanded. Entitlement to service connection for a bilateral leg disorder, to include as secondary to the service-connected right foot/ankle injury, is remanded. REASONS FOR REMAND The Veteran served on active duty with the Army from June 1968 to February 1970. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge at a videoconference hearing in February 2019. A transcript of the proceeding has been associated with the claims file. In April 2019, the Board remanded the appeal for further development. Regrettably, as detailed below, a remand is again required. Increased Rating for Right Foot/Ankle Disability Pursuant to the Board's remand, the Veteran underwent a VA foot examination in February 2021, during which he was diagnosed with a fracture of the right foot with residual pain and degenerative arthritis of the right foot. Portions of the Disability Benefits Questionnaire were left blanknamely, sections III -Flatfoot, IV-Plantar Fasciitis, V-Morton's Neuroma and Metatarsalgia, VI-Hammer Toe, VII-Hallux Valgus, VIII-Hallux Rigidus, IX-Pes Cavus and X-Malunion or Nonunion of Tarsal or Metatarsal Bones. Further, the examiner provided a negative response as to whether the Veteran used orthopedic shoes or had had prior surgery. However, a November 2019 VA examination diagnosed a "right foot condition," and then indicated associated diagnoses of pes planus, hammer toes and hallux valgus, and notes use of orthopedic shoes and prior surgery. Additionally, a February 2021 X-ray report shows that the Veteran has lost the arch in his foot, and VA treatment records document that the Veteran had a right foot hammer toe correction in 2015, and further show diagnoses of acquired claw toes and severe planovalgus foot deformity. The Board notes that the November 2019 VA examiner separately stated that the Veteran's pes planus and claw/hammer toes were "completely unrelated" to his metatarsal fracture, but provided no explanation. Accordingly, and as the February 2021 VA examination was inadequate, as it failed to reflect the Veteran's correct medical history and diagnoses, the Board finds another VA examination is warranted that addresses the additional diagnoses and clarifies whether they are related to his service-connected foot/ankle disability. Service Connection for a Bilateral Leg Disorder In November 2019, a VA examination and opinion was obtained regarding the Veteran's claimed bilateral leg disorder. The examiner was asked to opine whether the Veteran's bilateral leg disorder was due to service, or was caused or aggravated by his service-connected right ankle/foot injury. However, in rendering an opinion on direct service connection, the examiner did not address the Veteran's in-service treatment for swelling and aching in both legs in November 1968. Regarding secondary service connection, the examiner stated that the medical literature does not support a relationship between the Veteran's bilateral leg disorder and service-connected right ankle/foot injury. However, in April 2021, the Veteran's representative submitted arguments citing medical evidence supporting such a relationship. Accordingly, an addendum opinion is required. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected right ankle/foot injury. After a review of the Veteran's claims file, including his February 2019 Board hearing testimony, the examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. The examiner should clarify the Veteran's right ankle/foot injury diagnoses and symptomatology, and address whether any symptoms/diagnoses are related to his service-connected right ankle/foot injury. The examiner must attempt to elicit information regarding the degree of functional loss during flare-ups. To the extent possible, the examiner should identify any symptoms and functional impairments due to the right ankle/foot injury alone and discuss the effect of the Veteran's right ankle/foot injury on any occupational functioning and activities of daily living. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment 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), or the examiner (does not have the knowledge or training). Any opinion expressed should be accompanied by a complete rationale. 2. Obtain an addendum opinion from an appropriate clinician to determine the nature and etiology of any bilateral leg condition including, knee replacement surgery, neuritis of the posterior tibial nerve, severe right tibial compression neuropathy at the right ankle and more mildly of the left, and deep vein thrombosis (DVT). After a review of the Veteran's claims file, including his February 2019 Board hearing testimony, the examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including the November 1968 treatment note for swelling and aching in both legs. Additionally, the examiner is to opine whether any of the Veteran's bilateral leg conditions are at least as likely as not (1) proximately due to the Veteran's service-connected right/ankle foot injury; or (2) aggravated beyond its natural progression by his service-connected right/ankle foot injury. In rendering an opinion, the examiner should address the April 2021 arguments submitted by the Veteran's representative citing a recent study concluding that "increased foot pronation may compromise ankle plantarflexion moment during the stance phase of gait, which may overload knee and hip. Any opinion expressed should be accompanied by a complete rationale. 3. Readjudicate the appeal. L. M. BARNARD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A.Z., 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.