Citation Nr: 21028609 Decision Date: 05/11/21 Archive Date: 05/11/21 DOCKET NO. 14-16 765 DATE: May 11, 2021 REMANDED Entitlement to service connection for a back disability (previously denied as back pain), to include as secondary to service-connected plantar fasciitis, is remanded. REASONS FOR REMAND The Veteran had honorable active duty service during Peacetime with the United States Army from March 1979 to June 1979. The Veteran died on October [REDACTED], 2019. The appellant is his surviving spouse. See May 2020 Substitution. This matter comes before the Board of Veterans' Appeals (Board) from a March 17, 2010 rating decision. New service personnel records, including a Physical Evaluation Board examination, were added to the claims file in July 2018. Consequently, under 38 C.F.R. § 3.156(c), the Veteran's July 2009 claim is treated as still pending. The Board previously remanded the issue in February 2018 and August 2020. Entitlement to service connection for a back disability (previously denied as back pain), to include as secondary to service-connected plantar fasciitis, is remanded. The Veteran contends that his low back disorder was caused and/or aggravated by his plantar fasciitis. In July 2009, the Veteran submitted a statement on his Form 9 indicating that after he was discharged from service, he experienced pain in his feet continually and began experiencing "bad" back pain. The record does not contain sufficient evidence to adjudicate the Veteran's appeal. The record still lacks an adequate opinion on secondary service connection. The August 2018 VA examiner opined that chronic plantar fasciitis and pes planus "can cause" chronic heel pain which "can cause" an alteration in gait leading to lumbar injury and chronic back pain. The examiner reasoned that it was at least as likely as not the Veteran's foot conditions did result in the current lumbar spine conditions. This opinion is too speculative to establish a medical nexus, and the examiner did not indicate that speculation was required in the Veteran's specific case. See Obert v. Brown, 5 Vet. App. 30 (1993) (medical opinion expressed in terms of "may" also implies "may or may not" and is too speculative to establish medical nexus). The January 2021 VA examiner opined that the Veteran's back disability was not caused by nor aggravated beyond its natural progression by service-connected plantar fasciitis. The examiner ultimately concluded that it was due to something "intrinsic" in the Veteran's back. The examiner did not provide a full medical explanation for the opinion and did not address the August 2018 VA examiner's opinion, which conflicts with the January 2021 VA examiner's rationale that there is no clear evidence to suggest that an injury to one joint would have any significant impact on another or opposite joint or limb in the Veteran's case. Further, the examiner did not clarify which of the Veteran's back disabilities was addressed by the opinion. The Veteran's treatment records contain multiple diagnoses related to the lumbar spine: lumbar strain (August 2018), scoliosis (January 2021), and degenerative changes at L3-4, L4-5, and L5-S1 (VA X-rays since 2010). While the Board sincerely regrets the delay, a remand is required before the Board may make a determination on the merits of the claim. Once VA undertakes the effort to provide a medical examination or opinion, it must provide an adequate one. Barr v. Nicholson, 21 Vet. App. 303, 311-12 (2007). Accordingly, a remand is necessary to obtain separate addendum opinions for each diagnosis. The matters are REMANDED for the following action: 1. Obtain addendum opinions from an appropriate clinician that address each of the Veteran's back disabilities. The examiner should review the entire record, including the August 2018 and January 2021 VA examinations and opinions. The Veteran's treatment records contain multiple diagnoses related to the lumbar spine: lumbar strain (August 2018), scoliosis (January 2021), and degenerative changes at L3-4, L4-5, and L5-S1 (VA X-rays since 2010). For each low back disability identified, the examiner should provide the below opinions, accompanied by medical explanations. Is it at least as likely as not (50 percent probability or greater) caused by the Veteran's service-connected plantar fasciitis; Is it at least as likely as not aggravated by the service connected plantar fasciitis? If aggravation is found, to the extent possible, the examiner is requested to provide an opinion as to approximate baseline level of severity of the nonservice-connected disorder before the onset of aggravation. A complete detailed rationale is requested for each opinion that is rendered. The examiner is requested to consider and discuss both the January 2021 and August 2018 VA nexus opinions. If the examiner finds any of the above opinions cannot be provided without resorting to mere speculation, the examiner should provide a detailed explanation for why speculation would be required. 2. If the RO determines that an opinion is deficient in any manner, corrective action should be taken. Marissa Caylor Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M.M. Schneider 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.