Citation Nr: 21029776 Decision Date: 05/17/21 Archive Date: 05/17/21 DOCKET NO. 19-27 933 DATE: May 17, 2021 REMANDED Entitlement to service connection for a bilateral foot condition other than pes planus, to include as secondary to service-connected pes planus, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from November 1968 until June 1970. This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.902 (c). This appeal has been before the Board on several prior occasions. Most recently, in February 2021, the Board remanded the claim for the agency of original jurisdiction (AOJ) to make additional efforts to obtain private treatment records identified by the Veteran. The Board finds there has been substantial compliance with the Board's prior remand instructions. Stegall v. West, 11 Vet. App. 268, 271 (1998). However, for the reasons described below, the claim must be remanded again. Entitlement to service connection for a bilateral foot condition other than pes planus, to include as secondary to service-connected pes planus, is remanded. The Veteran asserts that he has a bilateral foot condition, other than pes planus, that is etiologically related to service, to include as secondary to service-connected pes planus. Subsequent to the Board's February 2021 remand, the AOJ obtained additional treatment records from Front Range Foot and Ankle clinic that were previously not associated with the claims file. The newly obtained medical records were not considered in the formation of the medical opinions contained in the record. The claim must be remanded for a medical opinion that considers those records. The December 2020 VA medical opinion is inadequate for additional reasons. The opinion offered negative direct and secondary nexus opinions for the Veteran's diagnosed hammer toes, hallux valgus, arthritis, plantar fasciitis, and historically noted bunions. However, the opinions are unsupported by sufficient rationale. The opinion provider concluded that pes planus did not cause or aggravate any other conditions but did not say why. No nexus opinion was provided for metatarsalgia, although one was specifically requested. On remand, the AOJ should obtain a clarifying medical opinion regarding the nature and likely etiology of all diagnosed foot disabilities. The matters are REMANDED for the following action: 1. Obtain an addendum medical opinion from an appropriate clinician, preferably a podiatrist, on the nature and likely etiology of all diagnosed foot disabilities, other than pes planus. Copies of all pertinent records must be made available to the examiner for review. If the opinion provider determines an opinion cannot be made without examination (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) one should be scheduled. After review of the clinical record and other documentation and examination of the Veteran, if necessary, the opinion provider is asked to answer the following: (a) Identify all diagnosed foot disabilities, other than pes planus. The examiner should consider the noted diagnoses of hammer toes, hallux valgus, arthritis, plantar fasciitis, metatarsalgia and historically noted bunions. (b) Is it at least as likely as not that any diagnosed foot disability, other than pes planus, was incurred in or is otherwise related to the Veteran's service? (c) Is it at least as likely as not that any diagnosed foot disability, other than pes planus was caused by the service-connected pes planus? (d) Is it at least as likely as not that any diagnosed foot disability, other than pes planus, was aggravated (defined as any increase in disability) the service-connected pes planus? A complete rationale must be provided for all opinions. If the examiner cannot provide an opinion without resort to speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge; the examiner's own expertise, or; whether additional facts are required and note what, if any, additional evidence would permit such an opinion to be made. 2. Confirm that the VA medical opinion provided comports with this remand, specifically that the standard for the secondary aggravation opinion is any increase in disability, not the standard of beyond the natural progression as noted on the examination form itself. If not, get an addendum. M.E. Larkin Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M.D. Collins, 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.