Citation Nr: 21030343 Decision Date: 05/18/21 Archive Date: 05/18/21 DOCKET NO. 15-29 593 DATE: May 18, 2021 REMANDED Entitlement to service connection for a lumbar spine disorder is remanded. Entitlement to service connection for a left foot disorder is remanded. REASONS FOR REMAND The Veteran had honorable active duty service from September 1980 to September 1989. Her active duty service from September 1989 to September 1991 has been determined to be dishonorable for VA purposes. In March 2019, the Veteran testified at a Board videoconference hearing before the undersigned Veterans Law Judge (VLJ). A transcript of the hearing is of record. In December 2020, the Board remanded this case for additional development. In a March 2021 rating decision, the Regional Office (RO) granted service connection for hemorrhoids, effective January 11, 2011. As this grant of service connection represents a full grant of the benefit sought, that issue is no longer on appeal. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997). 1. Entitlement to service connection for a lumbar spine disorder is remanded. In February 2021, the Veteran underwent a VA examination to evaluate the etiology of her lumbar spine disorder. The examiner diagnosed a lumbosacral strain and opined that it was at least as likely as not that the Veteran's back condition was incurred in or caused by the claimed in-service injury, event, or illness. The examiner explained that the Veteran was in service for 9 years, which involved heavy lifting and physical training daily and she testified that she developed back pain during basic training. The examiner also explained that the records demonstrate chronicity of care for low back pain. In March 2021, the RO procured another VA medical opinion for clarification purposes because the February 2021 VA examiner did not consider the Veteran's duties as a tactical telecommunications center operator and administrative specialist and did not discuss the medical records showing metastatic bone cancer of the spine. The March 2021 VA examiner rendered a negative nexus opinion and, in pertinent part, explained that there were no documented complaints of back pain in the Veteran's numerous VA treatment records, from October 2003 to May 2012. This statement, however, is inaccurate as VA treatment records reflect complaints of back pain in April 2010, January 2011, July 2011, and May 2012. As such, the March 2021 VA examiner's opinion appears to be based on an inaccurate factual basis. Accordingly, the Board finds the March 2021 VA medical opinion insufficient for rating purposes and remand is warranted for a new VA medical opinion consistent with the directives herein. 2. Entitlement to service connection for a left foot disorder is remanded. In February 2021, the Veteran also underwent a VA examination to evaluate the etiology of her left foot disorder. The examiner rendered a negative nexus opinion and explained that there were no records indicating a diagnosis for left hallux valgus during service or on separation examination. The examiner also explained that the Veteran's March 2019 testimony did not indicate left hallux valgus. In spite of the RO's efforts to obtain an adequate opinion, the Board finds the February 2021 VA examiner's rationale is insufficient for rating purposes. Namely, the examiner appears to have relied solely on the fact that the Veteran's hallux valgus was not diagnosed during service. Moreover, in the December 2020 remand, the Board specifically requested that the VA examiner consider and discuss the Veteran's March 2019 hearing testimony that her foot problem was due to her wearing boots in service. Altough the examiner mentioned the Veteran's March 2019 hearing testimony, the examiner did not otherwise consider/discuss whether the Veteran's left foot disorder developed as a result of wearing military boots. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Accordingly, remand is warranted for a new VA medical opinion consistent with the directives herein. The matters are REMANDED for the following actions: 1. Obtain a VA medical opinion from an appropriate examiner to determine the nature and etiology of the Veteran's lumbar spine disorder. The claims folder (including a copy of this remand) must be provided to and reviewed by the examiner. The examiner must provide an opinion as to whether it is at least as likely as not (i.e., 50 percent probability or greater) that the Veteran's lumbar spine disorder had its onset in, or is otherwise related to, the Veteran's active duty service from September 1980 to September 1989. In rendering the above opinion, the examiner is instructed to consider and discuss: i) the Veteran's March 2019 hearing testimony that her back pain initially began during basic training doing field exercises and physical training, and ii) the Veteran's June 2016 lumbar spine MRI showing multiple bone metastases and moderate to severe spondylotic thecal sac stenosis at L4-L5. The examiner is advised that the Veteran is competent to report her symptoms/history and that such reports must be acknowledged and considered in formulating any opinion. If her reports are discounted, the examiner should provide a reason for doing so. A rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall 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 VA medical opinion from an appropriate examiner to determine the nature and etiology of the Veteran's left foot disorder. The claims folder (including a copy of this remand) must be provided to and reviewed by the examiner. The examiner must provide an opinion as to whether it is at least as likely as not (i.e., 50 percent probability or greater) that the Veteran's left foot disorder had its onset in, or is otherwise related to, the Veteran's active duty service from September 1980 to September 1989. In rendering the above opinion, the examiner must specifically consider and discuss the Veteran's March 2019 hearing testimony that her foot problem was due to her wearing boots in service and was first diagnosed during her first duty station. The examiner is advised that the Veteran is competent to report her symptoms/history and that such reports must be acknowledged and considered in formulating any opinion. If her reports are discounted, the examiner should provide a reason for doing so A rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall 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. A. ISHIZAWAR Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Metzner, Paul 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.