Citation Nr: 21030900 Decision Date: 05/19/21 Archive Date: 05/19/21 DOCKET NO. 15-21 953 DATE: May 19, 2021 REMANDED Service connection for a left toe disorder, to include nerve damage, is remanded. Service connection for a right heel bone spur is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1973 to October 1979 with additional service in the Reserves including periods of ACDUTRA or INACDUTRA from October 1979 to January 1988 and from January 1988 to April 1996. These matters come to the Board of Veterans' Appeals (Board) on appeal from a June 2013 rating decision issued by the Department of Veterans' Affairs (VA) Regional Office (RO) in Waco, Texas. The Board previously remanded these claims in a March 2019 decision. As will be discussed in more detail below, unfortunately remand is again necessary to ensure substantial compliance with the March 2019 remand directives and that the Veteran receives an adequate VA examination. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Of note, within the March 2019 Board decision, service connection was granted for a left shoulder disorder, right knee disorder, left knee disorder, and back disorder. The award of service connection for these claims constitutes a full grant of the service connection benefits sought; thus, these issues are no longer before the Board. Grantham v. Brown, 114 F.3d 1156, 1158-59 (Fed. Cir. 1997). The Board also denied service connection for a right and left testicle disorder. Accordingly, these issues are no longer before the Board. 1. Service connection for a left toe disorder, to include nerve damage, is remanded. The Veteran contends his left toe disorder was caused by an injury during a period of ACDUTRA or INACDUTRA. The Board finds the evidence of record is insufficient to resolve the Veteran's claim. The Veteran was afforded a VA examination in September 2019. While the examiner stated that the Veteran had a left foot bone contusion that was less likely than not related to service, the examiner failed to address or consider the Veteran's lay statements of symptoms related to his left toe(s) since the 1994 fall. See Miller v. Wilkie, 32 Vet. App. 249 (2020). Additionally, treatment records reflect complaints of left foot pain under and over the toes in 2009, 2010, and 2011. The examiner, however, only addressed 2010 and 2011 symptoms attributing them to a metacarpal fracture. Further, the examiner stated that the Veteran denied any symptoms related to the left toe during the examination but elsewhere noted that the Veteran complained of pain directed to the second toe on the left foot. Thus, remand is necessary for clarification regarding this inconsistency. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993); Bowling v. Principi, 15 Vet. App. 1, 12 (2001). Accordingly, this claim is remanded for an addendum opinion. 2. Service connection for a right heel bone spur is remanded. The Veteran contends his right heel bone spur was caused by an injury during a period of ACDUTRA or INACDUTRA. The Board finds the evidence of record is insufficient to resolve the Veteran's claim. The Veteran was afforded a VA examination in September 2019 during which the examiner opined that the Veteran's right heel spur was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner reasoned that the Veteran's condition is more likely not related to the truck fall in 1994 because medical research provides that the heel can become more at risk and susceptible to injury with wear and tear and with age. The examiner, however, failed to address the Veteran's lay statements of experiencing symptoms in his right heel following the fall and continuing since the fall. Thus, remand is necessary for an opinion considering the Veteran's lay statements of symptoms. See Miller, 32 Vet. App. 249. Additionally, the Board notes the record contains a private provider's opinion in August 2019 wherein the provider opined that the Veteran's right heel spur was more likely than not developed during his military service. The provider reasoned that the Veteran's type of heel spur develops at the insertion of the plantar fascia which commonly becomes overused and inflamed from high activity level such as prolonged walking, standing, climbing, hiking, and running including with many laborious jobs such as active duty military. While the Board recognizes that the Veteran has only contended that his right heel bone spur symptoms began after his 1994 fall, the Board finds the evidence of record reasonably raises a new theory of entitlement to direct service connection for which an opinion needs to be obtained. See Robinson v. Peake, 21 Vet. App. 545, 554 (2008). Thus, this claim is remanded for another VA examination. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination with an appropriate examiner to determine the nature and etiology of any left toe disorder, to include nerve damage, and right heel spur. The entire claims file and this remand should be made available for review. The examiner shall render an opinion, including rationale, addressing the following: (a.) Whether the Veteran has a left toe disorder, to include nerve damage, or had a left toe disorder, to include nerve damage, at any time during the pendency of the Veteran's claim. (b.) If the Veteran has or had a left toe disorder, to include nerve damage, during the pendency of his claim, whether it is at least as likely as not (50 percent or greater probability) that the Veteran's left toe disorder was caused by or incurred during service, to include as a result of the 1994 truck fall. In so opining, the examiner is directed to consider the Veteran's lay statements of experiencing symptoms in his left toe(s) since the 1994 fall as well as treatment records including in 2009, 2010, and 2011 reflecting complaints of symptoms in the left toe(s). If the examiner determines the left toe disorder resolved during the pendency of the Veteran's appeal, an opinion should still be rendered regarding whether the left toe disorder was caused by or incurred during service, to include as a result of the 1994 truck fall. (c.) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's right heel bone spur was caused by or incurred during service, to include as a result of the 1994 truck fall and/or overuse and inflammation from high activity level during active duty. In so opining, the examiner is directed to address and consider the Veteran's lay statements of symptoms in the right heel since the 1994 fall. The examiner is also directed to address whether the Veteran's right heel bone spur was caused by or incurred during active duty service as a result of contended overuse and/or inflammation. The examiner must provide a complete rationale for any opinion expressed, based on the examiner's clinical and medical expertise; established medical principles; and references to the evidence of record, as appropriate. If any opinion cannot be expressed without resort to speculation, ensure that the examiner 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. 2. After the above development, and any other development deemed necessary, readjudicate the claims. SHEREEN M. MARCUS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A.C. Allen, 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.