Citation Nr: 21031067 Decision Date: 05/20/21 Archive Date: 05/20/21 DOCKET NO. 16-28 718 DATE: May 20, 2021 REMANDED Service connection for bilateral foot disability (including pes planus, plantar fasciitis, and tarsalgia) is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1999 to September 2003. This claim is an appeal to the Board of Veterans Appeals from a December 2007 rating decision. Although the Veteran originally requested a hearing in his VA Form 9 (Substantive Appeal), he withdrew this hearing request in an April 2019 statement. In an October 2019, the Veteran's claim was remanded to obtain opinions regarding the etiology of his diagnosed foot conditions. While the Board regrets the delay, an additional remand is required. Service connection for a bilateral foot disability is remanded. The Veteran is claiming he has a bilateral foot disability which was aggravated or caused by his active duty service. He is also claiming his bilateral foot disability is secondary to his left knee disability. See July 2016 statement. Current bilateral foot diagnoses are pes planus, plantar fasciitis, and tarsalgia. Notably, his entrance examination reflects he had mild asymptomatic bilateral pes planus and left foot tarsalgia. Therefore, the question before the Board is whether there is clear and unmistakable evidence that these preexisting disabilities were not aggravated by his active service. See 38 U.S.C. §§ 1111, 1153; 38 C.F.R. §§ 3.304(b), 3.306 (emphasis added). The Board must also consider secondary service connection on the basis of aggravation. Turning to the other diagnosis of plantar fasciitis, the question before the Board is whether this disability began during or is etiologically related to the Veteran's active duty service. The Board must also consider secondary service connection on the bases of causation and aggravation. Following the October 2019 remand, an examination and opinion were obtained. The Veteran reported at the examination that his bilateral foot disability had worsened since onset. The examiner opined that the Veteran's preexisting conditions were not clearly and unmistakably not aggravated by service; the reasoning, in part, is that there was no additional objective evidence to show continued treatment from 2003 to 2011. The Board finds this opinion is inadequate as it does not consider the Veteran's competent lay statements of chronicity of symptoms. See Dalton v. Nicholson, 21 Vet. App. 23, 39-40 (2007) (holding that medical examiner cannot rely solely on the absence of medical records corroborating the incurrence or continuity of a disorder, and furthermore, cannot ignore a Veteran's statements regarding lay observable symptoms). Additionally, the opinion regarding direct service connection does not contain any discussion of plantar fasciitis, other than indicating that the opinion was pertaining to this disorder; rather, it only mentions the Veteran's pes planus and tarsalgia. Further, there are no opinions regarding secondary service connection. Accordingly, new opinions are warranted. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (holding that when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate). The matters are REMANDED for the following action: 1. Obtain updated VA treatment records and associate them with the claims file. 2. Obtain a medical opinion regarding the Veteran's claim for a bilateral foot disability. An examination is not required unless the medical professional requested to provide these opinions finds one is necessary. The medical professional must obtain from the Veteran and record in the examination report a complete description regarding the onset and continuity of symptoms, which may be obtained via the ACE telephone process. Following a complete review of the evidence of record and with consideration of the Veteran's statements, the medical professional should provide the following information: (a) With regard to the diagnosis of bilateral pes planus, was this disability clearly and unmistakably NOT aggravated by the Veteran's active duty service? Why or why not? (b) With regard to the diagnosis of left foot tarsalgia, was this disability clearly and unmistakably NOT aggravated by the Veteran's active duty service? Why or why not? (c) With regard to the diagnosis of bilateral plantar fasciitis, is it at least as likely as not (50 percent probability or higher) that this disability began during or is etiologically related to the Veteran's active duty service? Why or why not? (d) With regard to any additional foot diagnoses found in the record, is it at least as likely as not (50 percent probability or higher) that the disability began during or is etiologically related to the Veteran's active duty service? Why or why not? If there are no additional foot disabilities other than those referenced in (a) through (c) above, the medical professional must state this. (e) With regard to any additional diagnosis in (d), is it at least as likely as not (50 percent probability or higher) that the disability was caused by the Veteran's service-connected left knee disability? Why or why not? (f) With regard to any additional diagnosis in (d), is it at least as likely as not (50 percent probability or higher) that the disability was aggravated by the Veteran's service-connected left knee disability? Why or why not? (g) With regard to bilateral pes planus, is it at least as likely as not (50 percent probability or higher) that the disability was aggravated by the Veteran's service-connected left knee disability? Why or why not? (h) With regard to left foot tarsalgia, is it at least as likely as not (50 percent probability or higher) that the disability was aggravated by the Veteran's service-connected left knee disability? Why or why not? (i) With regard to bilateral plantar fasciitis, is it at least as likely as not (50 percent probability or higher) that the disability was caused by the Veteran's service-connected left knee disability? Why or why not? (j) With regard to bilateral plantar fasciitis, is it at least as likely as not (50 percent probability or higher) that the disability was aggravated by the Veteran's service-connected left knee disability? Why or why not? The medical professional is informed of the following: A negative opinion based on lack of treatment will be deemed inadequate. The medical professional must consider AND discuss the Veteran's competent lay statements and must find them credible for the purposes of these opinions. A complete and separate rationale for each opinion must be provided. If the medical professional is unable to provide any opinion without resorting to speculation, he or she must explain why this is so. 3. In order to avoid an additional remand, the AOJ must review the examinations and opinions to ensure they are adequate and comply with the Board's specific remand directives herein. If deficient in any manner, corrective action must be taken at once. Jennifer White Veterans Law Judge Board of Veterans' Appeals Attorney for the Board O'Connell, Jessica L. 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.