Citation Nr: 21032139 Decision Date: 05/26/21 Archive Date: 05/26/21 DOCKET NO. 12-20 974A DATE: May 26, 2021 REMANDED Entitlement to service connection for a left foot disability is remanded. Entitlement to service connection for a right foot disability is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran had active duty service in the U.S. Army from November 1988 to June 1989 and from May 1994 to May 2000. The Veteran appeals the denial of service connection for a left and right foot disorder. In February 2019, the Board remanded the claim for service connection for further development include obtaining a VA examination and opinion as to the nature and etiology of the Veteran's foot disorder. In September 2019, the Veteran was afforded a VA examination in relation to his claim. The Board notes that in the September 2019 VA examination, the VA examiner did not specify a specific foot disorder as it was found that the examination was normal. At that time, the Veteran reported ongoing intermittent pain. No studies of the feet were performed. The examiner opined that the claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The examiner reasoned that the objective examination on that day was normal and that the symptoms were subjective only. It was determined that there was no objective evidence of a chronic condition. The VA examiner also opined that the claimed condition was less likely than not (less than 50 percent probability) proximately due to or the result of Veteran's service connected condition. The examiner reasoned that the examination was normal and that the two conditions were not medically related. The examiner stated that "the claimed disorder is a separate entity entirely from the service connected condition and unrelated to it. The medical literature does not support a medical relationship. A nexus has not been established." The examiner further opined that the claimed condition, "which clearly and unmistakably existed prior to service, was clearly and unmistakably not aggravated beyond its natural progression by an in-service injury, event, or illness." The examiner reasoned that "temporary aggravation is plausible, but there is no evidence of permanent aggravation of the pre-existing bilateral knee patellofemoral pain syndrome. The current medical literature does not support. A nexus has not been established." An addendum opinion was requested and it was obtained in October 2020. The VA examiner stated that the "diagnosis of pes planus (PP) is somewhat confusing." He opined that "it is more likely than not that the Veteran did not have significant PP prior to, during or after service. The Veteran did not have foot problems until 2010, as documented by the podiatry consult. At this time, a diagnosis of a right heel spur was made on x-ray. Left medial arch tenderness was also noted. It is more likely than not that these conditions arose after service and are unrelated to service, in any way." While the Veteran has been afforded a VA examination and an addendum opinion has been obtained, the Board finds that the record is still insufficient to address the issues on appeal. To that end, the September 2019 VA examiner did not actually identify the Veteran's specific foot disorders. The Board also finds that the opinion regarding secondary service connection is inadequate as she reasoned "there is no evidence of permanent aggravation of the pre-existing bilateral knee patellofemoral pain syndrome." The Board cannot conclude if this was an intentional statement or an error on part of the examiner, as such the opinion is inadequate. The Board also notes that while the October 2020 addendum opinion addressed direct service connection, no opinion was rendered regarding secondary service connection. In this situation, the Board finds that a remand for a new examination with a podiatrist is warranted. As the prior VA examiners have been unable to render adequate opinions on this matter, the Board finds that on remand the Veteran should be afforded a new examination by a podiatrist. Accordingly, the claim is remanded. Regarding the claim for individual unemployability, the Board finds that the issue of entitlement to TDIU is inextricably intertwined with the remanded claim and must also be remanded. See Parker v. Brown, 7 Vet. App. 116 (1994); Harris v. Derwinski, 2 Vet. App. 180, 183 (1991). The matters are REMANDED for the following action: 1. Obtain and associate with the claims folder any outstanding VA and private treatment records. 2. Schedule the Veteran for a VA examination with a podiatrist (or a similarly skilled examiner) to determine the nature and etiology of his bilateral foot disability. The Veteran's claims file (to include this decision) must be reviewed by the examiner in conjunction with the examination. Upon examination and interview of the Veteran, and review of pertinent medical history, the examiner should provide an opinion responding to the following: (a.) Diagnose all foot disorders that the Veteran has at the time of the examination and has had at any time during the appeal period (even if now resolved). (b.) For each foot disability diagnosed, opine whether the evidence of record clearly and unmistakably (i.e., is it undebatable) demonstrate that the Veteran had a foot condition prior to either of his active duty periods of service. (c.) If the answer to the above question is "yes," opine whether the evidence clearly and unmistakably demonstrate (i.e., it is undebatable) that the Veteran's foot condition, was aggravated by either of his active duty periods of service. In answering this question, the examiner should know that a lack of aggravation may be shown by establishing either that there was no increase in disability during service or that any increase in disability was due to the natural progression of the pre-existing condition. (d.) If the answer to either of the above questions is "no", then for each foot disability diagnosed, opine whether it at least as likely as not (50 percent or better probability) etiologically related to the Veteran's active duty service. (e.) If the answers to the questions posed in (b)(d) are negative, then, for each foot disability diagnosed opine whether it at least as likely as not (i.e., a 50 percent or greater possibility) that the Veteran's service-connected bilateral knee disorder caused and/or caused a functional increase in the severity of his right and/or left foot disorder at any time during the course of the appeal. To the extent that any testing is appropriate to proffer an opinion in this matter, those tests should be performed. 3. Thereafter, the AOJ should consider all of the evidence of record and readjudicate the issues on appeal. If any benefit sought remains denied, issue a supplemental statement of the case and allow the Veteran and his representative an opportunity to respond. Saudiee Brown Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T.S. Willie 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.