Citation Nr: 21032804 Decision Date: 05/28/21 Archive Date: 05/28/21 DOCKET NO. 16-46 467 DATE: May 28, 2021 REMANDED Entitlement to service connection for a lumbar spine disorder, to include as secondary to service connected right and left knee patellofemoral syndrome is remanded. Entitlement to service connection for left hallux valgus, claimed as a left foot condition, to include as secondary to service connected right and left knee patellofemoral syndrome, is remanded. Entitlement to service connection for right hallux valgus, claimed as a right foot condition, to include as secondary to service connected right and left knee patellofemoral syndrome, is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1985 to April 2005. These matters are before the Board of Veterans' Appeals (Board) on appeal of a May 2012 rating decision issued by a Regional Office (RO) of the Department of Veterans Affairs (VA). The claim was previously remanded by the Board in August 2019. The Veteran asserts service connection is warranted for his lumbar spine and hallux valgus disorders. Initially, the Veteran asserted his disorders were secondary to his service-connected knee disabilities. A VA etiology opinion as to secondary service connection on an aggravation basis was obtained in December 2019 following the Board's August 2019 remand. The December 2019 VA examiner opined that the Veteran's bilateral foot and lumbar spine disorders clearly and unmistakably existed prior to service and were not aggravated beyond its natural progression by an in-service event, injury or illness. However, this is the incorrect legal standard as the Veteran's March 1985 service entrance examination found his feet and spine to be normal. Thus, a remand is required to obtain an adequate etiology opinion as to secondary aggravation. El-Amin v. Shinseki, 26 Vet. App. 136, 140 (2013); see Stegall v. West, 11 Vet. App. 268, 271 1998). Alternatively, the Veteran asserted in a March 2013 statement that service connection is warranted on a direct basis. Specifically, the Veteran reported that while in service he was a Field Radio operator and the majority of his career was spent carrying his body weight around on his back and that this caused his back and feet to hurt. An etiology opinion as to direct service connection has not yet been obtained. The Board cannot make a fully-informed decision on the issue of direct service connection because no VA examiner has opined whether the Veteran's lumbar spine and hallux valgus disorders are directly related to service. On remand, an opinion as to direct service conenction should also be obtained. The matters are REMANDED for the following action: 1. The Veteran should be given the opportunity to identify any outstanding private or VA treatment records relevant to the claims on appeal. After obtaining any necessary authorization from the Veteran, all outstanding records should be obtained, to include updated VA treatment records. For private treatment records, make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and his representative and afford him an opportunity to submit any copies in their possession. For federal records, all reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 2. Following the receipt of outstanding records, obtain an addendum VA opinion from the VA examiner who conducted and provided the December 2019 VA examination and opinion regarding the Veteran's lumbar spine disorder. The entire record, to include a copy of this Remand, must be made available to and be reviewed by the examiner. Any indicated evaluations, studies, and tests should be conducted. The need for an in-person examination is left to the discretion of the examiner. The examiner should respond to the following questions: (A) Is it at least as likely as not (more than 50 percent probability) that the Veteran's lumbar spine disorder began in service, was caused by service, or is otherwise related to service? The examiner should specifically address the Veterans contentions that he spent the majority of his career as a Field Radio operator carrying his body weight around on his back, resulting in back pain. (B) Is it at least as likely as not (more than 50 percent probability) that the Veteran's lumbar spine disorder was aggravated beyond its natural progression by the Veteran's service-connected right and left knee patellofemoral syndrome? A clear rationale for all opinions is required. If an opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training). If the inability to provide an opinion without resorting to speculation is due to a deficiency in the record (additional facts are required), the RO should develop the claim to the extent it is necessary to cure any such deficiency. If the inability to provide an opinion is due to the examiner's lack of requisite knowledge or training, then the RO should obtain an opinion from a medical professional who has the knowledge and training needed to render such an opinion. 3. Following the receipt of outstanding records, obtain an addendum VA opinion from the VA examiner who conducted and provided the December 2019 VA examination and opinion regarding the Veteran's right and left hallux valgus. The entire record, to include a copy of this Remand, must be made available to and be reviewed by the examiner. Any indicated evaluations, studies, and tests should be conducted. The need for an in-person examination is left to the discretion of the examiner. The examiner should respond to the following questions: (A) Is it at least as likely as not (more than 50 percent probability) that the Veteran's right and left hallux valgus began in service, was caused by service, or is otherwise related to service? The examiner should specifically address the Veterans contentions that he spent the majority of his career as a Field Radio operator carrying his body weight around on his back, resulting in foot pain. (B) Is it at least as likely as not (more than 50 percent probability) that the Veteran's right and left hallux valgus were aggravated beyond its natural progression by the Veteran's service-connected right and left knee patellofemoral syndrome? A clear rationale for all opinions is required. If an opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training). (Continued on the next page) If the inability to provide an opinion without resorting to speculation is due to a deficiency in the record (additional facts are required), the RO should develop the claim to the extent it is necessary to cure any such deficiency. If the inability to provide an opinion is due to the examiner's lack of requisite knowledge or training, then the RO should obtain an opinion from a medical professional who has the knowledge and training needed to render such an opinion. KRISTY L. ZADORA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. M. Donahue Boushehri, 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.