Citation Nr: 21040284
Decision Date: 07/03/21	Archive Date: 07/03/21

DOCKET NO. 16-45 506
DATE: July 3, 2021

REMANDED

Entitlement to service connection for degenerative joint disease of the left foot first metatarsal, to include as secondary to the service-connected disability, is remanded.

REASONS FOR REMAND

The Veteran served on active duty from April 1986 to December 1992.

The matter was most recently remanded in April 2020. Unfortunately, there has not been substantial compliance with the prior remand directives and another remand is required. Stegall v. West, 11 Vet. App. 268 (1998).

The claim must be remanded again because the August 2020 VA opinion is inadequate, for the same reason an earlier VA opinion is inadequate.  The August 2020 examiner noted x-ray evidence of mild degenerative changes to the first MTP joint of the left foot. The examiner concluded that the first MTP finding is "unrelated" to the service-connected 5th metatarsal fracture as "no causation can be established;" ed it was age-related degeneration. The opinion did not include any comment on secondary service connection. As with the previous inadequate opinion, this examiner did not address the Veteran's statements that during service he ran numerous miles in inadequate footwear, specifically boots.

The matters are REMANDED for the following action:

1. Forward the copies of all pertinent records to an appropriate VA examiner to obtain a medical opinion on the likely etiology of the degenerative joint disease of the first metatarsal. If the examiner determines that an opinion cannot be provided without an examination, one should be scheduled. 

The examiner is asked to answer the following questions:

(a) Is it at least as likely as not (50 percent probability) that the degenerative joint disease (DJD) of the first metatarsal was incurred in or is otherwise related to service? Why or why not? In answering this, the examiner must specifically consider the Veteran's statements that he ran 3 miles a day in inadequate footwear (boots) at least 3 times a week while in service.

(b) If (a) is answered no, is it at least as likely as not (probability of at least 50 percent) that any currently diagnosed DJD of the first metatarsal is proximately due to (caused by) the Veteran's service-connected fracture of the fifth metatarsal disability? 

(c) If (b) is answered no, is it at least as likely as not (probability of at least 50 percent) that the currently diagnosed DJD of the first metatarsal has been aggravated by the Veteran's service-connected fracture of the fifth metatarsal disability?

The examiner is informed that aggravation here is defined as any increase in disability. If aggravation is present, the clinician should indicate, to the extent possible, the approximate level of disability (baseline) before the onset of the aggravation. 

A complete rationale must be provided for all opinions as adjudicators are precluded from making any medical findings. If the examiner is unable to provide an opinion without resort to speculation, he or she should explain why this is so and what, if any, additional evidence would be necessary before an opinion could be rendered.

2. Confirm that the VA medical opinion provided comports with this remand, specifically that the standard for the secondary aggravation opinion is any increase in disability, not the standard of beyond the natural progression as noted on the examination form itself. If not, get an addendum.

 

M.E. Larkin

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	T. Jarman, 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.