Citation Nr: 21040599
Decision Date: 07/06/21	Archive Date: 07/06/21

DOCKET NO. 12-02 569A
DATE: July 6, 2021

REMANDED

Entitlement to service connection for a right foot condition, to include flatfoot is remanded.

REASONS FOR REMAND

The Veteran served on active duty from March 1989 to March 1993, including service in the Southwest Asia Theater of Operations during the Persian Gulf War.  

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2010 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO).

This claim has an extensive procedural history and has been remanded numerous times, most recently in December 2020.

Entitlement to service connection for a right foot condition, to include flatfoot.

The Veteran through his representative asserts that he is entitled to service connection for a right foot disability and contends that the prior examination which was provided in connection with his right foot disability was inadequate; the Veteran's representative did not elaborate further on why the examination is inadequate. The Veteran through his representative highlights the fact that the Board has not found that the Veteran's complaints of foot pain, back, knee, wrist, and elbow pain since service are not credible. Furthermore, the representative asserts that the Veteran's right foot condition be considered on a secondary basis to his other musculoskeletal injuries. See Third Party Correspondence Received May 2021. 

The Veteran is currently service connected for the following musculoskeletal disabilities: fibromyalgia claimed as diffuse musculoskeletal pain of the back, knees, wrists, and right thigh numbness; psoriatic arthritis of the elbows; residuals of fractured left fourth and fifth metatarsals; undiagnosed illness manifested by left upper extremity paresthesia; undiagnosed illness manifested by right upper extremity paresthesia; and tinnitus.

The record contains numerous examinations related to the Veteran's right foot condition, however, none of these opinions address the relationship, if any, between the Veteran's right foot condition and his service-connected musculoskeletal disabilities. Thus, remand for an addendum opinion on secondary service connection is warranted. 

The matters are REMANDED for the following action:

1. Obtain an addendum opinion on the etiology of the Veteran's right foot condition. The examiner(s) must address the following:

(a.) Is it at least as likely as not (50 percent or greater probability) that the Veteran's right foot condition is proximately due to or caused by his service-connected musculoskeletal disabilities to include (1) fibromyalgia claimed as diffuse musculoskeletal pain of the back, knees, wrists, and right thigh numbness,(2) psoriatic arthritis of the elbows, (3) residuals of fractured left fourth and fifth metatarsals, (4) undiagnosed illness manifested by left upper extremity paresthesia, and (5) undiagnosed illness manifested by right upper extremity paresthesia?

(b.) Is it at least as likely as not (50 percent or greater probability) that the Veteran's right foot condition is aggravated (worsened) beyond its natural clinical course by his service-connected musculoskeletal disabilities to include (1) fibromyalgia claimed as diffuse musculoskeletal pain of the back, knees, wrists, and right thigh numbness,(2) psoriatic arthritis of the elbows, (3) residuals of fractured left fourth and fifth metatarsals, (4) undiagnosed illness manifested by left upper extremity paresthesia, and (5) undiagnosed illness manifested by right upper extremity paresthesia?

The examiner is reminded that causation and aggravation are separate questions, and therefore both theories must be addressed in the opinion.

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Rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s).

 

 

Tiffany Dawson

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	J. Dorsey-Kwansa, 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.