Citation Nr: 21041777 Decision Date: 07/10/21 Archive Date: 07/10/21 DOCKET NO. 13-06 371A DATE: July 10, 2021 REMANDED Entitlement to service connection for a right foot disability, to include Achilles tendonitis and plantar fasciitis, is remanded. Entitlement to service connection for a left foot disability, to include Achilles tendonitis and plantar fasciitis, is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1996 to October 2000. This case is before the Board of Veterans' Appeals (Board) on appeal from November 2011 and December 2018 rating decisions by a Department of Veterans Affairs (VA) Regional Office. In September 2014, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the electronic claims file. The Board remanded the matters for further development in March 2015, February 2019, and November 2020. Now the matters are returned to the Board. The Veteran is seeking service connection for his bilateral feet disability and TDIU. However, the Board finds that more development is necessary prior to final adjudication. In the latest November 2020 Remand order, the Board directed the Agency of Original Jurisdiction (AOJ) to obtain an addendum medical opinion. The Board specifically asked the examiner to identify the Veteran's current right and left foot disabilities, including the disabilities existed since August 2010 which may have been resolved, and provide an etiology opinion on the matter. The Board notes that an addendum opinion was obtained in February 2021. In the opinion, the examiner provided that there were no foot or ankle disabilities found after April 1997. In March 2021, the examiner provided an additional opinion and stated that there is no evidence of the Veteran's current plantar fasciitis or chronic Achilles tendonitis so that "the requested opinions are moot." The examiner stated that there are no service treatment records or post-separation medical records indicating chronic conditions relative to the claimed conditions. The examiner also provided that the Veteran's self-reports were acknowledged and not rejected, but "[it] alone does not constitute an existence of a disease." However, the Board notes that the examiner failed to provide why the Veteran's reports of symptoms, which are not rejected, do not amount to a current diagnosis. Also, significantly, the examiner did not consider the findings from the Veteran's previous imaging studies of his feet. For example, on September 2011 examination, the examiner noted that there were abnormal findings in the imaging studies of the Veteran's feet of degenerative or traumatic arthritis of both feet and heel spurs arising at the insertion of the plantar fascia with their respective calcaneal. See September 2011 Foot Miscellaneous Disability Benefits Questionnaire (DBQ); see also July 2016 Ankle Conditions DBQ (the examiner noted that there were heel spurs seen on the MRI; these could cause heel pain but not ankle pain). Moreover, the examiner provided that the Veteran was only seen on two occasions in March 1997 for his claimed conditions during the entire appeal period, but the evidence of record suggests that he had complaints of plantar fasciitis in 2012. See e.g., September 26, 2012 Primary Care Visit Note (treatment plan of home exercise program for knee, back, and plantar fasciitis was noted). Based on above, the Board finds that there has not been substantial compliance with the November 2020 Board Remand Directives and an addendum opinion must be obtained in order to make a fully informed decision on the matter. Stegall v. West, 11 Vet. App. 268, 271 (1998). Finally, because a decision on the remanded issues of service connection for right and left foot disabilities could significantly impact a decision on the issue of the Veteran's entitlement to TDIU, the issues are inextricably intertwined. Thus, a remand of the claim for TDIU is also required. Accordingly, the matters are REMANDED for the following action: 1. The AOJ must obtain an addendum opinion from the February 2021 VA examiner regarding the Veteran's service connection claims for right and left foot disabilities. If the February 2021 VA examiner is not available, the requested opinion with rationale should be rendered by another appropriate medical professional. If the examiner determines that a new examination is necessary, the AOJ should schedule one for the Veteran. The examiner should review the Veteran's claims file and a copy of this REMAND order before rendering the requested addendum opinion. The examiner is asked to identify the Veteran's current diagnoses related to his right and left feet, to include Achilles tendonitis and plantar fasciitis. Any diagnoses related to his feet found since August 2010 must be identified even if the condition has resolved between August 2010 and now. When identifying the Veteran's diagnoses, the examiner is specifically asked to address previous abnormal findings from imaging studies of the Veteran's feet. See September 2011 Foot Miscellaneous DBQ (the examiner noted degenerative or traumatic arthritis of both feet and heel spurs arising at the insertion of the plantar fascia with their respective calcaneal); see also July 2016 Ankle Conditions DBQ (the examiner noted that there were heel spurs seen on the MRI and these could cause heel pain but not ankle pain). The examiner must opine whether the Veteran's right and left foot disabilities, both current and/or resolved during the appeal period, are at least as likely as not (50 percent or greater probability) related to his service or had its onset in service. The examiner is specifically asked to consider and address 1) the Veteran's September 2014 hearing testimony of having to wear boots that were too small for 11 weeks during a boot camp, and falling down the stairs during basic training; and 2) the March 1997 in-service diagnosis and treatment for Achilles tendonitis. The examiner is advised again that the Veteran is competent to report his symptoms and history, and such reports must be acknowledged and considered in formulating any opinion. The Board emphasizes that the examiner must provide a complete written rationale for any opinion offered. Also, importantly, if the examiner cannot provide an opinion, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond based on given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner does not have the knowledge or training. 2. After completing the above actions and any other necessary development, the issue on appeal, including the inextricably intertwined issue of TDIU claim, must be readjudicated. If the claims remain denied, a Supplemental Statement of the Case must be provided to the Veteran and his attorney. After the Veteran and his attorney have had an adequate opportunity to respond, the appeal must be returned to the Board for appellate review. MICHAEL LANE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. E. Kim, 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.