Citation Nr: 21042614 Decision Date: 07/13/21 Archive Date: 07/13/21 DOCKET NO. 16-63 341 DATE: July 13, 2021 REMANDED Entitlement to service connection for a cervical spine disability is remanded. Entitlement to service connection for a bilateral foot disability, to include bilateral pes planus and plantar fasciitis, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from June 1991 to December 1992. By way of background, these matters were previously before the Board of Veterans' Appeals (Board) in August 2019, at which time the Board remanded the claims to the agency of original jurisdiction (AOJ) to afford the Veteran VA examinations to determine the nature and etiology of the disabilities on appeal. The case has now been returned to the Board for further appellate review. However, for the reasons discussed below, the Board finds that there has not been substantial compliance with the terms of its August 2019 remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). 1. Entitlement to service connection for a cervical spine disability is remanded. Although it sincerely regrets the additional delay, the Board finds that another remand is necessary in this case before the Veteran's claim can be properly adjudicated on its merits. Pursuant to the Board's August 2019 remand, the AOJ scheduled the Veteran for a VA neck examination. In January 2020, a clinician diagnosed the Veteran with cervicalgia, or neck pain. See VA examination dated January 7, 2020. The clinician opined that the disorder was less likely than not incurred in or caused by the Veteran's military service. In so finding, she reasoned that the disorder is not related to the Veteran's service because "[there was] no diagnosed neck condition until 2014." However, she further acknowledged that the Veteran's service treatment records (STRs) contain complaints of neck pain and stiffness, but she attributed the pain to the Veteran's back conditions. In an April 2020 addendum opinion, the clinician reiterated that the Veteran's in-service complaints of neck pain were symptoms of his back problems. See addendum medical opinion dated April 8, 2020. However, the Board finds the rationale provided by the clinician to be inadequate for adjudicative purposes. Specifically, the examiner did not address whether (and if so, to what extent) the Veteran's current cervicalgia is related to his in-service complaints of neck pain. Furthermore, the clinician did not address whether the Veteran's current neck pain was caused by or aggravated by his service-connected thoracic scoliosis with thoracolumbar pain, per his lay assertions. Therefore, a new medical opinion adequately addressing the elements of both direct service connection and secondary service connection, supported by a sound and well-reasoned rationale, is necessitated. 2. Entitlement to service connection for a bilateral foot disability, to include bilateral pes planus and plantar fasciitis, is remanded. The record reflects that the Veteran underwent a VA examination of his feet in January 2020, at which time an examiner diagnosed the Veteran with bilateral pes planus and bilateral plantar fasciitis. See VA examination dated January 7, 2020. The examiner opined that the diagnosed conditions were less likely than not proximately due to or a result of a service-connected disability. Apparently, this was made in error, as the supporting rationale largely discusses information or details appropriate to the legal criteria for direct service connection. The AOJ requested clarification of the January 2020 opinion, and the examiner provided an addendum opinion in July 2020. At that time, the examiner clarified her opinion that the Veteran's bilateral pes planus and bilateral plantar fasciitis were less likely than not proximately due to or the result of the Veteran's service-connected back disability. See addendum medical opinion dated July 30, 2020. In so finding, she reasoned that the Veteran's plantar fasciitis was caused by repetitive strain injury to the soles of the feet and that his pes planus was caused by "dysfunctions in the posterior tibial tendon which supports the arch." She further explained that no credible medical evidence supports a causal link between any thoracic spine condition and the diagnosed foot disabilities. Regarding aggravation of the foot disorders by the Veteran's service-connected back disability, she opined that the service-connected back disability less likely than not exacerbated the foot conditions. The examiner reasoned that, although the Veteran's back disability causes limited range of motion of his spine, such limitation would not cause strain to the ligaments on the bottom of the feet, further noting that the record contains no evidence of the back disability causing an altered gait. Given the foregoing, the Board observes that no medical opinion obtained pursuant to its August 2019 remand clearly addresses whether the Veteran's foot disorders are at least as likely as not related to his military service. As such, remand for an opinion concerning direct service connection of the disability is required. Accordingly, the matters are REMANDED for the following action: 1. Send the Veteran's claims file to an appropriate clinician for review and for the opinions sought regarding the Veteran's claims for entitlement to service connection for a cervical spine disability and for a bilateral foot disability. ONLY IF another examination is deemed necessary to answer the questions below, should one be scheduled. The clinician is asked to address the following: (a.) Is it at least as likely as not (50 percent probability or greater) that the Veteran's diagnosed cervicalgia was incurred in service or is otherwise etiologically related to his military service? The clinician should explain why or why not, to include a discussion of the significance, if any, of the continuity of symptomatology the Veteran has experienced since service. (b.) Is it at least as likely as not (50 percent probability or greater) that the Veteran's diagnosed cervicalgia was either caused by or aggravated beyond its natural progression by the Veteran's service-connected thoracic scoliosis with thoracolumbar pain? The clinician should explain why or why not, to include a discussion of whether the Veteran's service-connected back disability might prompt the Veteran to mechanically alter his posture or gait to mitigate back pain, and if so, the extent to which such a practice might cause the Veteran's neck pain. (c.) Is it at least as likely as not (50 percent probability or greater) that the Veteran's diagnosed bilateral foot disorders, to include (i) pes planus and (ii) plantar fasciitis, were incurred in service or are otherwise etiologically related to his military service? The clinician should explain why or why not, to include a discussion of the significance, if any, of the continuity of symptomatology the Veteran has experienced since service. It should be noted that the Veteran is competent to attest to observable symptomatology. The clinician is reminded that an absence of prior medical documentation of symptoms or treatment is not, per se, a sufficient basis upon which to find the lack of an association between a current disability and an in-service event/injury or a service-connected disability. The clinician must explain the rationale for all opinions in detail, citing to supporting clinical data and/or medical literature, as appropriate. 2. After completing the requested action, and any additional action deemed necessary, readjudicate the claims. If the benefits sought on appeal remain denied, the Veteran and his representative should be furnished with a Supplemental Statement of the Case and given the opportunity to respond before the case is returned to the Board for further appellate consideration. B. G. LeMoine Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board G. Tolbert, 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.