Citation Nr: 21042813 Decision Date: 07/13/21 Archive Date: 07/13/21 DOCKET NO. 15-06 092 DATE: July 13, 2021 REMANDED Entitlement to an initial compensable rating for service-connected left heel fracture is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. REASONS FOR REMAND The Veteran had active duty service from November 1967 to November 1969 and from May 2005 to November 2006. He had additional active duty for training (ACDUTRA) in April 1991. These matters come before the Board of Veterans' Appeals (Board) on appeal from a December 2014 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO), which granted service connection for a fracture of the left heel and assigned a noncompensable rating. The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a hearing in April 2018. A copy of the transcript has been reviewed and associated with the claims file. These matters were before the Bord in September 2018 and November 2020 and were remanded for additional evidentiary development. Entitlement to an initial compensable rating for service-connected left heel fracture is remanded; 2. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. Pursuant to the Board's remand instructions, a VA examination was performed in December 2020, at which time the examiner concluded that the Veteran's plantar calcaneal spur and degenerative changes in the first MTP joint are not related to his service-connected left heel fracture. The examiner further assessed the severity of the Veteran's service-connected chip fracture of the left heel and indicated that the Veteran did not report flare-ups of foot pain. However, the Veteran noted that his pain increased in cold weather. After a review of the evidence, the Board finds that an addendum medical opinion is warranted. In this regard, as set forth in the November 2020 remand instructions, flare-ups have been reported throughout the rating period on appeal and the examiner was asked to provide an opinion on whether the flare-ups are associated with additional functional loss, i.e., moderate, moderately severe, or severe foot injury during a flare-up. See 38 C.F.R. § 4.72, Diagnostic Code 5284. However, the December 2020 examiner only indicated that the Veteran did not report flare-ups during the time of the examination and did not provide the requested opinion. Accordingly, the Board finds that an addendum opinion is warranted on remand to determine the severity of the Veteran's service-connected left heel fracture, including during a flare-up. Lastly, the Board finds that the issue of entitlement to a TDIU is intertwined with the pending claim and will defer adjudication at this time. The matters are REMANDED for the following actions: 1. Obtain and associate with the claims file the Veteran's updated VA treatment records from August 2020 to the present. 2. Forward the claims file, including a copy of the remand, to the December 2020 VA examiner for an addendum opinion regarding the severity of the Veteran's service-connected left heel fracture. The claims file, including a copy of this remand, must be reviewed and such review should be noted in the examination report. The examiner should respond to the following: A. Is the Veteran's service-connected left heel fracture characterized as moderate, moderately severe, or severe? See 38 C.F.R. § 4.72, Diagnostic Code 5284. B. The Veteran has reported flare-ups of pain in cold weather and with prolonged walking, stair climbing, running, or jumping. Please review the record and express an opinion on whether the flare-ups are associated with additional functional loss, i.e., is the Veteran's service-connected left heel fracture characterized as moderate, moderately severe, or severe during a flare-up? See 38 C.F.R. § 4.72, Diagnostic Code 5284. The examiner must attempt to elicit information from the record and the Veteran regarding the severity, frequency, duration, or functional loss manifestations during flare-ups. Any ability to furnish such an estimate must be predicated on a lack of medical knowledge among the medical community at large and not the insufficient knowledge of the examiner. Additionally, the examiner must discuss the impact of the Veteran's service-connected left heel fracture on his ability to work, if any. The examiner should provide a comprehensive rationale for each opinion provided. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports are to be considered in formulating any opinion. If any 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. As appropriate, the AOJ should conduct additional development or supplement the record. Eric S. Leboff Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Merrick 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.