Citation Nr: 22013371 Decision Date: 03/09/22 Archive Date: 03/09/22 DOCKET NO. 14-26 115 DATE: March 9, 2022 REMANDED Entitlement to service connection for a left foot disability (other than plantar fasciitis) is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from August 1988 to March 1996. He had additional service in the United States Army National Guard, service that includes periods of active duty from January 2003 to April 2004, from July 2007 to September 2008, and from May 2011 to July 2012, and March 2017 to August 2019. This case comes before the Board of Veterans' Appeals (Board) on appeal from an April 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Paul, Minnesota. In May 2020, the Veteran testified before the undersigned Veterans Law Judge (VLJ) at a virtual hearing. A transcript of the hearing is of record. In June 2020 and June 2021, the Board remanded the Veteran's claim for additional development. Regrettably, the Board finds that another remand is necessary prior to readjudication of the claim. In November 2021 and December 2021, the Veteran was provided VA medical opinions in response to the Board's June 2021 remand. However, upon review, the Board finds that clarification is needed, as the examiner provided conflicting evidence regarding whether the Veteran has a current left foot disability (other than plantar fasciitis). Specifically, the Board notes that in November 2021, the examiner issued a VA medical opinion stating that the Veteran has a left foot diagnosis of metatarsalgia, and subsequently issued a positive nexus opinion as to this condition being related to the Veteran's active duty service. However, VA interpreted the examiner's diagnosis and medical opinion to be of the Veteran's right foot and not the left, and thus, requested further clarification of whether the Veteran has a left foot disability. In December 2021, the same examiner issued an addendum opinion and provided the same information as that which was provided in November 2021, which stated that the Veteran has a left foot diagnosis of metatarsalgia. Subsequently, VA issued another request for clarification based on the same premise that the examiner provided a diagnosis based on the Veteran's right foot and not left, to which the same examiner issued another addendum opinion in December 2021 stating that the Veteran does not have a left foot diagnosis other than his plantar fasciitis. As the examiner has now provided conflicting evidence of record regarding whether the Veteran has a current left foot diagnosis of metatarsalgia that is related to his active duty service, the Board finds that a remand is necessary for proper clarification. Additionally, the Board notes that even if the examiner did not provide conflicting evidence of record and correctly notated that the Veteran did not have a current left foot disability, then the addendum VA medical opinion would be deemed inadequate, as the examiner failed to provide a medical rationale to support such a finding and failed to consider the Veteran's reported pain and functional impairment as a qualified disability for VA purposes, as directed in the June 2021 Board remand. Therefore, the Board finds that the Veteran should be provided an additional addendum medical opinion that adequately addresses his claim, in accordance with VA's duty to assist. Accordingly, a remand is necessary to address the matters discussed above. The matters are REMANDED for the following action: 1. Request the Veteran to identify all medical providers (VA and private) from whom he has received treatment for his left foot condition (other than plantar fasciitis) and obtain any outstanding records and associate them with the Veteran's claims file. 2. After associating all newly acquired records with the claims file, send the claims file back to the November/December 2021 VA examiner to provide clarification on whether the Veteran has a current left foot disability (other than plantar fasciitis), and if so, to provide an opinion as to the nature and etiology of that left foot disability. If the November/December 2021 VA examiner is not available, then send the claims file to another appropriate clinician. The Veteran should be reexamined only if such is deemed necessary in order to provide the requested opinion. The entire claims file, including a copy of this remand, must be made available to the examiner, and note review of the record in the examination report. All relevant evidence should be discussed, to include all pertinent medical complaints, symptoms, and clinical findings. Following complete review of the record, the examiner must address the following: (a) Identify and clearly describe all diagnoses related to the Veteran's left foot condition (other than plantar fasciitis), to include pain that causes functional impairment. Here, the examiner is asked to specifically identify any functional impairment(s) caused by any left foot condition, to include pain. If the Veteran is not found to have/have had a left disorder other than plantar fasciitis, the examiner should so state and identify the medical rationale to support such a finding. (b) If the Veteran has a left foot condition other than plantar fasciitis, the examiner must opine whether it is at least as likely as not (50 percent or greater probability) had their onset during any period of active duty service, or are otherwise etiologically related to his active duty service, to include due to any physical demands of being in service. (c) The examiner should consider the entire claims file, and discuss the Veteran's lay statements regarding the nature, onset, and chronicity of symptoms, and reconcile any conflicting medical evidence or opinions of record. The examiner is advised that the Veteran is competent to report symptoms, and that his reports must be considered in formulating the requested opinion. (Continued on the next page) (d) All opinions should be supported by detailed rationale. If the examiner is unable to offer the requested opinion, it is essential that the examiner offer a rational for the conclusion that an opinion could not be provided without resorting to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Carter, 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.