Citation Nr: 22015207 Decision Date: 03/16/22 Archive Date: 03/16/22 DOCKET NO. 11-21 031 DATE: March 16, 2022 REMANDED Entitlement to service connection for a bilateral foot disability, to include calluses, bunions, and hallus valgus, is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1974 to September 1977 and from September 1990 to September 1991. The Veteran died in February 2018, during the pendency of the appeal. The Appellant, the surviving spouse, has been substituted in this appeal. In December 2020, the Board remanded this case for additional development. The Board finds that there has not been substantial compliance with the remand requests. Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to service connection for a bilateral foot disability, to include calluses, bunions, and hallus valgus is remanded. VA medical opinions were obtained following the December 2020 Board remand. The Board finds the March, July, and August 2021 VA medical opinions incomplete. In July 2021, a VA examiner opined that the right and left foot disabilities, which clearly and unmistakably existed prior to service, were clearly and unmistakably not aggravated beyond the natural progression by service. As a rationale, the examiner stated that there was no documentation in the records that were any changes in treatment for pre-existing right and left "foot corns that w[ere] incurred during [the Veteran's] military service or that worsened, aggravated, or altered the natural progression of [the] condition[s]." A rationale based on the absence of medical records without consideration of a Veteran's competent reports is inadequate. Dalton v. Nicholson, 21 Vet. App. 23 (2007). As the examiner did not consider the Veteran's lay statements of worsening during service, the opinion is incomplete. The examiner also opined that it was less likely than not that left foot calluses were incurred in service. As a rationale, the examiner stated that because there were left foot calluses at separation in 1991, left foot calluses were incurred in service. In order to be entitled to probative weight, a medical opinion must contain not only clear conclusions with supporting data, but also a reasoned explanation connecting the two. Nieves-Rodrigues v. Peake, 22 Vet. App. (2008). As the opinion is not supported by a thorough rationale, it is incomplete. In a July 2021 addendum opinion, the examiner stated that it was at least as likely as not that the bilateral foot callouses started during the Veteran's first period of service as evidenced in medical records and continued throughout his life. A medical opinion based on incorrect factual premise is not probative. Reonal v. Brown, 5 Vet. App. 458 (1993). As the evidence shows that the foot complaints began in 1984, the opinion is incomplete. An August 2021 VA examiner opined that a bilateral foot disability was not incurred in service. No rationale for the opinion was provided. The examiner stated that it was clear and unmistakable (undebatable) that the Veteran did not have a preexisting right or left foot disability to include hallux valgus and corns, at the time of entrance to the second period of active service. As a rationale, the examiner stated that a medical record review was negative for consistent clinical evidence of hallux valgus during active service from 1990 to 1991. The examiner did not reconcile the finding with the relevant evidence of record, to include other medical opinions. Therefore, the opinion is incomplete. A Board remand confers upon the Appellant the right to compliance with that order. Stegall v. West, 11 Vet. App. 268 (1998). Because there has not been substantial compliance with the remand requests, remand is necessary for a medical opinion. The matter is REMANDED for the following action: Forward the claims file to an appropriate medical professional to obtain an opinion addressing the etiology of a bilateral foot disability. As the Veteran is deceased, no VA examination should be scheduled. The examiner must review the claims file, to include a copy of this remand, and should note that review in the report. The examiner should provide clearly stated rationales with references to the record, diagnostic tests, and medical literature. The examiner should: (a.) List all diagnosed right or left foot disabilities shown by the record. For each diagnosed foot disability of either foot, opine when that disability is shown by the evidence of record. Then, opine whether it is clear and unmistakable that disability preexisted entrance to service in September 1974. Also, opine whether it is clear and unmistakable that disability preexisted entrance to service in September 1990. (b.) Opine whether it is clear and unmistakable (undebatable) that any right or left foot disability clearly and unmistakably pre-existed entrance to service in September 1974. If so, state what right or left foot disability preexisted service and discuss the evidence used to support that finding. (c.) Opine whether it is clear and unmistakable (undebatable) that any preexisting right or left foot disability was not aggravated (permanently worsened beyond the natural progress of the disorder) during service from September 1974 to September 1977. The examiner must consider the Veteran's lay statements, and should reconcile the opinion with the other opinions of record. (d.) Opine whether it is clear and unmistakable (undebatable) that any right or left foot disability clearly and unmistakably pre-existed entrance to service in September 1990. If so, state what right or left foot disability preexisted service and discuss the evidence used to support that finding. (e.) Opine whether it is clear and unmistakable (undebatable) that any preexisting right or left foot disability was not aggravated (permanently worsened beyond the natural progress of the disorder) during service from September 1990 to September 1991. The examiner must consider the Veteran's lay statements, and should reconcile the opinion with the other opinions of record. (f.) Opine whether it is at least as likely as not (50 percent or greater probability) that each right or left foot disability shown in the record had its onset during active service or is related to any event, injury, or disease during service. The examiner is advised that the Veteran had active service from September 1974 to September 1977 and from September 1990 to September 1991. If there is a more likely etiology than service, the examiner must explain why that etiology is more likely. The examiner must consider the Veteran's lay statements regarding symptoms during and since service, and should reconcile the opinion with the other opinions of record. Harvey P. Roberts Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E.O., 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.