Citation Nr: 22015451 Decision Date: 03/17/22 Archive Date: 03/17/22 DOCKET NO. 14-41 762 DATE: March 17, 2022 REMANDED Service connection for left achilles tendinitis is remanded. Service connection for a left plantar calcaneal spur is remanded. Service connection for a right plantar calcaneal spur is remanded. A rating higher than 10 percent for strain of the tarsal bones of the left foot with a talar osteochondral lesion and talonavicular degenerative/traumatic joint disease is remanded. A rating higher than 10 percent for strain of the tarsal bones of the right foot with degenerative/traumatic arthritis of the tibiotalar joint is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1999 to June 2002. The Board of Veterans' Appeals (Board) remanded her appeal to the agency of original jurisdiction (AOJ) for additional development in May 2018 and May 2020. On remand, the AOJ granted service connection for a left talar osteochondral lesion, left talonavicular degenerative/traumatic joint disease, and right tibiotalar joint degenerative/traumatic arthritis. These secondary disabilities are now rated along with the primary service-connected left and right tarsal/foot disabilities under the same diagnostic codes. See October 2020 Rating Decision. The issue of entitlement to service connection for these disabilities is no longer before the Board. Grantham v. Brown, 114 F.3d 1156, 1158-59 (Fed. Cir. 1997). Service Connection for Left Achilles Tendinitis & Plantar Calcaneal Spurs The Veteran contends that her left achilles tendinitis, left plantar calcaneal spur, and right calcaneal spur are all secondary to the service-connected tarsal/foot disabilities. In May 2020, the Board remanded for a VA examination and medical opinions for each disability. A VA contractor examined the Veteran and provided opinions in September 2020. The 2020 examiner determined that each claimed disability was less likely than not proximately due to or aggravated beyond its natural progression by the service-connected disabilities. The examiner provided the same reasoning for each disability with respect to both proximate causation and aggravation. In each case, the examiner stated simply that the claimed disabilities "are anatomically and physiologically unrelated" to the service-connected disabilities. The examiner did not elaborate. Under the "aggravation" portion of the opinion for left achilles tendinitis, the examiner excerpted part of a medical journal article on post-traumatic osteoarthritis of the ankle. The journal excerpt indicates that such osteoarthritis may "develop[] secondary to joint trauma with clinical signs of pain and dysfunction often lagging years or decades behind the initiating injury." The excerpt does not mention achilles tendinitis. Because the examiner did not offer any additional reasoning, it is not clear how this information is relevant to the Veteran's claim. Medical opinions are adequate when they sufficiently inform the Board of a medical expert's judgment on a medical question and the essential rationale for that opinion. Monzingo v. Shinseki, 26 Vet. App. 97, 105 (2012). In this case, the Board finds that the 2020 examiner did not adequately explain the reasoning for the opinions above. Similarly, the examiner failed to address proximate causation and aggravation as distinct concepts. The examiner instead provided the same conclusory answer to both questions. See El Amin v. Shinseki, 26 Vet. App. 136, 140 (2013) (VA medical opinions on secondary service connection must sufficiently address both proximate causation and aggravation). Another remand is necessary to ensure compliance with the Board's previous instructions. Stegall v. West, 11 Vet. App. 268, 271 (1998); see also Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (when VA undertakes the effort to provide a VA examination or obtain an opinion, it must ensure that the examination or opinion is adequate). On remand, the AOJ must obtain adequate medical opinions for the claimed disabilities. Increased Ratings for Left and Right Tarsal/Foot Disabilities The Board explained in the May 2020 remand that the increased rating issues on appeal are "inextricably intertwined" with the service connection issues. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991); Tyrues v. Shinseki, 23 Vet. App. 166, 177 (2009) (claims are inextricably intertwined where the adjudication of one claim could have a significant impact on the adjudication of another claim). Because the Board is again remanding the service connection claims above, the increased rating claims must be remanded as well. The Board by this remand makes no determination, expressed or implied, concerning the credibility of any statements on file. The matters are REMANDED for the following action: 1. Obtain addendum opinions on the etiology of the Veteran's claimed left achilles tendinitis, left plantar calcaneal spur, and right calcaneal spur. After reviewing the claims file, including this remand, examiner must address the following questions: (a.) Is it at least as likely as not (50 percent or greater probability) that left achilles tendinitis was incurred in or otherwise caused by service? (b.) Is it at least as likely as not (50 percent or greater probability) that left achilles tendinitis is proximately due to or the result of the service-connected tarsal/foot disabilities? (c.) Is it at least as likely as not (50 percent or greater probability) that left achilles tendinitis is aggravated beyond its natural clinical course by the service-connected tarsal/foot disabilities? (d.) Is it at least as likely as not (50 percent or greater probability) that a left plantar calcaneal spur was incurred in or otherwise caused by service? (e.) Is it at least as likely as not (50 percent or greater probability) that a left plantar calcaneal spur is proximately due to or the result of the service-connected tarsal/foot disabilities? (f.) Is it at least as likely as not (50 percent or greater probability) that a left plantar calcaneal spur is aggravated beyond its natural clinical course by the service-connected tarsal/foot disabilities? (g.) Is it at least as likely as not (50 percent or greater probability) that a right plantar calcaneal spur was incurred in or otherwise caused by service? (h.) Is it at least as likely as not (50 percent or greater probability) that a right plantar calcaneal spur is proximately due to or the result of the service-connected tarsal/foot disabilities? (i.) Is it at least as likely as not (50 percent or greater probability) that a right plantar calcaneal spur is aggravated beyond its natural clinical course by the service-connected tarsal/foot disabilities? 2. Review the medical opinion(s) above to ensure substantial compliance with the Board's directives. Take any necessary corrective action. 3. Readjudicate the Veteran's claims, including the intertwined increased rating issues, in a supplemental statement of the case. Allow the Veteran and her representative the opportunity to respond. Then return to the Board for further appellate review as necessary. KELLI A. KORDICH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D.Z. Wall, 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.