Citation Nr: 22015759 Decision Date: 03/18/22 Archive Date: 03/18/22 DOCKET NO. 17-51 751 DATE: March 18, 2022 REMANDED Entitlement to service connection for residuals of a left great toe injury is remanded. REASONS FOR REMAND The Veteran served in the New Jersey Army National Guard, with a period of active duty from May 1981 to January 1982 and verified periods of active duty for training (ACDUTRA) from May 1976 to September 1976 and from October 13, 1979 to October 27, 1979. This matter is on appeal from a June 2016 decision of a Department of Veterans Affairs (VA) Regional Office (RO). In November 2020, a videoconference hearing was held before the undersigned. A transcript of the hearing is in the record. The case was previously before the Board in March 2021 when it was reopened and remanded for further development. The matter seeking service connection for a left knee disability was previously on appeal to the Board. A July 2021 rating decision awarded service connection for a left knee condition. As such, the matter that was before the Board has been resolved in full and the matter will not be discussed further herein. Entitlement to service connection for residuals of a left great toe injury is remanded. The Veteran contends that he is entitled to service connection for residuals of a left great toe injury. Upon review of the record, the Board finds that an addendum opinion must be obtained to adequately address the nature and etiology of the Veteran's condition. In July 2021, the Veteran was provided with a VA examination in which the examiner stated that the Veteran has no diagnosis and that he does not have a left great toe disability, including any symptoms such as numbness, that cause functional impairment. However, the examiner also noted that the Veteran reported difficulty feeling his toe, which affected his ability to walk. The examiner further indicated that contributing factors of disability were disturbance of locomotion and interference with standing. Further, during the November 2020 hearing, the Veteran reported that he has experienced nonstop tingling and numbness in the left great toe since the injury. The Board notes that the Veteran is competent to report readily observable symptoms such as numbness and tingling, and the Board finds no compelling reason to doubt the credibility or sincerity of these reports. Layno v. Brown, 6 Vet. App. 465, 469 (1994). Additionally, June 1999 treatment records note that the Veteran reported a history of left knee pain that radiated down to the toes three to four times a month. To establish the presence of a disability, there must be competent evidence specific to the claimant tending to show that the impairment rises to a level to affect earning capacity, which may include showing manifestations of a similar severity, frequency, and duration as those VA has determined by regulation would cause impaired earning capacity in an average person. See Wait v. Wilkie, 33 Vet. App. 8 (2020). VA must undertake an individualized assessment, which includes a preliminary evaluation of the degree of impairment. Id. Here, the evidence reflects that the Veteran's employment has included working in security. Thus, in making an individualized assessment, the Board concludes that tingling and numbness in the toe that disturbs locomotion and interferes with standing would cause impairment of earning capacity in a job involving security. See, e.g., 38 C.F.R. § 4.124a, Diagnostic Codes 8521, 8524, 8525. Therefore, the evidence supports the Veteran's symptoms result in functional impairment of earning capacity. As such, and since the VA examiner did not provide an etiology opinion regarding the left great toe, the Board finds that remand is necessary to obtain such an opinion. Further, as noted above, service connection for a left knee disability has been granted. The June 1999 treatment records raise questions as to whether the Veteran's left great toe condition is caused or aggravated by the service-connected left knee disability. Thus, an opinion should also be obtained on this question. The record also reflects the Veteran receives VA treatment; thus, updated VA treatment records should be associated with the claims file. The matters are REMANDED for the following action: 1. Obtain the Veteran's VA treatment records for the period from September 2021 to the present. 2. After completing the development requested in item 1, return the claims file to the July 2021 VA examiner, or another appropriate clinician if that examiner is not available, for review and an addendum medical opinion. The reviewing clinician should be requested to provide opinions (based on a review of the record) to answer the following: (a.) Is it at least as likely as not (approximately a 50 percent or greater probability) that the symptoms of the left great toe that cause functional impairment of earning capacity were incurred in service or are otherwise related to an in-service injury, disease, or event, to include an injury where a trailer hitch dropped on his left great toe? In providing an opinion on this question, the examiner is asked to consider the Veteran's testimony at the November 2020 hearing regarding an injury to his left great toe and September 1981 service treatment records regarding a similar injury that was recorded as being to the right great toe. (b.) Is it at least as likely as not (approximately a 50 percent or greater probability) that the service-connected left knee condition caused or aggravated (i.e., any incremental increase in the severity of the condition) the symptoms of the left great toe that cause functional impairment of earning capacity? (Continued on the next page) A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. M. SORISIO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. H. White, 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.