Citation Nr: 22018718
Decision Date: 03/30/22	Archive Date: 03/30/22

DOCKET NO. 17-49 652
DATE: March 30, 2022

REMANDED

Service connection for bilateral hallux valgus and degenerative arthritis, to include as secondary to the service-connected bilateral plantar fascitis, is remanded.

REASONS FOR REMAND

The Veteran had active service from October 1992 to October 1996.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 2014 rating decision.

This issue was previously before the Board in September 2021.

Service connection for bilateral hallux valgus and degenerative arthritis, to include as secondary to the service-connected bilateral plantar fascitis, is remanded.

VA obtained an opinion in October 2021.  For secondary service, the examiner determined the Veteran's claimed bilateral hallux valgus and degenerative arthritis are less likely than not caused or aggravated by any of the Veteran's service-connected condition, including his service-connected bilateral plantar fasciitis.  For their rationale, the examiner notes a review of the medical literature finds the reverse relationship is more likely or persons with hallux valgus are more likely to have plantar fasciitis rather than plantar fasciitis causing hallux valgus and/or degenerative changes.  In addition, the examiner states, "it is noted that pes planus is associated with development of hallux valgus; however, it is noted that this Veteran was not found to have or diagnosed with Hallux Valgus [sic]."  They then state, "These conclusions apply to the Degenerative Arthritis because the arthritis is due to the Hallux Valgus, also not due to the Plantar Fasciitis."

The Board finds the medical opinion obtained in October 2021 is inadequate because it is unclear, in that the examiner stated that the Veteran was "not found to have or diagnosed with hallux valgus."  Further, no rationale was provided for the conclusion that the Veteran's bilateral hallux valgus and degenerative arthritis were not aggravated by his service-connected plantar fasciitis.  

Accordingly, a remand is required to obtain an addendum medical opinion that sufficiently addresses secondary service connection.

The matters are REMANDED for the following action:

1. Obtain any outstanding VA treatment records and any outstanding private medical records identified by the Veteran as pertinent to his claim.

2. Obtain an addendum medical opinion to determine the etiology of the Veteran's bilateral hallux valgus and degenerative arthritis.  The Board leaves it to the discretion of the examiner as to whether a new VA examination is necessary.

Following a review of the record, the examiner should provide an opinion as to 

(a.) Whether the Veteran's bilateral hallux valgus and degenerative arthritis were caused by (in whole or in part) his service-connected bilateral plantar fascitis, to include as a result of issues such as constant and chronic biomechanical compensation, adaptation, altered gait, or weight-shifting.

(b.) Whether the Veteran's bilateral hallux valgus and degenerative arthritis are/were aggravated by (any incremental increase in disability or any additional impairment of earning capacity regardless of its permanence) his service-connected bilateral plantar fascitis, to include as a result of issues such as constant and chronic biomechanical compensation, adaptation, altered gait, or weight-shifting.

The examiner must provide separate opinions and rationales for secondary causation and secondary aggravation.

The examiner must provide a comprehensive report that includes a complete rationale for all opinions and conclusions reached.  If the examiner is unable to provide any required opinion, they should explain why.  If an opinion cannot be provided without resorting to mere speculation, they should provide a complete explanation as to why this is so.  If the inability to provide a more definitive opinion is the result of a need for additional information, the examiner should identify the additional information that is needed.

 

P. M. DILORENZO

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Buck Denton

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.