Citation Nr: 23057790 Decision Date: 10/25/23 Archive Date: 10/25/23 DOCKET NO. 14-13 603 DATE: October 25, 2023 REMANDED Entitlement to service connection for a right foot disability, to include pes planus, plantar fasciitis, hallux valgus, and a nerve disability, is remanded. Entitlement to service connection for a left foot disability, to include hallux valgus, and a nerve disability, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from July 1967 to July 1969. This appeal stems from a May 2011 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). This appeal has a long procedural history and has been before the Board previously. Most recently, in October 2022, the Board remanded this appeal for adequate VA medical opinions pursuant to a prior April 2022 remand. Subsequently, by a May 2023 rating decision, the RO granted service connection for left flat foot and left foot plantar fasciitis. With respect to these issues, this is considered a full grant of the benefits sought on appeal, and these issues are no longer in appellate status. Unfortunately, there has not been substantial compliance with the Board's previous remand directives regarding some of the other issues on appeal. Although the Board sincerely regrets the additional delay this will cause, another remand is required obtain adequate medical opinions for the remaining issues on appeal. Stegall v. West, 11 Vet. App. 268, 271 (1998). The Veteran underwent peripheral nerve and foot conditions examinations in April 2023, at which time the examiner rendered diagnoses of bilateral compression neuropathy, diabetic neuropathy, bilateral flat foot, bilateral plantar fasciitis, and bilateral hallux valgus. Regarding the right and left foot nerve disability, the examiner opined that the claimed condition was less likely than not related to service. The examiner reasoned: Veteran was diagnosed with diabetic peripheral neuropathy and left lower extremity lumbar radiculopathy in 2010. There is no evidence veteran had foot neurological diagnosis while in service. A nexus has not been established. The examiner further reasoned: Based on review of the available evidence, it is less likely than not that the claimed condition is due to service as there is scant data supporting a nexus between the current diagnosis of plantar fasciitis, pes planus, hallux valgus and military service. Veterans earliest right foot diagnosis was found in...early 2000s. There is one note with brief mention of right foot pain in 1968 with no right foot diagnosis, only left. Without chronicity during service or after service, a post-service event, illness, or injury is considered to be a more likely etiology. In a July 2023 addendum opinion pertaining to the left foot, the examiner noted: the current diagnosis of Bilateral Compression Neuropathy secondary to bilateral S1 and right L5 nerve root and military service. Without chronicity during service or after service, a post-service event, illness, or injury is considered to be a more likely etiology. In another July 2023 addendum, the examiner checked the box for the claimed condition was at least as likely as not incurred in or caused by service; however, in the rationale, the examiner just listed evidence pertaining to the left foot. This opinion was followed by another addendum, which provided a negative nexus opinion for both the left and right feet. On review, the Board finds these opinions confusing and inadequate. First, while the examiner noted that the first indication of right foot disability was not until 2000s, the examination report noted the date of diagnosis for pes planus and plantar fasciitis as "1968" and "1969." Second, the Board specifically asked the examiner to address the separation examination reports of foot trouble and leg cramps, VA treatment records dated in 1980 of radiating pain, and other medical evidence as well as lay assertions that the symptoms of nerve problems began in 1967. Neither examiner addressed this evidence. Third, the examiners' opined that a post-service event, illness, or injury is considered to be a more likely etiology of the claimed right foot disability, yet failed to identify any such injury. For these reasons, an addendum medical opinion is necessary prior to adjudicating the merits of these claims. The matters are REMANDED for the following action: 1. Ensure all outstanding VA treatment records are associated with the claims file. 2. Obtain addendum medical opinion from an appropriate examiner regarding the nature and etiology of the Veteran's right and left foot disabilities. The claims file and a copy of this remand will be made available to the examiner, who will acknowledge receipt and review of these materials. The need for another examination is left to the discretion of the medical professional offering the addendum opinion. After a review of the record, the examiner is asked to respond to the following: (a) Identify all currently diagnosed left foot disabilities, to include any nerve disability. (b) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the diagnosed right foot pes planus, plantar fasciitis, hallux valgus, and/or any nerve problem had their onset during service or is otherwise related to it? (c) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the diagnosed left foot hallux valgus and/or any nerve disability had their onset during service or is otherwise related to it? In doing so, the examiner is asked to consider the following: (i) September 1967 STR (clinician diagnosed probable plantar fascial strain); (ii) October 1967 STR (regarding left foot complaints, clinician diagnosed mild pes planus); (iii) June 1968 STR (clinician noted redundant heel and sole tissue left greater than right and diagnosed flat feet); (iv) September 1968 STR, medical report (noted bilateral foot complaints, including intermittent pain in arch of right foot on prolonged standing); (v) September 1968 STR (clinician diagnosed pes planus and noted pain on palpation of left foot); (vi) June 1969 separation report of medical examination (noted abnormal examination of feet); (vii) June 1969 separation report of medical history (Veteran endorsed foot trouble and leg cramps); (viii) February 1980 VA foot imaging received in August 1979 (showed left mild hallux valgus); (ix) Veteran's lay statement that bilateral foot pain began in 1967 (see April 2021 VA foot examination, history); (x) 1989-1990 VA treatment records received in October 1990 (noted complaints of and treatment for low back pain radiating down left lower extremity and left lower extremity numbness); (xi) Veteran's lay statement that bilateral lower extremity nerve symptoms began in 1967 (see July 2017 VA peripheral nerve examination, history). A complete rationale should be provided for all opinions. Please note: lack of contemporaneous medical records does not serve as an "absolute bar" to the service connection claim and cannot be used as a rationale in explaining why the current disability is not related to service. 3. Thereafter, readjudicate the remanded claims. Colleen M. Glaser-Allen Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Yaffe, 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.