Citation Nr: 23023158 Decision Date: 04/20/23 Archive Date: 04/20/23 DOCKET NO. 19-15 296 DATE: April 20, 2023 REMANDED Entitlement to service connection for a right foot disability is remanded. Entitlement to service connection for a left foot disability is remanded. Entitlement to service connection for a skin disability is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1972 to August 1976. He testified before the undersigned in June 2020; a transcript of the hearing is associated with the record. These matters were most recently remanded in February 2022. Unfortunately, there has not been substantial compliance and the matters must be remanded. Stegall v. West, 11 Vet. App. 268 (1998). 1. Entitlement to service connection for a right foot disability. 2. Entitlement to service connection for a left foot disability. 3. Entitlement to service connection for a skin disability. The claims must be remanded again because the June 2022 VA opinions are inadequate. The June 2022 examinations noted diagnoses of plantar fasciitis and dermatitis. The examiner offered the same rationale for the negative nexus opinions for the foot and skin disabilities. That is, that it was not possible to establish continuity between anything that may have happened in service and the current foot and skin conditions because the Veteran's annual examination in March 2021 "did not mention any issue." The examiner did not identify the nature of the March 2021 examination, but VA treatment dated March 24, 2021, show the Veteran presented for follow up of unrelated conditions. In an August 2022 VA addendum opinion related to the foot claims only, the examiner noted the Veteran's statements could not be corroborated by the records and that it was "up to the VA to decide whether to overlook the lack of evidence." The opinions are all inadequate because they are based on a lack of documented treatment, despite prior remand directives saying the Veteran's competent lay statements regarding symptomatology must be accepted. The matters are REMANDED for the following action: 1. Forward copies of all pertinent records to an appropriate clinician, preferably one who has not previously opined in this case, to obtain a medical opinion on the likely etiology of the diagnosed foot and skin disabilities. If the examiner determines that an opinion cannot be provided without an examination, one should be scheduled. The examiner is asked to answer the following: (a) Identify all diagnosed foot and skin conditions since April 2017. (b) Is it at least as likely as not that any identified disability affecting either foot was incurred in or is otherwise related to service? (c) Is it at least as likely as not that any diagnosed skin condition was incurred in or is otherwise related to service? In answering these questions, the examiner must specifically discuss the following: (i) the notations of blisters and ingrown toenails in the STRs; (ii) the Veteran's claim of foot pain after frequent marching: (iii) the Veteran's report that he may have injured his feet when he jumped out of a truck during service, and; (iv) that his feet became itchy during service and the symptoms have continued since then. The examiner is advised that the Veteran is competent to provide evidence of symptomatology readily apparent to him, regardless of whether the symptoms are noted in the service medical records or on the date of examination. The examiner may NOT rely on the absence of a medical record or evidence of medical treatment as the sole rationale for any negative medical nexus opinion. A complete rationale must be provided for all opinions. If the examiner cannot provide an opinion without resort to speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge; the examiner's own expertise, or; whether additional facts are required and note what, if any, additional evidence would permit such an opinion to be made. 2. Confirm that the VA medical opinions provided comports with this remand, specifically that the opinion does not rely on the absence of medical records or medical treatment. If it does, get an addendum. M.E. Larkin Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Jarman, 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.