Citation Nr: 23047698 Decision Date: 08/30/23 Archive Date: 08/30/23 DOCKET NO. 20-04 608 DATE: August 30, 2023 REMANDED Entitlement to service connection for bilateral pes planus is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from June 1980 to June 1985, and from December 1985 to August 1994, as well as in the United States Army from January 2003 to August 2003. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2018 rating decision issued by a Department of Veterans Affairs (VA) Regional Office. Entitlement to service connection for bilateral pes planus is remanded. The Veteran was afforded a VA examination for his bilateral pes planus in March 2018. The VA examiner provided a negative nexus opinion for his left flat foot/pes planus because his military physical examinations did not reveal the condition of left pes planus. In an April 2018 addendum opinion, the same VA examiner opined that the Veteran's right flat foot/pes planus was less likely than not incurred in or caused by gout during service or aggravated by service for the same reason as she had provided for the left foot. She elaborated on this opinion by stating that gout has no pathophysiological relationship to pes planus. The Board finds that the March 2018 and April 2018 etiology opinions are inadequate for decision making purposes, and thus remand is required to obtain an addendum medical opinion. First, the direct service connection opinions are exclusively based on the absence of service treatment records, which on its own is not a valid reason for consideration in a medical nexus opinion. See Dalton v. Nicholson, 21 Vet. App. 23 (2007) (wherein the Court determined an examination was inadequate because the examiner did not comment on the Veteran's report of in-service injury and, instead, relied on the absence of evidence in his service treatment records to provide a negative opinion). Second, it appears that the Veteran's service treatment records were incomplete at the time of the examination and opinions. In May 2019, the Veteran, through his representative, submitted two service treatment records, a January 2003 medical examination report and a February 2003 treatment record, from his active duty time with the United States Army. See Mat 2019 Medical Treatment Record - Government Facility. These records show a diagnosis of bilateral pes planus and treatment for foot pain. As these records are relevant to the Veteran's claim and were not available for consideration by the previous examiner, remand is warranted for a new medical opinion. Remand is also warranted to ensure that all of the Veteran's service treatment records have been obtained before an addendum opinion is obtained. Finally, the examiner did not provide an opinion as to whether the Veteran's service-connected gout of the bilateral hands/fingers, ankles, and feet aggravated his bilateral pes planus beyond its natural progression. Based on the foregoing, the Board finds that remand is warranted to obtain any outstanding service treatment records and to obtain an addendum medical opinion. The matter is REMANDED for the following action: 1. Obtain any outstanding service treatment records, specifically those during the period of the Veteran's service with the Army National Guard from August 1994 to September 2004, to include the period of active duty from January 2003 to August 2003. 2. Once the above development has been completed, forward the claims file to a qualified medical professional to obtain a VA medical opinion regarding the nature and etiology of the Veteran's bilateral pes planus. Following a review of the claims file, the examiner is asked to opine on the following: (a) Is it approximately at least as likely as not that the Veteran's bilateral pes planus began during active service or is otherwise etiologically related to his active service? In providing a response to the above question the examiner is asked to consider and address the service treatment records from the Veteran's active duty service, specifically his records with the Army, which note a diagnosis of bilateral pes planus and treatment for bilateral foot pain. (b) If not, is it approximately at least as likely as not that the Veteran's bilateral pes planus is proximately due to his service-connected gout of the bilateral hands/fingers, ankles, and feet? (c) If not, is it approximately at least as likely as not that the Veteran's bilateral pes planus is aggravated by his service-connected gout of the bilateral hands/fingers, ankles, and feet? A complete rationale must be provided for all opinions expressed. If an opinion cannot be offered without resort to mere speculation, the examiner must indicate why this is the case and what additional evidence, if any, would allow for a more definitive opinion. Melanie J. Mann Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Fairlie, 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.