Citation Nr: 25003704 Decision Date: 03/19/25 Archive Date: 03/19/25 DOCKET NO. 19-25 173 DATE: March 19, 2025 REMANDED Entitlement to service connection for a right foot condition is remanded. Entitlement to service connection for a left foot condition is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1967 to July 1969. He appeals an April 2018 rating decision by the Agency of Original Jurisdiction (AOJ) that denied service connection for right and left foot conditions. See April 2018 rating decision. The Board of Veterans' Appeals (Board) has remanded this matter on several occasions, most recently in October 2024. See October 2024 Board remand. The October 2024 Board remand directed the AOJ to obtain a new examination and opinion regarding the Veteran's right and left foot disabilities. Accordingly, the Veteran attended a VA examination in November 2024. The examiner diagnosed him with bilateral hallux valgus, bilateral hallus rigidus, and bilateral planter fibromatosis (Ledderhose disease). See November 2024 VA examination report. As to nexus, the examiner provided negative nexus opinions for all three diagnoses as they relate to the Veteran's contention that his foot condition is due to "walking in swamp water while wearing boots or swamp water inside the boots." See November 2024 VA medical opinion. The examiner cited to peer reviewed medical literature as support for his negative opinions; however, the opinions do not contain further discussion as to why the lack of same is dispositive of the claim. Critically, there is no discussion of the facts specific to the Veteran in relation to the medical literature referenced by the examiner. See Bailey v. O'Rourke, 30 Vet. App. 54, 60 (2018) (reliance on the absence of medical literature supporting nexus without discussing the specific facts pertaining to a veteran's condition or individual circumstances in inadequate). Thus, remand is required to provide the Veteran with an adequate VA opinion. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Importantly, the prior October 2024 Board remand directives specifically requested that the examiner address the Veteran's two main contentions. First, "going in and out of that mud day in and day out as an Army infantryman is what hurt [his] feet." Second, that he began having problems with his feet when "a guy ran me over when we were running to the bunker to escape mortar fire. I thought my big toe on my right foot had just popped out of place. Later I found out that it had broken the joint on my big toe." See November 2022 Veteran statement (emphasis added); see also October 2024 Board remand directives. The AOJ requested an addendum opinion to ensure compliance with the Board's prior remand directives. The VA examiner provided this addendum opinion in December 2024. The examiner continued his negative nexus opinions and added the following statement regarding the significance of the Veteran's statement about his feet being run over: "receiving trauma in any part of the body that requires NO ACUTE MEDICAL INTERVENTION is of no medical significance-[for example,] a laceration with a knife which require stitches [versus] a papercut-both break skin integrity, both bleed, however papercut is of no clinical significance when compared with the need of medical intervention (stitches). Likewise, [the Veteran's] report that [he] "was run over by a car" without any need of further medical intervention (no fractures, bleeding, trauma, etc.) is of no clinical significance." See December 6, 2024 VA addendum medical opinion. The examiner's statement that the Veteran required no further medical intervention, including lack of fracture, after his foot was injured during service is untrue and directly contradicts the Veteran's statement that he later found out he had indeed broken the joint of his big toe. An opinion based on an inaccurate factual premise has no probative value. See Reonal v. Brown, 5 Vet. App. 458, 460 (1993). Accordingly, the December 2024 VA addendum opinion is inadequate, and remand is required. See Barr, supra. Lastly, the Board notes that there are outstanding relevant VA treatment records. Specifically, the Veteran's VA treatment records contain scanned documents into the VistA Imaging system that are not associated with the claims file, and the Board does not have access to VistA Imaging. For example, there are non-VA consult result notes scanned into the system dated in August and October 2024. See August 1, 2024 and October 28, 2024 VA treatment notes. Ultimately, these scanned documents unavailable to the Board may very well be relevant to the instant appeal. On remand, the AOJ shall attempt to obtain and associate any outstanding relevant records viewable in VistA Imaging with the Veteran's claims file. The matters are REMANDED for the following action: 1. Obtain any outstanding and updated relevant VA and/or private treatment records and associate the same with the claims file, including the outstanding records viewable in VistA Imaging. All obtained records should be associated with the evidentiary record. If any identified records are not obtainable (or none exist), the Veteran should be notified, and the record clearly documented. 2. Thereafter, obtain an opinion from an appropriately qualified clinician to determine the nature and etiology of the Veteran's right and left foot conditions. The evidentiary record, including a copy of this remand, must be made available to and reviewed by the reviewing clinician. The opinion must include a notation that this record review took place. It is up to the discretion of the reviewing clinician as to whether an examination is necessary to provide an adequate opinion. After the record review and examination of the Veteran, if deemed necessary by the reviewing clinician, the reviewing clinician is asked to respond to the following: (a.) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's right foot condition was incurred in, or is otherwise related to, his time on active duty, to include (1) going in and out of mud day in and day out, and (2) having his feet run over during service? (b.) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's left foot condition was incurred in, or is otherwise related to, his time on active duty, to include (1) going in and out of mud day in and day out, and (2) having his feet run over during service? In rendering these opinions, the reviewing clinician is advised that the Veteran is competent to report his symptoms and history. Such reports must be acknowledged and considered in formulating any opinion. If the reviewing clinician rejects the Veteran's reports, he or she must provide an explanation for such rejection. The reviewing clinician is not to improperly discount the Veteran's lay statements or mistakenly rely on an absence of medical evidence in the record to support his or her conclusions. The complete rationale for all opinions should be set forth and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an opinion cannot be provided without resorting to mere speculation, the reviewing clinician must provide a complete explanation for why an opinion cannot be rendered. In so doing, the reviewing clinician must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). 3. After the above development has been completed, readjudicate the claims. If any benefit sought remains denied, provide the Veteran and his representative with a supplemental statement of the case (SSOC), and return the case to the Board. DONNIE R. HACHEY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Poe, 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.