Citation Nr: 25007771 Decision Date: 06/11/25 Archive Date: 06/11/25 DOCKET NO. 22-00 464 DATE: June 11, 2025 REMANDED Entitlement to service connection for bilateral flat feet is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from December 1976 to November 1989. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a September 2017 rating decision issued by a VA Regional Office (RO). In April 2024 and February 2025 decisions, the Board remanded the issue of entitlement to service connection for bilateral flat feet for further development. While the Board regrets the additional delay, there has not been substantial compliance with prior Board remand directives; the claim must be remanded again. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Service connection for bilateral flat feet. In June 2024, a VA examiner found that the Veteran had bilateral flat feet during a period in which the Veteran had an "other than honorable conditions" discharge. However, due to the poor quality of the Veteran's service treatment records (STRs), the examiner was unable to determine the date of diagnosis. See June 2024 C&P Exam. The Board issued a remand order for further development, as the VA examiner did not address the entirety of the Veteran's foot symptomatology in service. See February 2025 BVA Decision. As per Board remand directives, an addendum opinion was provided in March 2025. There, a VA examiner opined that "in review of the STRs, Veteran was noted to have flatfeet on entrance exam on 08/30/1976, DX with pes planus at the time. Veteran flatfeet condition occurred prior to active duty. Therefore, Veteran does not have a diagnosis of bilateral flat feet that is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) incurred in or caused by (the) bilateral feet during service. A nexus has not been established." See February 2025 C&P Exam. A supplemental statement of the case (SSOC) was provided in March 2025. The Veteran responded by stating his belief that his condition was aggravated by his military service and cited treatment in 1978 as evidence. See April 2025 Third Party Correspondence. The claim is now before the Board. As noted above, the VA examination did not consider aggravation. However, VA must consider aggravation when the theory is explicitly raised, or has been reasonably raised, by the record. See Walsh v. Wilkie, 32 Vet. App. 300, 307 (2020). The Board finds that the Veteran's testimony alone is not sufficient to find demonstrate an increase in severity, from which the disability would be presumed to have been aggravated in service. Horn v. Shinseki, 25 Vet. App. 231, 234 (2012). The Veteran has not been shown to have the requisite skills, education, or expertise to make the medical determination that the aforementioned symptoms in service were part of, or were caused by, his pes planus. Jandreau v. Nicholson, 492 F.3d 1372, 1376 (Fed. Cir. 2007). Moreover, a "permanent" increase in severity is required to establish "aggravation" of a preexisting disability for the purpose of applying the presumption of aggravation under 38 U.S.C. § 1153. Ward v. Wilkie, 31 Vet. App. 233, 239-42 (2019). Temporary or intermittent flare-ups of a preexisting injury or disease are not sufficient to be considered "aggravation in service" unless the underlying condition itself, as contrasted with mere symptoms, has worsened. See Jensen v. Brown, 4 Vet. App. 304, 306 -07 (1993); Green v. Derwinski, 1 Vet. App. 320, 323 (1991); Hunt v. Derwinski, 1 Vet. App. 292, 297 (1991). Neither the Veteran nor the Board may provide such a medical opinion. However, the Board accepts the Veteran's arguments as sufficient to raise the possibility of aggravation. The February 2025 VA examiner only addressed direct service connection, without considering the possibility of aggravation. Therefore, the opinion is incomplete and inadequate for adjudication purposes. See El-Amin v. Shinseki, 26 Vet. App. 136, 140 (2013) (a medical opinion is inadequate when it fails to adequately address the question of aggravation). Where VA provides the Veteran with an examination in a service connection claim, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Therefore, VA must supplement the record by seeking an addendum opinion. The matter is REMANDED for the following action: Arrange for an addendum opinion by the February 2025 VA examiner if available, or an otherwise qualified VA examiner if not, to determine the etiology of the Veteran's flatfoot condition. The examiner should opine as to whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the diagnosed condition was aggravated by (increased in severity due to) the Veteran's military service. If the examiner believes an in-person examination is necessary, such should be arranged. If the diagnosed flatfoot condition is determined to not have been caused or aggravated by service, identify the etiology for such disability that is considered to be more likely (and explain why that is so). In doing so, the examiner must consider all medical and lay evidence of record, including evidence of foot pain found in the Veteran's STRs and pain reported by the Veteran. A complete rationale (that expressly references the Veteran's lay statements and the medical record) should be provided for any opinion expressed. By law, the Board is not permitted to rely on any conclusion that is not supported by a thorough explanation. Providing an opinion or conclusion without a thorough explanation will delay processing of the claim and may also result in a clarification being requested. If an opinion cannot be provided without resort to mere speculation, indicate whether the need to speculate is due to a deficiency in the state of general medical knowledge (i.e., no one could respond given medical science and the known facts), a deficiency in the record (i.e., additional facts are required), or the examiner does not have the requisite knowledge or training. S. CHARLES NEILL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P. Abels, 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.