Citation Nr: 25008455 Decision Date: 06/26/25 Archive Date: 06/26/25 DOCKET NO. 14-19 416 DATE: June 26, 2025 REMANDED Entitlement to service connection for bilateral flat feet is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from November 1988 to August 1996. This issue comes before the Board of Veterans' Appeals (Board) from an August 2012 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran subsequently appealed the rating decision to the Board. In September 2018, the Veteran had a hearing before the undersigned Veterans Law Judge (VLJ). A copy of the hearing transcript has been associated with the claims file. This case was initially before the Board in March 2019, when the issue listed above was remanded for additional development. In February 2022, the Board denied the claim, which the Veteran appealed to the United States Court of Appeals for Veterans Claims (Court). In December 2022, the Court issued an order that vacated the February 2022 Board decision and remanded the claim for compliance with its November 2022 Joint Motion for Remand (JMR). The Board remanded this matter in March 2023 and again in December 2023. A Supplemental Statement of the Case (SSOC) was issued in September 2024 and the matter is again before the Board. 1. Entitlement to service connection for bilateral flat feet is remanded. In the December 2023 Board remand, the Board found the May 2023 VA medical opinion to be inadequate. Specifically, the VA examiner did not adequately consider whether the Veteran's bilateral flat feet had its onset during active service or was otherwise causally related to his service, to include marching with heavy rucksacks in service. The VA examiner was instructed to discuss the Veteran's in-service treatment of his feet, as well as his complaints of numbness in the big toes following an incident in service where he reported his feet stayed wet for three days. The examiner was also instructed to specifically consider and discuss the Veteran's consistent reports of experiencing foot pain continuously since service but did not do so. Another VA medical opinion was obtained in January 2024. Unfortunately, the VA examiner again did not adequately address the Veteran's lay statements and theory of entitlement as directed to do so in the December 2023 Board remand. The VA examiner provided a negative opinion. While the VA examiner adequately addressed the Veteran's complaints of pain and numbness in his feet after being exposed to cold and wet weather, the examiner did not adequately address the Veteran's assertions that that his foot problems are related to marches while carrying heavy rucksacks. The VA examiner acknowledged the Veteran's assertion and seemingly concedes that carrying heavy loads can put stress on the feet and exacerbate discomfort or contribute to other foot problems but summarily dismisses the Veteran's assertion, stating carrying heavy loads is not typically considered the primary cause of developing flat feet. The examiner stated flat feet is more commonly influenced by factors like genetics, age, obesity, injury, or certain medical conditions rather than solely by carrying heavy loads but provides no further analysis. The examiner's opinion relies on generalities such as "typically" and "more commonly" rather than applying the Veteran's specific situation, evidence, and assertions in formulating a medical opinion. The Board also notes that, without any further explanation by the examiner, there is an inherent inconsistency in dismissing carrying heavy loads as a cause and then citing to obesity as one of the more common factors. In addition, the VA examiner was directed to specifically consider and discuss the Veteran's consistent reports of experiencing foot pain continuously since service. This was not done. Unfortunately, this matter must be remanded again in order to ensure substantial compliance with the December 2023 remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The matters are REMANDED for the following action: Obtain an addendum opinion from a qualified examiner. An examination is not required unless deemed necessary by the examiner. Following review of the claims file the examiner should provide an opinion on the following: Whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's bilateral flat feet had its onset during the Veteran's active service or is otherwise causally related to his service, to include marching with heavy rucksacks in service. The Veteran has reported that during the course of his service he engaged in regular road marches with heavy rucksacks while stationed at Fort Bragg, Korea, and Saudi Arabia, that his flat feet are attributed to this repeated activity, and that his foot problems began in service and have continued to the present day. In rendering this opinion, the examiner must specifically consider and discuss the Veteran's reports of marching with heavy rucksacks and his in-service treatment of his feet, as well as the Veteran's consistent reports of experiencing foot pain continuously since service. If the examiner renders a negative opinion, they must reconcile that finding with the Veteran's specific complaints, as contrasted to the general statements made by the January 2024 VA examiner's statement that weight-bearing activities such as rucksack marches are "not typically considered the primary cause of developing flat feet, as flat feet is more commonly influenced by factors like genetics, age, obesity, injury, or certain medical conditions rather than solely by carrying heavy loads" (emphasis added). The examiner is advised that the Veteran is competent to report history and symptoms and that those reports must be considered in formulating any requested opinion. Any opinion(s) offered should be accompanied by a clear and specific rationale consistent with the evidence of record. If the examiner finds it impossible to provide any requested opinions without resort to speculation, he or she should so indicate and explain why such a finding is made. Caroline Fleming Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Blackmore, Bryan R. 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.