Citation Nr: 18131295
Decision Date: 08/31/18	Archive Date: 08/31/18

DOCKET NO. 15-45 464
DATE:	August 31, 2018
REMANDED
Entitlement to service connection for a lumbar spine disability, to include as secondary to service-connected right great toe disability, is remanded.
Entitlement to service connection for a left hip disability, to include as secondary to service-connected right great toe disability, is remanded.
Entitlement to service connection for a right hip disability, to include as secondary to service-connected right great toe disability, is remanded.
Entitlement to service connection for left knee disability, to include as secondary to service-connected right great toe disability, is remanded.
Entitlement to service connection for a right ankle disability, to include as secondary to service-connected right great toe disability, is remanded.
REASONS FOR REMAND
The Veteran had active duty service from January 1987 to February 1989.  These matters come before the Board of Veterans’ Appeals (Board) on appeal of a May 2013 rating decision.
Following the issuance of the October 2015 statement of the case, the Veteran submitted additional medical evidence in support of his appeal without a waiver of AOJ consideration; however, since the Veteran’s Form 9 was received after February 2, 2013, a waiver of review by the AOJ was not required.  See 38 U.S.C. § 7105(e).
1. The claims of entitlement to service connection for a lumbar spine disability, a left hip disability, a right hip disability, a left knee disability and a right ankle disability, to include as secondary to service-connected right great toe disability, are remanded.
The Veteran contends that disabilities of the lumbar spine, bilateral hips, left knee and right ankle are all secondary to his service-connected great right toe.  In particular, he alleges that his great right toe disability causes him to walk with an antalgic gait which has resulted in, and/or aggravated, his claimed disabilities. 
The record contains VA examination reports and private medical opinions; however, none of the opinions fully address the Veteran’s contentions.
In a May 2011 letter, a private podiatrist stated that the Veteran’s antalgic gait (due to forefoot pain) has caused abnormal joint motion of the knees and hip.  The podiatrist opined that the Veteran has developed knee, hip and lower back pain as a result of his forefoot pathology.  The podiatrist did not provide any further rationale for the opinion.  
Following VA examinations of the spine, hips, knee and right ankle in February 2013, the examiner opined that there was no evidence connecting the Veteran’s osteoarthritis in multiple joints to the right foot condition.  The examiner explained that the Veteran’s osteoarthritis in multiple joints appeared with aging in the majority of the population.  The examiner explained that the Veteran’s gait was minimally impaired, with a small limp, and that it was difficult to separate as a sequela from the left knee surgery in 1981 and the back surgery in 1997 that could also contribute to the traumatic arthritis in the joints.  Here, the examiner provided an overall negative nexus statement that did not fully address each claimed disability.  Moreover, the examiner did not address each disability on an aggravation basis.
In a November 2012 medical treatment report, a private podiatrist stated that it “makes sense logically that with his foot hurting the way he [the Veteran] has described that he will stand and walk differently, which can put strain on his knees, hip and lower back.”  The podiatrist’s statement is speculative.
In light of the above, the Board finds that further VA examination and opinions are warranted.
The matters are REMANDED for the following action:
1. Forward the Veteran’s claims file, to an appropriate examiner for a records review and request that he or she provide an opinion with respect to the etiology of the Veteran’s claimed disabilities of the lumbar spine, bilateral hips, left knee and right ankle, to include as secondary to service-connected great right toe disability.  After a review of the entire record, including a copy of this Remand, the examiner should provide an opinion as to whether it is at least as likely as not that the Veteran’s lumbar spine, left hip, right hip, left knee and/or right ankle disability(ies) were/was caused, or aggravated by, the service-connected right great toe disability, to include his contentions that his disabilities are secondary to an antalgic gait caused by his service-connected right great toe disability.  
The term “aggravation” means an increase in the underlying disability beyond the natural progression of the disease, as contrasted to a temporary worsening of symptoms.
A complete rationale for any opinion should be provided.
2. When the development requested has been completed, the claims should be readjudicated by the AOJ with consideration of all additional evidence.  If any benefit sought is not granted, the Veteran and his representative should be furnished a Supplemental Statement of the Case (SSOC) and be afforded a reasonable opportunity to respond before the record is returned to the Board for further review.
 
U. R. POWELL
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	J. Henriquez, Counsel

For A Complete Guide To VA Disability Claims and to find out more about your potential VA disability case and how to obtain favorable VA Rating Decision! Visit: VA-Claims.org

For More Information on Veterans Disability Compensation Benefits! Visit: DisableVeteran.org ~ A Non-Profit Non Governmental Agency


Advertisements

Leave a Reply

Please log in using one of these methods to post your comment:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.