Citation Nr: 18142797 Decision Date: 10/17/18 Archive Date: 10/16/18 DOCKET NO. 09-40 558 DATE: October 17, 2018 REMANDED Service connection for a lumbar spine disorder, to include lumbosacral strain, degenerative disc disease and degenerative arthritis, secondary to service-connected bilateral pes planus is remanded. Service connection for left knee degenerative joint disease, secondary to service-connected bilateral pes planus is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Marine Corps from November 1973 to November 1975. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a December 2010 and September 2011 rating decision of the Little Rock, Arkansas Regional Office (RO). In July 2017, the Board denied service connection for the underlying claims. In a June 2018 Joint Motion for Partial Remand (JMPR), the U.S. Court of Appeals for Veterans’ Claims (Court) vacated and remanded the July 2017 Board decision. Service connection for lumbar spine and left knee disorder The Court found that the July 2017 Board decision did not discuss private treatment records, dated December 2010 to December 2012, from the Arkansas Pain Center that noted the Veteran’s asymmetrical gait. The remand directives below are structured to conduct appropriate medical inquiry on review. The matters are REMANDED for the following actions: 1. Advise the Veteran that he may submit any additional medical and non-medical evidence relating to his lumbar spine and left knee disorder that is not already in VA’s possession. 2. Return the file to the VA examiner who conducted the October 2015 VA medical examination. If the examiner is not available, have the file reviewed by a similarly-qualified examiner. Another examination is not required; however, if the VA examiner indicates that he or she cannot respond to the Board’s questions without examination of the Veteran, another examination should be afforded to the Veteran. All relevant medical and non-medical records must be made available to the examiner for review of pertinent documents. The examination report should specifically state that such a review was conducted. The examiner must provide a comprehensive explanation for all opinions provided. THE EXAMINER IS ADVISED THAT THE VETERAN HAS AN ANTALGIC GAIT REGARDLESS OF WHETHER HE IS OBSERVED TO HAVE A NORMAL GAIT IF HE IS REQUIRED TO ATTEND THE VA EXAMINATION. Lumbar spine disorder: Based upon a review of the relevant evidence and sound medical principles, the VA examiner should provide the following opinion: Was the Veteran’s lumbar spine disorder, to include lumbosacral strain, degenerative disc disease and degenerative arthritis aggravated by his asymmetrical gait due to the service-connected bilateral pes planus? In rendering the above opinion, the examiner must review the record. In addition to any records that are generated because of this remand, the VA examiner’s attention is drawn to the following: • In private treatment records dated December 2010 to December 2012 from the Arkansas Pain Center, the Veteran consistently reported experiencing low back pain. It was consistently noted that the Veteran’s gait was asymmetrical on the left side and tandem gait was symmetrical. It was also noted that the Veteran was obese, ranging from 231 to 251 pounds. • In the July 2014 VA examination, the Veteran was diagnosed with a lumbosacral strain and degenerative disc disease. He reported experiencing lower back pain and stiffness since undergoing a pulling incident in 2010 at his post-service occupation in a VA medical center. • The July 2014 VA examiner opined that the Veteran’s lumbar spine disorder was not caused or aggravated by his service-connected bilateral pes planus because there was no evidence to connect his lumbar spine disorder to his bilateral pes planus. The examiner noted that the Veteran’s gait was normal and his lumbar spine injury in 2010 worsened his symptoms. • In the October 2015 VA examination, the Veteran was diagnosed with degenerative arthritis of the spine. He reported falling on his back during service, undergoing a back strain in 2010 and that his bilateral pes planus has aggravated his lumbar spine. • The October 2015 VA examiner opined that the Veteran’s lumbar spine disorder resulted from normal wear and tear from his reported post-service occupation. The examiner noted that the Veteran’s gait was normal and would not result in a back disorder. • In a June 2016 independent medical opinion, C.R.H., M.D. opined that the Veteran’s lumbar spine disorder was due to wear and tear and a normal accumulation of living. • In a September 2016 statement, the Veteran reported having walked with an antalgic gait since separation from service and that the “normal wear and tear” was due to walking with an altered gait. Left knee disorder: Based upon a review of the relevant evidence and sound medical principles, the VA examiner should provide the following opinion: Was the Veteran’s left knee degenerative joint disease aggravated by his asymmetrical gait due to the service-connected bilateral pes planus? In rendering the above opinion, the examiner must review the record. In addition to any records that are generated because of this remand, the VA examiner’s attention is drawn to the following: • In private treatment records dated December 2010, June 2011 and August 2011 from the Arkansas Pain Center, the Veteran reported experiencing left knee pain. It was noted that the Veteran’s gait was asymmetrical on the left side and tandem gait was symmetrical. It was also noted that the Veteran was obese, ranging from 247 to 251 pounds. • In the July 2014 VA examination, the Veteran was diagnosed with left knee degenerative joint disease. He reported having injured his left knee in service and has not experienced trouble with the left knee until a few years ago. • The July 2014 VA examiner opined that the Veteran’s left knee disorder was not caused or aggravated by the service-connected bilateral pes planus because it was due to aging and there was no other evidence to connect it to other causes. The examiner noted that the Veteran’s gait was normal and that his feet did not affect his knees. • In the October 2015 VA examination, the Veteran was diagnosed with left knee degenerative joint disease. The Veteran reported having worked in the supply department at a VA medical center for 30 years where he constantly walked and climbed. • The October 2015 VA examiner opined that the Veteran’s left knee disorder resulted from normal wear and tear. The examiner noted that the Veteran’s gait was normal and did not contribute to his left knee disorder. • In a June 2016 independent medical opinion, C.R.H., M.D. opined that the Veteran’s left knee disorder was due to wear and tear and a normal accumulation of living. • In a September 2016 statement, the Veteran reported having walked with an antalgic gait since separation from service and that the “normal wear and tear” was due to walking with an altered gait. The Veteran requested to limit the theory of secondary service connection to aggravation. (Continued on the next page)   3. Readjudicate the issues on appeal. If the benefit sought on appeal remains denied, the Veteran should be provided a supplemental statement of the case (SSOC). An appropriate period should be allowed for response before the case is returned to the Board. Vito A. Clementi Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. Cohen, Associate Counsel