Citation Nr: 18148968 Decision Date: 11/09/18 Archive Date: 11/08/18 DOCKET NO. 15-01 690 DATE: November 9, 2018 REMANDED Entitlement to service connection for headaches, to include as secondary to bilateral knee retropatellar pain syndrome, is remanded. Entitlement to service connection for a foot disability manifested by pain, to include as secondary to bilateral knee retropatellar pain syndrome, is remanded. REASONS FOR REMAND The Veteran had active service from July 1996 to June 1997. These matters come to the Board on appeal from a February 2013 rating decision. The issue of entitlement to service connection for headaches, to include as secondary to bilateral knee retropatellar pain syndrome, is remanded. The issue of entitlement to service connection for a foot disability manifested by pain, to include as secondary to bilateral knee retropatellar pain syndrome, is remanded. The Veteran contends that her current headaches and left foot condition are secondary to her service-connected bilateral knee retropatellar pain syndrome. The VA obtained examinations and medical opinions in February 2013 to determine the nature and etiology of her claimed conditions. With regard to both disabilities at issue on appeal, the VA examiner stated they were less likely than not proximately due to or the result of the Veteran’s service-connected disability. The examiner stated that she could find no medical evidence based literature that supported correlation between headaches and retropatellar syndrome. The examiner did not reference the facts particular to the Veteran’s disability in the rationale. Further, the examiner stated that the Veteran sprained her left ankle in December 2012 with normal x-rays, and that she could only be assumptive in her opinion. The Board finds these opinions inadequate for decision making purposes. When VA undertakes the effort to provide an examination in a service connection claim, it must ensure that the examination is adequate for decision-making purposes. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007); see also 38 C.F.R. § 3.159 (c)(4). The Board notes that the examiner does not address whether either disability was aggravated, or, worsened beyond its natural progression, by a service-connected disability. The examiner also stated that her opinion on the left foot was “assumptive.” The Board notes that if an examiner cannot provide an opinion requested without resorting to speculation, then the examiner should explain the inability to provide the opinion, identifying precisely what facts could not be determined. In particular, he/she should comment on whether an opinion could not be rendered because the limits of medical knowledge have been exhausted or whether additional testing or information could be obtained that would lead to a conclusive opinion. See Jones v. Shinseki, 23 Vet. App. 382, 389 (2010). Thus, an addendum opinion is necessary on remand. The matters are REMANDED for the following action: 1. Forward the record and a copy of this Remand to the examiner who provided the February 2013 medical opinions, or, if that examiner is unavailable, to another suitably qualified examiner, for completion of an addendum opinion. If the examiner determines that a new examination is necessary to provide a requested opinion, such examination should be scheduled. The examiner must provide an opinion as to: (a.) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran has a headache disability that is proximately due to, or the result of, service-connected bilateral knee retropatellar pain syndrome. Rationale specific to the facts of this Veteran’s case must be provided for the opinion proffered, and not simply reference to generic medical literature. (b.) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran has a headache disability that has been aggravated by service-connected bilateral knee retropatellar pain syndrome. Rationale specific to the facts of this Veteran’s case must be provided for the opinion proffered, and not simply reference to generic medical literature. (c.) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran has a foot disability that is proximately due to, or the result of, service-connected bilateral knee retropatellar pain syndrome. Rationale specific to the facts of this Veteran’s case must be provided for the opinion proffered, and not simply reference to generic medical literature. (d.) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran has a foot disability that has been aggravated by service-connected bilateral knee retropatellar pain syndrome. Rationale specific to the facts of this Veteran’s case must be provided for the opinion proffered, and not simply reference to generic medical literature. Aggravation is defined for legal purposes as a chronic worsening of the underlying condition versus a temporary flare-up of symptoms, beyond its natural progression. If the examiner cannot provide a requested opinion without resorting to speculation, then the examiner should explain the inability to provide the opinion, identifying precisely what facts could not be determined. In particular, he/she should comment on whether an opinion could not be rendered because the limits of medical knowledge have been exhausted or whether additional testing or information could be obtained that would lead to a conclusive opinion. 2. After completion of the above, review the expanded record, including any evidence entered since the most recent statement of the case, and determine whether the benefits sought may be granted. If any benefit sought remains denied, furnish the Veteran and her   representative with a supplemental statement of the case. A reasonable period should be allowed for response before the appeal is returned to the Board. U. R. POWELL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Baker, Associate Counsel