Citation Nr: 18155815 Decision Date: 12/06/18 Archive Date: 12/06/18 DOCKET NO. 15-13 569 DATE: December 6, 2018 REMANDED Entitlement to service connection for low back condition, secondary to service-connected right knee disability, is remanded. Entitlement to service connection for right hip condition, secondary to service-connected right knee disability, is remanded. Entitlement to service connection for left knee condition, secondary to service-connected right knee disability, is remanded. Entitlement to service connection for right ankle condition, secondary to service-connected right knee disability, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from September 1968 to September 1972. Low Back, Right Hip, Right Ankle, and Left Knee Although the Board regrets further delay, additional development is required prior to adjudication of the Veteran’s claims. The Veteran contends that his low back, right hip, right ankle, and left knee condition are related to his service-connected right knee osteoarthritis/meniscus tear. In April 2013, the Veteran received a VA examination for his claimed conditions. The examiner opined that there was no evidence of a right ankle pathology and therefore, there was no ankle condition as a result of the Veteran’s right meniscus tear, and any ankle complaints were not from his right meniscus tear. The examiner also stated there was no pain in the Veteran’s right ankle until 2 years prior. The examiner further stated there were no manifestations of the Veteran’s right ankle due to his meniscus tear because in the examiner’s years of practice and personal experience, a right meniscus tear does not affect the ankle and there was no medical basis to support a relationship with his ankle and his knee. Regarding the Veteran’s right hip condition, the examiner noted the Veteran’s right hip abduction was 30 degrees without pain. The examiner then opined that the Veteran’s right hip condition is not caused by or a result of his right meniscectomy. The examiner rationalized that meniscectomies of the knee do not affect the hip and the Veteran’s bilateral hip pain was consistent with aging and weight. The examiner provided there was no evidence of a hip problem. The examiner then stated there was no basis for aggravation and there were no manifestations proximately related to medial meniscus tear based on his clinical and personal experience. The examiner further stated there was no evidence that meniscus tears in knee should cause hip pain for a condition that is not even accurately diagnosed. For the Veteran’s low back condition, the examiner opined that the Veteran’s back status has not been caused by his right knee meniscus. The examiner explained that the Veteran’s right meniscus did not cause his back conditions which are consistent with normal aging. Regarding manifestations of the Veteran’s low back condition that are proximately due to the Veteran’s right knee meniscus tear, the examiner stated there was no basis for connection between the back and right knee. For rationale, the examiner noted his own practice and personal experience. The Board finds the April 2013 VA opinion is inadequate to fairly adjudicate the Veteran’s claims for service connection. Firstly, although the examiner stated that the Veteran does not currently suffer from a right ankle condition, and therefore there was no pathology to relate to his right knee tear, the Board recognizes the Court’s recent ruling in Saunders v. Wilkie, No. 2017-1466, 2018 U.S. App. LEXIS 8467 (Fed. Cir. Apr. 3, 2018), that found “pain alone can serve as a functional impairment and therefore, qualify as a disability.” Thus, due to the Veteran’s medical records and the April 2013 examiner noting complaints of right ankle pain, the April 2013 opinion is inadequate under Saunders and a new examination is required in order to obtain a new opinion addressing the above. Id., See also McLendon v. Nicholson, 20 Vet. App. 79 (2006). Further, although the examiner opined that the Veteran’s right hip and low back condition were not caused by the Veteran’s right knee tear and there was no basis for aggravation, the Board funds that this explanation is not an adequate discussion or rationale for aggravation. The examiner should have considered and provided a clear explanation on whether the Veteran’s right knee condition aggravates his right hip and low back condition, to include his complaints of pain. Lastly, the Board notes that the examiner provided no opinion on the etiology of the Veteran’s left knee pain and/or condition. The Board also notes that the examiner did not review the Veteran’s claims file for any of the opinions rendered. Therefore, due to the examiner not providing an aggravation opinion or considering the Veteran’s pain as a disability, as well as the examiner not reviewing the Veteran’s claims file, a remand is required in order to obtain new opinions addressing the above. McLendon v. Nicholson, 20 Vet. App. 79 (2006). The matters are REMANDED for the following action: 1. Obtain and associate with the Veteran’s electronic claims file any outstanding VA treatment records and private medical records relevant to the Veteran’s claims. 2. After all outstanding records have been associated with the file, send the claims file to someone other than the April 2013 VA examiner, if possible, to determine the etiology of the Veteran’s right ankle, right hip, left knee, and low back conditions. The record and a copy of this Remand must be made available to the examiner. If the examiner determines that an examination of the Veteran is necessary to provide the requested opinion with rationale, then such examination should be scheduled. Following a review of the entire record, the Veteran’s competent lay statements, as well as the Veteran’s report regarding the onset and progression of his current symptomatology, the examiner should opine as to the following: a) Whether it is at least as likely as not (50 percent probability or more) that the Veteran’s right ankle condition, right hip condition, left knee condition, and low back condition are due to or caused by his service-connected right knee disability. b) Whether it is at least as likely as not (50 percent probability or more) that the Veteran’s right ankle condition, right hip condition, left knee condition, and low back condition, are aggravated by his service-connected right knee disability. “Aggravation” is defined as any worsening beyond the natural progression of the disability. c) If the Veteran’s right ankle condition, right hip condition, left knee condition, and back condition are NOT due to or aggravated by his service-connected right knee disability, is it at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran’s conditions had their onset during, or are otherwise related to, his active duty service. Please provide an opinion and rationale for each disability separately. In offering any opinion, the examiner must consider the full record, to include the lay statements regarding in-service incurrence, and the opinion should reflect such consideration. A clearly stated rationale for any opinion offered should be provided and must not be based solely on the lack of any in-service records. If the examiner is unable to provide an opinion without resort to speculation, he or she should explain whether the inability is due to the limits of the examiner’s medical knowledge, medical knowledge in general or there is evidence that, if obtained, would permit the opinion to be provided. JENNIFER HWA Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Negron, Associate Counsel