Citation Nr: 18157089 Decision Date: 12/11/18 Archive Date: 12/11/18 DOCKET NO. 12-32 808 DATE: December 11, 2018 ORDER The claim for entitlement to service connection for a right ankle disability as secondary to residuals of a surgical repair of a right quadriceps tendon tear compensated under 38 U.S.C. § 1151 is granted. The claim for entitlement to service connection for a left ankle disability as secondary to residuals of a surgical repair of a right quadriceps tendon tear compensated under 38 U.S.C. § 1151 is granted. REMANDED The claim for entitlement to a total disability rating due to individual unemployability resulting from service-connected disability (TDIU) is remanded. FINDINGS OF FACT 1. The Veteran’s right ankle degenerative joint disease (DJD) status post open reduction internal fixation (ORIF) fracture is aggravated beyond its natural progression by the right knee residuals of surgery to the right quadriceps tendon which are compensated as if service-connected under 38 U.S.C. § 1151. 2. The Veteran’s a chronic lateral collateral ligament sprain of the left ankle was incurred secondary to the right knee residuals of surgery to the right quadriceps tendon which are compensated as if service-connected under 38 U.S.C. § 1151. CONCLUSIONS OF LAW 1. Service connection for right ankle DJD status post ORIF fracture as secondary to residuals of surgery to the right quadriceps tendon compensated under 38 U.S.C. § 1151 is warranted. 38 U.S.C. §§ 1131, 1151; 38 C.F.R. §§ 3.303, 3.310. 2. Service connection for a chronic lateral collateral ligament strain of the left ankle as secondary to residuals of surgery to the right quadriceps tendon compensated under 38 U.S.C. § 1151 is warranted. 38 U.S.C. §§ 1131, 1151; 38 C.F.R. §§ 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1979 to September 1982. This case comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2010 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). This case was previously before the Board in June 2018 when the Board granted compensation for an additional right knee disability incurred due to VA surgical treatment of a torn right quadriceps tendon under 38 U.S.C. § 1151. The claims for service connection for a bilateral ankle disability and entitlement to TDIU were remanded for additional development. These claims have now returned to the Board for further appellate action. 1. Entitlement to service connection for a right ankle disability. 2. Entitlement to service connection for a left ankle disability. The Veteran contends that service connection is warranted for disabilities of the right and left ankles as the conditions are secondary to the surgical residuals of a torn right quadricep tendon. The Veteran is compensated “as if service-connected” under 38 U.S.C. § 1151 for residuals incurred due to the tendon repair surgery, to include impairment of the right knee. The Veteran specifically contends that the instability and weakness of his right knee have caused multiple falls resulting in chronic right and left ankle disabilities. The weight of the competent evidence establishes that the Veteran’s right ankle disability is aggravated by the right knee surgical residuals, while the left ankle disability is directly caused by the same surgical residuals. The lay and medical evidence shows that the Veteran fell in August 2009 fracturing his right ankle and requiring surgery on August 16, 2009. Two months later, on October 19, 2009, the Veteran underwent a right ruptured quadriceps tendon repair at the VA Medical Center (VAMC). The Veteran incurred an additional disability to the right knee because of the tendon repair surgery. VA treatment records document numerous post-surgical falls related to the right knee instability and weakness. In November 2018 a VA examiner provided a medical opinion in support of the claims, concluding that the Veteran’s right ankle disability was aggravated beyond its natural progression by the post-surgical falls, while the left ankle condition was incurred secondary to the same falls. The Veteran also provided credible testimony in May 2016, describing the symptoms and falls he experiences due to the surgical residuals including right knee problems. The Board therefore finds that the criteria for secondary service connection are established with respect to both ankle conditions and the claims are granted. REASONS FOR REMAND Entitlement to a TDIU. The Board regrets further delay in this case, but finds that the Veteran’s claim for TDIU is intertwined with the award of service connection for right and left ankle disabilities in this decision. The award of service connection must be implemented before a decision may be made regarding the claim for TDIU. The matter is REMANDED for the following action: Implement the Board’s decision herein and readjudicate the claim for TDIU. M. H. Hawley Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Riley, Counsel