Citation Nr: 18158659
Decision Date: 12/18/18	Archive Date: 12/17/18

DOCKET NO. 08-30 666
DATE:	December 18, 2018
REMANDED
Service connection for a right lower extremity neurological disorder, to include as secondary to the service-connected right knee disability is remanded.
REASONS FOR REMAND
The Veteran served on active duty from October 1975 to October 1978.  The issue is on appeal from a May 2007 rating decision.
By way of history, in an October 2015 Joint Motion for Partial Remand, the United States Court of Appeals for Veterans Claims (Court) vacated, in part, an April 2015 Board of Veterans’ Appeals (Board) decision that denied service connection for a neurological disorder due to residuals of a tear of the medial collateral ligament from the tibial insertion with chondromalacia of the right patella (right knee disability).  The Board was instructed to obtain an addendum opinion as the October 2014 VA examiner had failed to provide an adequate opinion on whether the Veteran’s service-connected right knee disability had aggravated his right lower extremity neurological disorder.  In May 2016, upon a January 2016 Board remand, a VA addendum opinion was obtained.
In October 2016, the Board denied entitlement to service connection for a separate neurological disorder due to the service-connected right knee disability.  The Veteran, again, appealed the decision to Court.  In February 2018, Court issued a Memorandum Decision, vacating the October 2016 denial and on remand, requiring the Board to obtain and rely upon adequate medical opinions with sufficient rationales.  The Court found that the Board had first erred when it processed the Veteran’s claim for right lower extremity neurological disorder as an increased ratings claim, rather than as a secondary service connection claim to his service-connected right knee disability.  Further, the Board also erred when it relied on a May 2016 addendum opinion, which stated that the right lower extremity sciatica should not have been worsened by a knee condition, as this was simply a restatement of the examiner’s conclusion without any other supporting rationale whatsoever.  Therefore, the Board erred when it combined the October 2014 VA examination opinion and May 2016 addendum opinion to serve as sufficient rationale for its October 2016 denial.
On remand, a VA addendum opinion should be obtained, addressing whether the Veteran’s service-connected right knee disability caused or aggravated his right lower extremity neurological disorder.
The matter is REMANDED for the following action:
1. Obtain an addendum VA opinion from the same May 2016 VA examiner.  If the same VA examiner is unavailable, obtain an addendum opinion from another appropriate clinician.  Whether a physical examination is required is left to the examiner’s discretion.  The examiner is requested to address the following:
Provide a diagnosis for any right lower extremity neurological disorder found.
For every right lower extremity neurological disorder found, opine as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s service-connected right knee disability caused or aggravated his right lower extremity neurological disorder.
“Aggravation” is defined as a permanent worsening of the pre-existing or underlying condition, as contrasted to temporary or intermittent flare-ups of symptoms which resolve with return to the previous baseline level of disability.
The examiner should provide a complete and thorough rationale for all opinions offered.  If the examiner cannot provide an opinion without resorting to mere speculation, then he or she must provide a complete and thorough rationale as to why an opinion cannot be provided. 
2. Readjudicate the appeal.
 
L. M. BARNARD
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	J. Lee, Associate Counsel