Citation Nr: 18160970 Decision Date: 12/28/18 Archive Date: 12/28/18 DOCKET NO. 11-21 371 DATE: December 28, 2018 REMANDED Entitlement to service connection for a lumbar spine disorder, to include as secondary to service connected bilateral foot hallus valgus, is remanded. Entitlement to service connection for a bilateral knee disorder, to include as secondary to service connected bilateral foot hallus valgus, is remanded. Entitlement to service connection for a bilateral ankle disorder, to include as secondary to service connected bilateral foot hallus valgus, is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1969 to March 1971. In November 2012, September 2013, August 2016, and October 2017 the Board previously remanded these matters for further development. The case has been returned to the Board at this time for further appellate review. In October 2017, the Board remanded the above claims so that a new VA examination and opinion could be obtained. The Board noted that VA examinations conducted in 2010, 2011, and 2012 resulted in negative opinions as to direct and secondary service connection claims for the claims on appeal. Further, the Board noted that positive private medical opinions of record were inadequate for adjudication purposes as the private medical reports did not identify the Veteran’s lumbar spine, ankle, or knee disabilities, did not indicate that the private practitioners had reviewed the Veteran’s claims file, service treatment records, or other medical records in rendering these opinions, and lacked a complete rationale in which to enable the Board to render an informed decision. In its remand directives, the Board requested that the examiner specifically reconcile the prior VA medical opinions from 2010, 2011, and 2012 as well as the January and February 2017 private medical opinions from the Veteran’s treating private chiropractors. In November 2017, the Veteran underwent VA examination. Upon examination, he was diagnosed with arthritis of the spine, degenerative joint disease of both knees, and degenerative arthritis of both ankles. While the examiner provided a negative opinion as to direct causation, it is unclear as to whether he used the correct evidentiary standard in forming this opinion. Specifically, he stated that “VA requires that there is at a least a 50% probability that relationship claimed to be the causative factor be recognized by the medical community as having a legitimate biomechanical basis for causing the claimed pathology.” Further, the examiner failed to provide an opinion as to secondary service connection. Based on the foregoing, the Board finds that a new VA examination and opinion is warranted. The matters are REMANDED for the following action: Ensure that the Veteran is scheduled for a VA orthopedic examination with an examiner who has not previously participated in this case in order to determine whether his lumbar spine, bilateral knee and bilateral ankle disorders are related to service or secondary to his service-connected bilateral foot hallus valgus. The claims folder must be made available to and be reviewed by the examiner. All tests deemed necessary should be conducted and the results reported in detail. Following examination of the Veteran and review of the claims file, the examiner should state all lumbar spine, bilateral knee and bilateral ankle disorders found, to include any arthritic conditions thereof. Then, the examiner must opine whether the Veteran’s lumbar spine, bilateral knee and bilateral ankle disorders, to include degenerative joint disease/arthritis of the lumbar spine, bilateral knees, and bilateral ankles, at least as likely as not (50 percent or greater probability) began in or is otherwise related to his miliary service. Next, if the examiner does not find that the Veteran’s lumbar spine, bilateral knee, and bilateral ankle disorders are directly related to military service, the examiner must opine whether his lumbar spine, bilateral knee, and bilateral ankle disorders at least as likely as not are (a) caused by; or, (b) aggravated (i.e., chronically worsened) by the Veteran’s service-connected bilateral foot hallus valgus, to include any abnormal gait or weightbearing as a result of those disabilities. The examiner is reminded that he or she must address both prongs (a) and (b) above. The examiner must also specifically reconcile 2010, 2011, 2012, and 2017 VA examiners’ opinions, as well as the January and February 2017 private medical opinions from the Veteran’s treating private chiropractors. In addressing the above, the examiner should consider any of the Veteran’s lay statements regarding symptomatology during service and any continuity of symptomatology since discharge and/or since onset. The examiner should also consider any other pertinent evidence of record, as appropriate. All findings should be reported in detail and all opinions must be accompanied by a clear rationale. MARTIN B. PETERS Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD L. Bristow Williams, Associate Counsel