Citation Nr: 19122002 Decision Date: 03/26/19 Archive Date: 03/23/19 DOCKET NO. 13-29 310 DATE: March 26, 2019 REMANDED Entitlement to service connection for left ankle arthritis, to include secondary to tibia and fibula fracture with degenerative joint disease of the left knee is remanded. Entitlement to service connection for right ankle arthritis, to include secondary to tibia and fibula fracture with degenerative joint disease of the left knee is remanded. Entitlement to service connection for right knee arthritis, to include secondary to tibia and fibula fracture with degenerative joint disease of the left knee is remanded. Entitlement to service connection for left leg neuropathy, to include secondary to tibia and fibula fracture with degenerative joint disease of the left knee is remanded. Entitlement to a disability rating in excess of 30 percent for service-connected residuals of a tibia and fibula fracture with degenerative joint disease of the left knee is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1948 to April 1956. This matter comes before the Board of Veterans’ Appeals (Board) from December 2009 and April 2015 rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned in an August 2018 Board hearing. The transcript is of record. 1. Entitlement to service connection for right knee degenerative arthritis The Veteran contends that his right knee degenerative arthritis is related to service or in the alternative to his service-connected residuals of his tibia and fibula fracture with degenerative joint disease of the left knee. In September 2009, the Veteran underwent a VA knee examination. The examiner found the Veteran’s right knee degenerative joint disease is not caused or the result of the Veteran’s left knee disability. The examiner reasoned that orthopedic literature disputes that an injured limb with normal extensions produces an overload and therefore injury to the opposite limb. The examiner explained that there was no overload even in such situations of compromise as when the injured limb is post-polio or amputation with prosthesis. The examiner further reasoned that the Veteran was more likely to have right knee degenerative joint disease due to his long-standing diabetes and his general age. The Board finds the September 2009 VA examination is not adequate for adjudication. The examiner did not provide an opinion as to whether the Veteran’s right knee injury was related to service. Further, the examiner did not provide an opinion as to whether the Veteran’s right knee degenerative arthritis was aggravated by his left knee disability. Therefore, the Board finds a that a remand is warranted to afford the Veteran a VA examination for his right knee. 2. Entitlement to service connection for bilateral ankle arthritis The Veteran contends that his bilateral ankle arthritis is related to his service or in the alternative to his residuals of his tibia and fibula fracture with degenerative joint disease of the left knee. The Board notes that the Veteran has a diagnosis of arthritis of the ankles in April 2009. The Veteran testified in an August 2018 Board hearing. The Veteran stated that while in-service he climbed up and down poles and carried heavy packs across rough terrain. The Veteran further stated that he believed his knees might be related to his ankle disabilities. The Board cannot make a fully-informed decision on the issue of the Veteran’s ankle disability because no VA examiner has opined the Veteran’s ankles are related to his service and/or to his service-connected residuals of his tibia and fibula fracture with degenerative joint disease of the left knee. Therefore, a remand is warranted to afford the Veteran an examination. 3. Entitlement to service connection for left leg neuropathy The Veteran contends that his left leg neuropathy is secondary to his residuals of his tibia and fibula fracture with degenerative joint disease of the left knee. The Board notes the Veteran has a current diagnosis of lower extremity diabetic neuropathy. The Board cannot make a fully-informed decision on the issue of left leg neuropathy because no VA examiner has opined whether the Veteran’s service-connected tibia and fibula fracture with degenerative joint disease of the left knee caused or more importantly aggravated the Veterans neuropathy of his left leg. Therefore, a remand is warranted to afford the Veteran a VA examination. 4. Entitlement to a disability rating in excess of 30 percent for service-connected residuals of a tibia and fibula fracture with degenerative joint disease of the left knee The Veteran contends that his residuals of his tibia and fibula fracture with degenerative joint disease of the left knee are more severe. Specifically, the Veteran contends that he should be rated 40 percent because he utilized a brace for his leg. The Veteran underwent a VA examination in April 2015. The Board finds that the April 2015 examination did not comply with Correia v. McDonald, 28 Vet. App. 158, 168 (2016) because the examiner did not provide passive range of motions measurements for the Veteran’s left knee. Further, the examination did not comply with Sharp v. Shulkin, 29 Vet. App. 26, 34-36 (2017). The examiner did not estimate the functional loss that would occur during flares-ups. Therefore, because the examination is not adequate a remand is warranted to provide the Veteran with a new VA examination. Further, the April 2015 examiner did not provide a description of whether the Veteran’s tibia and fibula had a malunion or nonunion with loose motion. As the Veteran is rated under Diagnostic Code 5262 (Impairment of the Tibia and Fibula), upon remand the examiner should also provide a description of the Veteran’s tibia and fibula impairment, if any. The matters are REMANDED for the following action: 1. Obtain any update relevant VA treatment records. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of the Veteran’s right knee degenerative arthritis. The examiner should provide the following opinions: (a.) Whether it is at least as likely as not related to an in-service injury, event, or disease, including climbing poles in-service or hiking with heavy packs over rough terrain. (b.) Whether the Veteran’s right knee degenerative arthritis is at least as likely as not (1) proximately due to the service-connected residuals of his tibia and fibula fracture with degenerative joint disease of the left knee, or (2) aggravated beyond its natural progression by the service-connected residuals of his tibia and fibula fracture with degenerative joint disease of the left knee. 3. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of the Veteran’s bilateral ankle disabilities. The examiner should provide the following opinions: (a.) Identify all bilateral ankle disabilities, to include ankle degenerative joint disease, if present. (b.) For each identified ankle disability, the examiner must opine as to whether it is at least as likely as not related to an in-service injury, event, or disease, including climbing poles in-service or hiking with heavy packs over rough terrain. (c.) For each identified ankle disability, the examiner must opine as to whether the Veteran’s the bilateral ankle disabilities are at least as likely as not (1) proximately due to the service-connected residuals of his tibia and fibula fracture with degenerative joint disease of the left knee, or (2) aggravated beyond its natural progression by the service-connected residuals of his tibia and fibula fracture with degenerative joint disease of the left knee. 4. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of the Veteran’s left leg neuropathy. The examiner should provide the following opinions: (a.). Whether the Veteran’s left leg neuropathy is at least as likely as not (1) proximately due to the service-connected residuals of his tibia and fibula fracture with degenerative joint disease of the left knee, or (2) aggravated beyond its natural progression by the service-connected residuals of his tibia and fibula fracture with degenerative joint disease of the left knee. 5. Schedule the Veteran for an examination of the current severity of his service-connected residuals of his tibia and fibula fracture with degenerative joint disease of the left knee, to include a determination of whether the Veteran has tibia and fibula nonunion with loose motion requiring a brace. The examiner must test the Veteran’s active motion, passive motion, and pain with weight-bearing and without weight-bearing. The examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. To the extent possible, the examiner should identify any symptoms and functional impairments due to residuals of his tibia and fibula fracture with degenerative joint disease of the left knee alone and discuss the effect of the Veteran’s residuals of his tibia and fibula fracture with degenerative joint disease of the left knee on any occupational functioning and activities of daily living. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). S. L. Kennedy Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Department of Veterans Affairs