Citation Nr: 20008003 Decision Date: 01/30/20 Archive Date: 01/30/20 DOCKET NO. 06-28 424 DATE: January 30, 2020 REMANDED Service connection for a right knee disability, to include as secondary to service-connected pes planus and cold injury residuals of the lower extremities is remanded. Service connection for a left knee disability, to include as secondary to service-connected pes planus and cold injury residuals of the lower extremities is remanded. REASONS FOR REMAND The Veteran served on active duty in the Marine Corps from September 1969 to August 1971. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from rating decisions from the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran presented sworn testimony at a hearing before the undersigned in July 2009. In May 2019, the Board remanded the present issues for further development, to include a VA examination. The Veteran was provided a VA examination in June 2019. Service connection for a right knee disability, to include as secondary to service-connected pes planus and cold injury residuals of the lower extremities is remanded. Service connection for a left knee disability, to include as secondary to service-connected pes planus and cold injury residuals of the lower extremities is remanded. Regrettably, a remand is necessary for further evidentiary development of the Veteran’s service connection claims on appeal. The June 2019 VA examination did not comply with the remand directives; therefore, it must be remanded again to ensure compliance. Stegall v. West, 11 Vet. App. 268 (1998). In the recent May 2019 Board decision, the Board noted the Veteran contends that her service-connected cold injury residuals of the bilateral extremities and pes planus caused or aggravated her current knee disabilities. The Board founds that further medical development was needed to render a fully informed decision on the issues. Specifically, in November 2017, a VHA medical expert opined, in pertinent part, that the Veteran’s knee arthritis is most likely related, in pertinent part, to abnormal gait. The expert further explained that “foot pronation certainly contributed to [the Veteran’s] gait issues.” While the expert opined that pes planus causes knee pain, but does not cause or aggravate knee arthritis, the expert did not indicate the source of the Veteran’s foot pronation. As the Veteran’s current 30 percent disability rating for pes planus contemplates manifestations such as marked pronation deformity, an opinion was needed to address whether the Veteran’s pes planus (or cold injury residuals) has manifested with pronation that could have caused her current knee arthritis. Critically, none of the VA examinations of record addressed whether the Veteran’s service-connected lower extremity disabilities have manifested with foot pronation. Subsequently, the issues were remanded for a VA examiner to address: (1) whether it is at least likely as not that any current arthritis began during active service or manifest to a compensable degree within one year after discharge from service, and (2) whether any current knee disability was proximately due to or was aggravated beyond its natural progression by a service-connected disability? In addressing this inquiry, the examiner was to specify whether the Veteran’s current service-connected lower extremity disabilities (namely pes planus) manifest with foot pronation? If so, the examiner was to address the November 2017 VHA expert’s opinion that foot pronation certainly contributed to the Veteran’s abnormal gait, which is one of the most likely causes of her current knee arthritis. The Veteran was afforded a VA examination in June 2019 for her knee disabilities. The examiner opined that the arthritis of the medial compartments of the Veteran’s knees were more then likely due to her elevated BMI and aging, the pes planus and degenerative arthritis seemed to have a contemporaneous onset, and the Veteran did not have chronic gait abnormality due to the feet resulting in degenerative arthritis of the upper or lower extremities. As to addressing the second remand directive, the examiner opined the knee conditions were not proximately due to or aggravated beyond natural progression by service-connected disabilities because elevated BMI and aging is more likely the cause for the arthritis of the knees and upper extremities, while the Veteran does not have marked pronation of the feet. The VA examiner did not consider the 2017 VHA opinion that did not indicate that marked pronation is required for an impact on the knees, and failed to address whether the Veteran has pronation of the feet, since the Veteran’s treatment records support a finding of pronation well before the onset of the knee conditions. Accordingly, the examiner needed to address whether the pronation is related to the service-connected lower extremity conditions and failed to do so. The examiner’s rationales as to the knee disabilities as secondary to the service-connected lower extremity disabilities are not deemed adequate. The Board finds that the June 2019 VA examiner did not substantially comply with these directives. Thus, a remand is necessary to obtain an adequate opinion regarding the likely etiology of the Veteran’s claimed right knee and left knee disabilities. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007); Stegall, 11 Vet. App. at 268. The matters are REMANDED for the following action: 1. Obtain any missing VA or private treatment records and associate them with the claims file. 2. Schedule the Veteran for an examination to ascertain the nature, onset and etiology of her knee disabilities. he examiner is to address each of the following inquiries in terms of whether it is at least as likely as not: Did any current arthritis begin in active service or manifest to a compensable degree within one year after discharge from service? (Continued on the next page)   Is any current knee disability caused by or related to a service-connected disability? In addressing this inquiry, the examiner is to specify whether the Veteran’s current service-connected lower extremity disabilities (namely pes planus) manifest with foot pronation? If so, please address the November 2017 VHA expert’s opinion that foot pronation certainly contributed to the Veteran’s abnormal gait, which is one of the most likely causes of her current knee arthritis. The examiner should review the entire claims file associated with the Veteran in providing the medical opinion, which includes treatment records that shows documented pronation of the feet prior to 2010, the onset of the knee disabilities. If there is a finding of pronation that is related to the service-connected lower extremity conditions, the examiner should opine whether there is medical evidence supporting a finding that the pronation has caused or is related to the knee disabilities at issue. STEVEN D. REISS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Zarar Ahmed, Attorney Advisor The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.