Citation Nr: 20020122 Decision Date: 03/18/20 Archive Date: 03/18/20 DOCKET NO. 19-37 366 DATE: March 18, 2020 REMANDED Entitlement to service connection for right ankle osteomyelitis is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1961 to May 1962. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a September 2017 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). Entitlement to service connection for right ankle osteomyelitis is remanded. The Veteran contends that his right ankle osteomyelitis is due to his peripheral neuropathy of the lower extremities. He argues that osteomyelitis is related to a spider bite that he could not feel because of service-connected neuropathy of the lower extremities. See Form 9 (November 2019); NOD (October 2017). To ensure that VA has met its duty to assist, the Board finds that remand is necessary. 38 C.F.R. § 3.159(e). To establish a claim for entitlement to secondary service connection, three criterions must be met. 38 C.F.R. § 3.310. A veteran must have (1) a current disability that is not already service-connected; (2) at least one service-connected disability; and (3) evidence that the non-service-connected disability is either proximately due to or the result of a service-connected disability, or, aggravated beyond its natural progression by a service-connected disability. Allen v. Brown, 7 Vet. App. 439 (1995). Here, the medical evidence of record reflects treatment for right ankle osteomyelitis. See Medical Treatment Record - Non-Government Facility (July 2017). Service connection is in effect for peripheral neuropathy. A September 2017 VA medical opinion reflects that the Veteran’s right ankle osteomyelitis is not caused by peripheral neuropathy, but provides no opinion as to whether it was aggravated by service-connected peripheral neuropathy. El-Amin v. Shinseki, 26 Vet. App. 136, 140-41 (2013) (a medical opinion addressing secondary service connection must assess not only if the claimed disability was caused by the service-connected disability, but also if it was aggravated by that service-connected disability). As such, the medical opinion’s rationale is incomplete and a new medical opinion is required. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The matters are REMANDED for the following action: 1. Obtain all VA treatment from July 2017 to the Present. 2. Thereafter, obtain an addendum opinion from an appropriate clinician addressing the nature and etiology of his right ankle osteomyelitis. The examiner should opine whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s right ankle osteomyelitis is aggravated, worsened beyond normal progression, by service-connected peripheral neuropathy. A complete rationale is required. 3. Ensure that all VA medical opinions obtained include a complete rationale for the conclusions reached. The medical opinions must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. C.A. SKOW Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. M. Pesin 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.