Citation Nr: 20021229 Decision Date: 03/25/20 Archive Date: 03/25/20 DOCKET NO. 20-03 694 DATE: March 25, 2020 REMANDED Entitlement to service connection for a left ankle sprain as secondary to service-connected right knee strain is remanded. Entitlement to service connection for a left foot fracture as secondary to service-connected right knee strain is remanded. REASONS FOR REMAND The Veteran served active duty service from January 1998 to October 2003. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2019 rating decision by the Department of Veteran Affairs (VA) Regional Office (RO). 1. Entitlement to service connection for a left ankle sprain as secondary to service-connected right knee strain is remanded. 2. Entitlement to service connection for a left foot fracture as secondary to service-connected right knee strain is remanded. The Veteran contends that his left ankle sprain and left foot fracture are due to his service-connected right knee strain. In particular, he stated that his right knee gave out, causing him to trip and fall, resulting in his left ankle sprain and left foot fracture. A November 2017 VA medical record notes that the Veteran sought emergency treatment for left foot pain and reported that his right knee had given out. Service connection may also be established on a secondary basis for a disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a) (2018). Secondary service connection may also be established for a nonservice-connected disability which is aggravated by a service-connected disability. In such an instance, the Veteran may be compensated for the degree of disability over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310(b) (2018); see Allen v. Brown, 7 Vet. App. 439, 448 (1995). In the December 2018 VA medical opinion, the VA examiner opined that it is less likely like than that the Veteran’s left ankle sprain is proximately due to or the result of his left foot fracture. The VA examiner reasoned that the left foot and left ankle injuries were sustained in 2017 during the same event and were therefore simultaneous injuries. In the December 2018 supplemental VA medical opinion, the VA examiner opined that the Veteran’s left ankle sprain and left foot fracture are less likely than not proximately due to or the result of his service-connected right knee strain. The VA examiner reasoned that while the Veteran stated that the right knee did give out prior to the left foot and left ankle injury, she could not say with certainty, based on the last knee examination and STRs, that the injuries were due to or a result of the right knee. Once VA undertakes the effort to provide an examination when developing a service connection claim, even if not statutorily obligated to do so, it must provide one that is adequate for purposes of the determination being made. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Here, the first December 2018 VA medical opinion did not address the Veteran’s left ankle sprain and left foot fracture as secondary to his service-connected right knee sprain. The subsequent December 2018 supplemental VA medical opinion rationale was not sufficient. The VA examiner did not adequately address the Veteran’s right knee giving out, specifically the November 2017 VA medical record that details treatment for the fall. Additionally, no opinion regarding aggravation was provided. To be adequate, a VA opinion must provide separate rationales for both causation and aggravation in a secondary service connection claim. Atencio v. O’Rourke, 30 Vet. App. 74 (2018). Thus, a supplemental medical opinion is necessary. The matters are REMANDED for the following action: 1. Provide the Veteran’s claims file to a qualified examiner to determine the etiology of the Veteran’s left ankle sprain. The entire claims file and a copy of this remand must be made available to the examiner for review. A new examination is only required if deemed necessary by the examiner. Although an independent review of the claims file is required, the Board calls the examiner’s attention to the following: a. The May 2017 VA medical record where it notes that the Veteran’s right knee pops on occasion after sitting or when walking. Also, the Veteran complained his right knee gives out. b. The November 2017 VA medical record where it notes that the Veteran was treated for a left ankle pain due to his right knee giving out. c. The February 2019 Notice of Disagreement (NOD) where the Veteran states his left ankle sprain is due to his right knee giving out. The examiner must provide opinions as to the following: a. Whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s left ankle sprain is proximately due to or the result of his service-connected right knee strain. b. Whether it is at least as likely as not that the Veteran’s left ankle sprain was aggravated beyond its natural progression by his service-connected right knee sprain. The examiner must provide a complete rationale for his or her opinion(s) in the examination report. 2. Provide the Veteran’s claims file to a qualified examiner to determine the etiology of the Veteran’s left foot fracture. The entire claims file and a copy of this remand must be made available to the examiner for review. A new examination(s) is only required if deemed necessary by the examiner. Although an independent review of the claims file is required, the Board calls the examiner’s attention to the following: a. The May 2017 VA medical record where it notes that the Veteran’s right knee pops on occasion after sitting or when walking. Also, the Veteran complained his right knee gives out. b. The November 2017 VA medical record where it notes that the Veteran was treated for a left foot pain due to his right knee giving out. c. The February 2019 NOD where the Veteran states his left foot fracture is due to his right knee giving out. The examiner must provide opinions as to the following: a. Whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s left foot fracture is proximately due to or the result of his service-connected right knee strain. b. Whether it is at least as likely as not that the Veteran’s left foot fracture was aggravated beyond its natural progression by his service-connected right knee sprain. The examiner must provide a complete rationale for his or her opinion(s) in the examination report. 3. If the claims remain denied, the RO should issue an appropriate supplemental statement of the case and afford the Veteran an opportunity to respond. The case should then be returned to the Board, if in order, for further review. D. Martz Ames Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. Willoughby, Associate Counsel 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.