Citation Nr: 20031896 Decision Date: 05/06/20 Archive Date: 05/06/20 DOCKET NO. 14-24 586A DATE: May 6, 2020 REMANDED Entitlement to service connection for a left ankle disability, to include as secondary to service-connected status post fracture right second metatarsal, is remanded. REASONS FOR REMAND The Veteran served on active duty for training from October 2000 to March 2001. The Board of Veterans’ Appeals (Board) thanks the Veteran for her honorable service to the country. This matter comes before the Board on appeal from a May 2011 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama. In July 2017, the Veteran testified at a Board video-conference hearing held at the Montgomery, Alabama RO before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the Veteran’s claims file. This matter was previously before the Board in April 2018, at which time the Board remanded the claim to the RO to obtain supplemental medical opinions. The matter was returned to the Board in October 2019, at which time the Board again remanded the issue to the RO to obtain an additional medical opinion addressing the Veteran’s contention of entitlement to service connection for her left ankle disability on a secondary basis to her service-connected status post fracture right second metatarsal. Entitlement to service connection for a left ankle disability, to include as secondary to service-connected status post fracture right second metatarsal, is remanded. Service connection is warranted if it is shown that a veteran has a disability resulting from an injury incurred or a disease contracted in active duty service or for aggravation of a pre-existing injury or disease in active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Establishing direct service connection generally requires competent evidence of: (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Alternatively, a veteran can receive compensation via secondary service connection, which can be established when a disability is shown to be proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310. To be awarded secondary service connection, there must be evidence sufficient to show: (1) that a current disability exists; and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. Id.; Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Here, the Veteran contends that her service-connected status post fracture right second metatarsal has caused her to rely more heavily on her left leg and ankle, thereby causing the 2006 left ankle injury and current disability. Specifically, she asserts that her left ankle disability was caused by or aggravated by the service-connected right ankle disability. A review of the Veteran’s medical records reflects that she experienced a left ankle injury in either May or June 2006. June 2006 medical records indicate that the Veteran sought treatment for the injury; and an x-ray reportedly revealed a hairline fracture. The Veteran contends that this injury has caused pain and swelling in her left ankle, which compromises her ability to walk. In May 2011, an examiner diagnosed the Veteran with a left ankle strain and noted that she relayed that she favors her left side, due to her service-connected right ankle disability, and that she walked with an antalgic gait. However, the examiner did not address these considerations when rendering an opinion that the Veteran’s right ankle disability less likely than not caused her left ankle injury. In July 2018, another examiner diagnosed the Veteran’s left ankle disability as “trauma” and noted that she reportedly wears an ankle brace on her left ankle on a daily basis. The examiner concluded, after reviewing relevant medical records, that the Veteran’s left ankle injury was “unrelated to her [right] toe injury.” However, he did not explain the rationale for his conclusion, nor did he furnish an opinion as to whether the Veteran’s service-connected right ankle disability aggravated her left ankle disability. Pursuant to the Board’s October 2019 remand, the Veteran was afforded a VA examination in December 2019 for her left ankle disability. At that time, a clinician diagnosed the Veteran with a ligament sprain and degenerative arthritis of the left ankle. The clinician opined that the Veteran’s left ankle disability was less likely than not incurred in or caused by her military service. She additionally posited that the Veteran’s “left ankle condition is less likely than not related to her previous right [second] metatarsal fracture.” However, the clinician did not provide an adequate rationale for the assertion or an opinion as to whether the right ankle disability aggravated the left ankle disability, per the Board’s remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (a remand confers on the veteran, as a matter of law, the right to compliance with the remand orders). Because the medical opinions currently of record do not, individually or collectively, furnish a sufficient evidentiary basis for the Board to render a fully-informed decision on the merits of the Veteran’s claim, the Board finds that another remand is necessary to obtain an additional medical opinion adequately addressing the Veteran’s contention that her service-connected right ankle disability caused or aggravated her left-ankle disability. Accordingly, the matter is REMANDED for the following action: 1. Please obtain all updated VA and non-VA treatment records. 2. Send the Veteran’s claims file to an appropriate clinician for review and the opinion sought. Schedule the Veteran for a VA examination only if deemed necessary. After a review of the file, the clinician is asked to address the following: (a.) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s left ankle disability was caused by her service-connected status post fracture right second metatarsal? The clinician should consider, and discuss as necessary, the Veteran’s statement that her service-connected right ankle disability caused her to favor her left side, thus leading to her 2006 left ankle injury. (b.) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s left ankle disability was aggravated (any increase in disability) by her service-connected status post fracture right second metatarsal? The clinician should consider, and discuss as necessary, the Veteran’s statement that her service-connected right ankle disability caused her to favor her left side, thus leading to her 2006 left ankle injury. The examiner must explain the rationale for all opinions in detail, citing to supporting clinical data and/or the Veteran’s medical history, as appropriate. If the examiner   cannot provide an opinion without resorting to speculation, he or she should provide an explanation as to why this is so. M. C. GRAHAM Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board G. Tolbert, 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.