Citation Nr: 20041485
Decision Date: 06/17/20	Archive Date: 06/17/20

DOCKET NO. 15-10 577A
DATE: June 17, 2020

REMANDED

Entitlement to service connection for a left ankle disability is remanded.

REASONS FOR REMAND

The Veteran served on active duty for training from May 1964 to November 1964. The Veteran also served in the Puerto Rico National Guard. 

This matter is before the Board of Veterans’ Appeals (Board) on appeal from a September 2012 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO).  In November 2017, the Veteran appeared at a hearing before the undersigned Veterans Law Judge.  A transcript of the hearing is in the record.  In March 2018 and February 2020, the Board remanded the case to the RO for additional development. 

In its most recent remand, the Board requested a medical opinion regarding whether a current left ankle disability was caused by service or caused or aggravated by the Veteran’s service-connected left knee disability, to include as a result of an altered gait.  In March 2020, a VA physician assistant offered a negative opinion.  However, the only rationale provided to support the opinion was that arthritis is a natural disease process of aging and that arthritis of one joint is not known to cause arthritis in another joint.  This is not a sufficient explanation.  While arthritis could be the result of aging, VA recognizes arthritis due to trauma as a disability.  See 38 C.F.R. § 4.71a, Diagnostic Code 5010.  If the implication is that VA’s regulation is not in keeping with medical knowledge, a more robust explanation is necessary and possibly citation to medical literature.  In addition, the Board specifically requested that the examiner discuss the possibility of an altered gait from the service-connected knee disability causing or aggravating a left ankle disability.  The opinion does not do that.  Another opinion should be obtained from a physician.  

This matter is REMANDED for the following action:

The claims file should be sent to a physician to offer an opinion as to whether it is at least as likely as not (50 percent probability or greater) that any current disability of the left ankle onset during service or is otherwise related to an in-service injury, event, or disease.

In offering the opinion, the examiner is asked to consider the lay statements from the Veteran, his family, and a service comrade, that essentially state he suffered a left leg injury during service when his leg slipped between bleachers, to include lacerations.  The examiner should also consider the separation examination report showing normal evaluation of the lower extremities (although a scar on the left foot toe was noted) and the corresponding report of medical history where the Veteran reported having foot trouble but denied having swollen or painful joints.  

The examiner should also address whether any current disability of the left ankle is at least as likely as not (a) caused by, or (b) aggravated by (worsened beyond natural progression) service-connected left knee disability, to include as a result of an altered gait.

The need for an examination is left to the discretion of the examiner.  A rationale for all opinions offered is requested as the Board is precluded from making any medical findings. 

 

 

Nathan Kroes

Veterans Law Judge

Board of Veterans’ Appeals

Attorney for the Board	Russell P. Veldenz, 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.