Citation Nr: 20046077 Decision Date: 07/09/20 Archive Date: 07/09/20 DOCKET NO. 17-04 777 DATE: July 9, 2020 REMANDED Entitlement to service connection for a right ankle disability is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from November 1999 to November 2004 with service in Iraq. 1. Entitlement to service connection for a right ankle disability is remanded. The Board remanded the Veteran’s claim in November 2018 to obtain a medical opinion on the etiology of his right ankle disability. An addendum opinion was obtained in February 2020. VA opinion, February 2020. The examiner provided a negative opinion, relying in part on a lack of arthritis until October 2012. She also provided a list of risk factors for ankle sprain, including prior ankle injury. However, she failed to explain why the Veteran’s multiple in-service right ankle sprains did not contribute to his current right ankle disability, including recurrent sprains, as suggested by the listed risk factors. Further, the examiner failed to explain why a lack of arthritis in the ankle bones earlier than October 2012 ruled out a chronic ankle sprain disability manifesting in the ankle ligaments. Finally, while she noted the apparent positive medical evidence, including December 2015, May 2016, October 2018, and December 2018 VA treatment records (VA TRs) noting chronic ankle sprains and instability since his in-service right ankle sprain, she did not rebut these records or explain why they did not support the Veteran’s contentions. In light of these deficiencies, the claim must be remanded for another addendum opinion. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The matters are REMANDED for the following actions: 1. Send the Veteran’s claims file to an appropriate examiner to provide an addendum opinion regarding the nature and etiology of his right ankle disability. The Veteran may be recalled for examination if deemed necessary. Note that the Board recognizes the potential practical difficulties in scheduling an examination in light of the COVID-19 epidemic and requests flexibility and understanding in affording the Veteran any warranted examination. The examiner must identify all of the diagnosed right ankle conditions, including those that have resolved during the appeals period (July 2013 to the present). For each identified diagnosis, the examiner should state whether such a diagnosis at least as likely as not began in or is related to the Veteran’s time in service. The examiner MUST address: (a) the December 2015 VA TR noting “chronic findings of old trauma,” (b) the May 2016 VA TR noting that a “clinical history consistent with ankle instability,” (c) the October 2018 VA TR noting “recurrent right ankle injury, including a distant fracture that was not operated,” (d) the December 2018 VA TR noting “chronic right ankle sprains” with the initial sprain occurring in 2001, AND (e) the list of risk factors provided by the February 2020 examiner, suggesting that the Veteran’s earlier right ankle sprains made him more susceptible to future ankle sprains. The term “at least as likely as not” does not mean “within the realm of medical possibility.” Rather, it means that the weight of medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of the conclusion (e.g., etiology) as it is to find against the conclusion. 2. THE AOJ MUST REVIEW THE CLAIMS FILE AND ENSURE THAT THE FOREGOING DEVELOPMENT ACTION HAS BEEN COMPLETED IN FULL. IF ANY DEVELOPMENT IS INCOMPLETE, APPROPRIATE CORRECTIVE ACTION MUST BE IMPLEMENTED. IF ANY REPORT DOES NOT INCLUDE ADEQUATE RESPONSES TO THE SPECIFIC OPINIONS REQUESTED, IT MUST BE RETURNED TO THE PROVIDING EXAMINER FOR CORRECTIVE ACTION. [CONTINUED ON THE NEXT PAGE] YVETTE R. WHITE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Moore, 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.