Citation Nr: 21000876 Decision Date: 01/06/21 Archive Date: 01/06/21 DOCKET NO. 12-05 940 DATE: January 6, 2021 REMANDED Entitlement to service connection for a left ankle disability, to include as secondary to left knee and lumbar spine disabilities, is remanded. REASONS FOR REMAND The Veteran honorably served in the United States Army from November 1991 to June 1994 with additional periods of active duty for training (ACDUTRA) and inactive duty for training (INACDUTRA) in the Minnesota Army National Guard. This matter is before the Board of Veterans’ Appeals (Board) on appeal of a January 2013 rating decision of the Regional Office (RO). The Veteran’s claim has been previously remanded by the Board, most recently in July 2020. Entitlement to service connection for a left ankle disability, to include as secondary to left knee and lumbar spine disabilities is remanded. The Veteran contends that he is entitled to service connection for a left ankle disability. Alternatively, he contends that his left ankle disability is secondary to service-connected left knee and lumbar spine disabilities. In August 2018, VA requested an addendum opinion for the Veteran’s left ankle disability which was provided in November 2019 and determined to be inadequate. Pursuant to the July 2020 Board remand, an addendum opinion was obtained in September 2020 which is essentially the same as the November 2019 opinion and was provided by the same VA examiner. Both opinions indicated that the Veteran’s left ankle sprain was not aggravated by his service connected back or left knee condition. The examiner noted that the Veteran does not have evidence of chronic limping due to his service-connected injuries and that evidence suggests injury in one extremity rarely causes major problem in the opposite or uninjured extremity. The examiner also discussed that foot and ankle problems are unlikely to cause additional stress on the spine or other leg. However, the service-connected knee injury and claimed ankle injury are in the same extremity and the opinion requested was regarding the effect of the spine and knee on the ankle. Additionally, VA treatment records reflect the Veteran often has an antalgic gait and uses a cane. In addition to inadequacies noted in the prior Board remand, the November 2019 and September 2020 rationales are inadequate and inconsistent with the record. The opinion is also internally inconsistent because the examiner answers yes regarding whether the Veteran’s claimed disability is at least as likely as not aggravated beyond its natural progression by the service-connected condition. While a prior 2012 VA examination report also provided a negative nexus opinion regarding aggravation by the service-connected left knee condition, the 2012, 2019 and 2020 VA examiners have not discussed the evidence regarding left ankle pain or injury in 2004, 2006, and 2007 or the Veteran’s complaints regarding continuity of symptomatology. Specifically, the November 2019 and September 2020 examiner reported that the medical record is silent for any left ankle condition. However, service treatment records dated in June 2004 and April 2006 and private treatment records dated in February 2008 reflect the Veteran’s complaints regarding his left ankle symptomatology. It is unclear whether the Veteran experienced any ankle injury during period of ACDUTRA or INACDUTRA and if so, whether any currently diagnosed ankle disability is related to either injury. Thus, on remand, addendum opinion should address the Veteran’s reports of ankle pain dating back to 2004. As the record does not clearly document the exact dates of the Veteran’s period of ACDUTRA, and INACDUTRA. This must be verified prior to a determination of service connection. The matters are REMANDED for the following actions: 1. Provide a precise listing of the Veteran’s specific periods of active duty, active duty for training (ACDUTRA), and inactive duty for training (INACDUTRA). A retirement points summary will not suffice. 2. Forward the entire claims file in electronic records to a suitably qualified VA examiner other than the examiner who completed the November 2019 and September 2020 opinions. The examiner should review the claims folder and acknowledge such review. If additional examination is indicated, it should be scheduled in accordance with applicable procedures and all indicated studies should be performed. Following a review of the claims file, the reviewing examiner is requested to: Provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that any left ankle disability had onset in, or is otherwise related to, active military service, or is caused by disease or injury during a period of ACDUTRA or an injury during a period of INACDUTRA. Alternatively, provide an opinion as to whether it is at least as likely as not (i.e. 50 percent or greater probability) that the Veteran’s left ankle disability is proximately due to or aggravated by any of the Veteran’s service connected disabilities, to include the service-connected back and left knee disabilities. The examiner must consider and address: 1) the treatment records dated in June 2004, April 2006, and February 2008 reflect the Veteran’s complaints regarding his left ankle; 2) VA treatment records noting limp, antalgic gait and use of cane; 3) all diagnoses regarding left ankle during appeal period, including degenerative changes, tendonitis, sprain, and osteoarthritis of the left ankle; and 5) the Veteran’s lay statements. The Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptoms. If there is a medical basis to support or doubt any statements or histories provided by the Veteran regarding any of his claimed conditions, the examiner should state this and provide a fully reasoned explanation. Otherwise, the Veteran’s statements should be considered competent and credible. The VA examiner is cautioned that the term “aggravated,” as used in 38 C.F.R. § 3.310(b), does not require that there be “permanent worsening” of the nonservice-connected disability. Instead, secondary service connection is warranted for “any incremental increase in disability and any additional impairment of earning capacity in nonservice-connected disabilities resulting from service-connected conditions, above the degree of disability existing before the increase regardless of its permanence.” See Ward v. Wilkie, 31 Vet. App. 233, 239 (2019). The examiner must provide a complete rationale for any opinion expressed, based on the examiner’s clinical and medical expertise; established medical principles; and references to the evidence of record, as appropriate. Cynthia M. Bruce Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Williams, 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.