Citation Nr: 21002347 Decision Date: 01/13/21 Archive Date: 01/13/21 DOCKET NO. 10-46 322 DATE: January 13, 2021 REMANDED Entitlement to service connection for a right knee disability, to include as secondary to a right ankle disability is remanded. Entitlement to service connection for a lower back disability, to include as secondary to a right ankle disability is remanded. Entitlement to service connection for a left foot disability, to include as secondary to a right ankle disability is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from September 1983 to September 1986. The Veteran testified before a Veterans Law Judge (VLJ) in July 2014. The claims were Remanded for further development in February 2015. The VLJ that took the Veteran’s testimony in 2014 became no longer associated with the Board. The Veteran then testified before the undersigned Veterans Law Judge in September 2020. Transcripts of both hearings are of record. 1. Entitlement to service connection for a right knee disability, to include as secondary to a right ankle disability is remanded. 2. Entitlement to service connection for a lower back disability, to include as secondary to a right ankle disability is remanded. 3. Entitlement to service connection for a left foot disability, to include as secondary to a right ankle disability is remanded. Although the October 2015 examiner and later September 2019 VHA opinion opined on whether the Veteran’s service-connected right ankle caused his other disabilities, they did not provide an opinion as to whether the service-connected disabilities aggravated the other disabilities. As the Board specifically requested opinions that included aggravation, the failure to include an opinion is in error and remand is necessary. The matters are REMANDED for the following action: Obtain an addendum opinion determine the nature and etiology of any chronic right knee, lower back, and/or left foot disability. Specifically, the examiner should provide an opinion as to whether it is at least likely as not that the Veteran’s any right knee, lower back, and/or left foot disability: a. was proximately due to the Veteran’s service-connected right foot/ankle disabilities. b. underwent any incremental increase in disability, regardless of its permanence, due to the service-connected right foot/ankle disabilities. The term “incremental increase in disability” means additional impairment of earning capacity. Objective measurement, or numerical quantification, is not required to ascertain an increase in disability. Moreover, any “incremental increase in disability” need not be permanent. The examiner should explicitly address the Veteran’s contentions that his ankle caused a leg-length discrepancy and a gait disturbance that in turn affected his other joints. A rationale for all requested opinions shall be provided. Reference to findings from identified studies is preferred over reference to medical literature in the abstract. If the examiner relies on his or her medical experience as a rationale, it is appropriate to identify specifics such as an estimate of the number of patients the examiner has seen with similar conditions, the time the examiner has been practicing in the field, or any relevant specialized education or training experiences that go beyond the examiner’s degree or accreditation. If the examiner determines that an opinion cannot be rendered without result to mere speculation, then it should be clear in the examiner’s remarks whether it cannot be determined from current medical authority or if an opinion could be rendered if additional facts were known. If additional facts are needed, the examiner shall state what facts, if known, would impact his or her ability to render an opinion and how. Simply stating that an opinion cannot be provided without resort to mere speculation is not acceptable without a detailed reason as to why this is so. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Paul Saindon, Special 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.